Battle of the Blood: A Journey Through Leukemia and Lymphoma
PATH 3500
An interactive case study by Group 28
Pathology 3500
Table of Contents
Click for more info!
Follicular Lymphoma
Leukemia
Diffuse Large B-cell Lymphoma
Lymphoma
Case Study #1
Acute Lymphoid Leukemia
Case Study #2
Chronic Myeloid Leukemia
References
PATHology 3500
What is Leukemia?
Leukemia is a type of cancer that affects the blood-forming tissues of the body, such as the bone marrow and lymphatic system. Typically, leukemia impacts the white blood cells (leukocytes), which play a crucial role in fighting infections. Normally, these cells grow and divide in a controlled manner as needed by the body. However, in individuals with leukemia, the bone marrow produces an abnormally high number of dysfunctional white blood cells.[1]
[2]
Table of Contents
Next
PATHology 3500
What is Lymphoma?
Lymphoma is a form of cancer that affects the lymphatic system, which plays a key role in the body's immune defenses against diseases. This type of cancer begins when normal cells in the lymphatic system grow uncontrollably.[4]
[3]
Table of Contents
Next
PATHology 3500
What is Lymphoma?
Lymphoma is a form of cancer that affects the lymphatic system, which plays a key role in the body's immune defenses against diseases. This type of cancer begins when normal cells in the lymphatic system grow uncontrollably.[4]
[3]
Table of Contents
Next
Pathology 3500
1. Follicular Lymphoma
Follicular lymphoma accounts for 40% of all adult lymphomas. Patients can live for many years with this B-cell lymphoma, as it is generally slow-growing, however it is uncurable.[5] Follicular lymphoma is often diagnosed through a biopsy of the lymph nodes and/or usage of a PET or CT scan, and may involve bone marrow testing to identify its spread.[6]
[7]
Risk factors
Signs & Symptoms
More
Treatments
Table of Contents
Pathology 3500
Risk factors
Signs & Symptoms
[8]
Treatments
2. Diffuse Large B-Cell Lymphoma
Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for approximately 30–40% of adult lymphomas.[8] DLBCL is typically diagnosed through a lymph node biopsy, with additional imaging such as PET or CT scans to assess the extent of disease, and bone marrow biopsy in select cases.[9]
Table of Contents
More
Pathology 3500
3. Acute Lymphoid Leukemia (ALL)
ALL is cancer of the lymphoid cells. It is the most common type of cancer in children.[10] The prognosis is generally better for children than adults with the 5 year survival rate for kids at 85%.[11] Diagnosis is through blood tests to check for abnormal levels of WBC, RBC and platelets, bone marrow tests to identity leukemic cells and imaging studies to detect spread.[13]
[14]
Risk factors
Signs & Symptoms
More
Treatments
Table of Contents
Pathology 3500
4. Chronic Myeloid Leukemia (CML)
Risk factors
Signs & Symptoms
Treatment
[15]
CML is a myeloproliferative disorder with an excessive production of granulocytes, driven the presence by the Philadelphia (Ph1) chromosome.[16] CML occurs in 1/100,000 individuals under 20 years old and 1-3% of children with leukemia[18]. It is usually diagnosed through a peripheral blood smear or bone marrow biopsy, looking for the presence of leukoerythroblastosis.[18]
Table of Contents
Test yourself!
More
Read the Clues...
Find the Diagnosis
[19]
Table of Contents
the Diagnosis is...
Acute Lymphoblastic Leukemia!
Explanation...
Click here to go back to the info page.
[19]
Table of Contents
Read the Clues...
Find the Diagnosis
[20]
Table of Contents
the Diagnosis is...
Explanation...
Follicular Lymphoma!
Click here to go back to the info page.
[20]
Table of Contents
Pathology 3500
5. References
- Mayo Clinic. (n.d.). Leukemia symptoms and causes. Mayo Clinic. Retrieved March 26, 2025, from https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373
- Cleveland Clinic. Leukemia: Symptoms, Signs, Causes, Types & Treatment. Cleveland Clinic, n.d., https://my.clevelandclinic.org/health/diseases/4365-leukemia.
- Mayo Clinic. (n.d.). Lymphoma symptoms and causes. Mayo Clinic. Retrieved March 26, 2025, from https://www.mayoclinic.org/diseases-conditions/lymphoma/symptoms-causes/syc-20352638
- Cleveland Clinic. Lymphoma: Symptoms, Signs, Causes, Types & Treatment. Cleveland Clinic, n.d., https://my.clevelandclinic.org/health/diseases/22225-lymphoma.
- Follicular lymphoma. Leukaemia Foundation. (May, 2024). https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/lymphoma/non-hodgkin-lymphoma/follicularlymphoma/#:~:text=The%20most%20common%20first%20sign,generalised%20unexplained%20aches%20and%20pains.
- WebMD. (n.d.-b). Follicular lymphoma: Causes, symptoms, treatment, and more. WebMD. https://www.webmd.com/cancer/lymphoma/follicular-lymphoma
- Follicular lymphoma. (n.d.). https://www.mybeckman.ca/resources/disease-research/leukemia-and-lymphoma/b-cell/follicular-lymphoma
- Cleveland Clinic. (n.d.). Diffuse large B-cell lymphoma. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24405-diffuse-large-b-cell-lymphoma
- National Center for Biotechnology Information. (n.d.). Diffuse large B-cell lymphoma. In Bookshelf. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557796/
- What Is Acute Lymphocytic Leukemia (ALL)? Acute Lymphocytic Leukemia (ALL). (Oct, 2018). Retrieved March 2, 2025, from https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/about/what-is-all.html
- Acute lymphocytic leukemia—Symptoms and causes. (Dec, 2020). Mayo Clinic. Retrieved March 2, 2025, from https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/symptoms-causes/syc-20369077
- Risk Factors for Acute Lymphocytic Leukemia (ALL). (Feb, 2024). Retrieved March 2, 2025, from https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/causes-risks-prevention/risk-factors.html
- Acute Lymphoblastic Leukemia (ALL). (April, 2023). Cleveland Clinic. Retrieved March 2, 2025, from https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia
- Acute lymphocytic leukemia | pathology | Britannica. (n.d.). Encyclopedia Britannica. https://www.britannica.com/science/acute-lymphocytic-leukemia (IMAGE)
- To, M., & Villatoro, V. (Jun, 2019). Chronic myelogenous leukemia (CML). A Laboratory Guide to Clinical Hematology. https://pressbooks.openeducationalberta.ca/mlsci/chapter/chronic-myelogenous-leukemia-cml/
- Lanzkowsky, P. (2011). Manual of Pediatric Hematology and Oncology. Elsevier/Academic Press.
- Cortes , J., Pavlovsky, C., & Saubele, S. (Nov, 2021). Chronic Myeloid leukaemia. The Lanclet (Vol. 398, pp. 1914–1926). essay, Elsevier.
- Chronic myelogenous leukemia treatment. Chronic Myelogenous Leukemia Treatment - NCI. (Nov, 2023). https://www.cancer.gov/types/leukemia/patient/cml-treatment-pdq#:~:text=Treatment%20of%20chronic%20phase%20chronic%20myelogenous%20leukemia%20may%20include%20the,Chemotherapy.
- Chatgpt. (n.d.). "create an image 2 year old boy " https://chatgpt.com/. Retrived March 20, 2025
- Chatgpt. (n.d.). "generate an image of male around 60's " https://chatgpt.com/. Retrived March 20, 2025
- Painless lymph node enlargement
- Swelling of the neck
- Loss of appetite
- Night sweats
- Fever
- Chills[6]
- Older age
- Immunodeficiency
- Autoimmune diseases (rheumatoid arthritis, Sjögren’s syndrome)
- Prior chemotherapy or radiation
- Epstein-Barr virus (EBV)
- Genetic mutations[9]
- Enlarging painless lymph node(s)
- Swelling (neck, armpit, or groin)
- Fever
- Night sweats
- Weight loss
- Fatigue
- Abdominal pain
- Difficulty breathing[9]
- Radiation
- Chemotherapy
- Stem cell transplant[6]
The clues strongly suggest ALL because they align with key risk factors and symptoms of the disease! Let's break it down:
- Age Factor – Our patient is only 2 years old, and Acute Lymphoblastic Leukemia (ALL) is the most common cancer in young children, especially under 5.
- Fatigue – If the bone marrow isn't making enough red blood cells, oxygen delivery drops. That results chronic tiredness (fatigue)—just like our patient has.
- Bone Pain – Leukemia cells crowd the bone marrow, causing pain inside the bones.
- Bruising – Platelets help with clotting. If leukemia lowers platelet levels, bruising happens easily.
- Secondhand Smoke – While not a direct cause, exposure to harmful chemicals in smoke is a known risk factor of ALL.
- Blood Test Results – The patient has low red blood cells (anemia), low white blood cells (weakened immunity), and low platelets (bruising/bleeding issues)—all classic for leukemia!
- Treatments can include chemotherapy in phases (induction, consolidation, maintenance) over 2 years,
- Targeted therapies (ex: tyrosine kinase inhibitors)
- Stem Cell Transplants (sometimes)[13]
- Targetted therapy drugs like Tyrosine-Kinase inhibitors
- Highdose chemotherapy with donor stem cell transplant
- Radiation Therapy
- Sugery options like a Splenectomy[18]
*Treatments often depend on the staging and phases of the disease
- HIV
- Rheumatoid arthritis
- Recurrent mutations in histones
- Radiation
- Chemicals[6]
More on ALL
Lymphoid cells are B-cells and T-cells. It is the most common type of cancer in children, particularly affecting those between the ages of 2 and 5. The risk declines with age 75-80% of ALL is made of B-cells. B-cells produce antibodies to fight infections. B-cells play a role in humoral immune response by recognizing antigens and producing specific antibodies 20-25% of ALL is made of T-cells. T-cells help destroy infected or cancerous cells and support other immune cells. T-cells are involved in direct killing infected host cells, activating other immune cells and regulating the immune response [10,11]
Symptoms
- Initally clincally stable
Non-specific symptoms:
- fever
- night sweats
- abdominal pain
- bone pain[17]
Hyperviscosity symptoms:
- neruological dysfunction
- headaches
- strokes
- visual distrubances: retinal hemorrhages, papilledema; or pripaism[17]
End-Stage symptoms:
- hepatomegaly and splenomegaly with a pallor appearance[17]
*Symtoms depend on the phase of the disease
Chronic phase
Accelerated phase
Blast phase
The clues point straight to Follicular Lymphoma, given that all the characteristic risk factors and symptoms of the disease all line up! Let's take a step back to understand everything:
- Age Factor – Follicular lymphoma is most common in people over 50, making age a key risk factor.
- Gender Risk – Men are generally at higher risk than women for developing follicular lymphoma.
- Medical History – A history of rheumatoid arthritis is linked to an increased risk of lymphoma.
- Peripheral Symptoms – The patient has swollen lymph nodes, night sweats, fever, and chills, all hallmark signs.
- Treatment Response – Follicular lymphoma is slow-growing and responds well to radiation therapy, making it a suitable treatment choice.
- Chemotherapy
- Targeted therapy
- Radiation therapy
- Stem cell transplant (for refractory cases)[9]
More on DLBCL
DLBCL is an aggressive B-cell lymphoma caused by mutations in genes like BCL2, BCL6, and MYC, leading to uncontrolled cell growth and survival. Dysregulated pathways like NF-κB and PI3K/AKT further promote tumor progression.[9]Regarding its histology, DLBCL shows large, abnormal B cells in a diffuse pattern, replacing normal lymph tissue. Cells have prominent nucleoli and high mitotic activity.[9]
- Radiation exposure
- Chemical exposure
- Viral infections (HTLV-1, Epstein-earr virus)
- Genetic syndromes (Down Syndrome / Chromosome 21)[10]
- Radiation Exposure
- Age (25-60)
- Sex (males > females)
- Smoking
- Diet[18]
- Fatigue (due to anemia)
- Frequent infections
- Bruising & Bleeding
- Bone pains
- Swollen lymph nodes (neck, armpits, abdomen, groin)[11],[13]
*symptoms often appear suddenly
More on CML
Regarding the histology, the bone marrow in CML is hypercellular, with a marked increase in granulocytic precursors at various stages of maturation. The myeloid-to-erythroid ratio is significantly elevated. The peripheral blood shows leukocytosis with an excess of neutrophils, basophils, and immature myeloid cells. In the chronic phase, blasts are low, but in the accelerated or blast phase, they increase significantly, resembling acute leukemia.[19]
More on Follicular Lymphoma
Follicular lymphoma is most common people over 50. It is slightly more common in men than women.[5] 50% of all people diagnosed are alive 20 years after diagnosis. It is said to respond especially well to radiation.[6] In about 40% of cases, follicular lymphoma can transform to diffuse large B-cell lymphoma.[6]Under the microscope, follicular lymphoma shows numerous well-defined follicles that vary in size and shape.[6]
Battle of the Blood: A Journey Through Leukemia and Lymphoma
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Transcript
Battle of the Blood: A Journey Through Leukemia and Lymphoma
PATH 3500
An interactive case study by Group 28
Pathology 3500
Table of Contents
Click for more info!
Follicular Lymphoma
Leukemia
Diffuse Large B-cell Lymphoma
Lymphoma
Case Study #1
Acute Lymphoid Leukemia
Case Study #2
Chronic Myeloid Leukemia
References
PATHology 3500
What is Leukemia?
Leukemia is a type of cancer that affects the blood-forming tissues of the body, such as the bone marrow and lymphatic system. Typically, leukemia impacts the white blood cells (leukocytes), which play a crucial role in fighting infections. Normally, these cells grow and divide in a controlled manner as needed by the body. However, in individuals with leukemia, the bone marrow produces an abnormally high number of dysfunctional white blood cells.[1]
[2]
Table of Contents
Next
PATHology 3500
What is Lymphoma?
Lymphoma is a form of cancer that affects the lymphatic system, which plays a key role in the body's immune defenses against diseases. This type of cancer begins when normal cells in the lymphatic system grow uncontrollably.[4]
[3]
Table of Contents
Next
PATHology 3500
What is Lymphoma?
Lymphoma is a form of cancer that affects the lymphatic system, which plays a key role in the body's immune defenses against diseases. This type of cancer begins when normal cells in the lymphatic system grow uncontrollably.[4]
[3]
Table of Contents
Next
Pathology 3500
1. Follicular Lymphoma
Follicular lymphoma accounts for 40% of all adult lymphomas. Patients can live for many years with this B-cell lymphoma, as it is generally slow-growing, however it is uncurable.[5] Follicular lymphoma is often diagnosed through a biopsy of the lymph nodes and/or usage of a PET or CT scan, and may involve bone marrow testing to identify its spread.[6]
[7]
Risk factors
Signs & Symptoms
More
Treatments
Table of Contents
Pathology 3500
Risk factors
Signs & Symptoms
[8]
Treatments
2. Diffuse Large B-Cell Lymphoma
Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for approximately 30–40% of adult lymphomas.[8] DLBCL is typically diagnosed through a lymph node biopsy, with additional imaging such as PET or CT scans to assess the extent of disease, and bone marrow biopsy in select cases.[9]
Table of Contents
More
Pathology 3500
3. Acute Lymphoid Leukemia (ALL)
ALL is cancer of the lymphoid cells. It is the most common type of cancer in children.[10] The prognosis is generally better for children than adults with the 5 year survival rate for kids at 85%.[11] Diagnosis is through blood tests to check for abnormal levels of WBC, RBC and platelets, bone marrow tests to identity leukemic cells and imaging studies to detect spread.[13]
[14]
Risk factors
Signs & Symptoms
More
Treatments
Table of Contents
Pathology 3500
4. Chronic Myeloid Leukemia (CML)
Risk factors
Signs & Symptoms
Treatment
[15]
CML is a myeloproliferative disorder with an excessive production of granulocytes, driven the presence by the Philadelphia (Ph1) chromosome.[16] CML occurs in 1/100,000 individuals under 20 years old and 1-3% of children with leukemia[18]. It is usually diagnosed through a peripheral blood smear or bone marrow biopsy, looking for the presence of leukoerythroblastosis.[18]
Table of Contents
Test yourself!
More
Read the Clues...
Find the Diagnosis
[19]
Table of Contents
the Diagnosis is...
Acute Lymphoblastic Leukemia!
Explanation...
Click here to go back to the info page.
[19]
Table of Contents
Read the Clues...
Find the Diagnosis
[20]
Table of Contents
the Diagnosis is...
Explanation...
Follicular Lymphoma!
Click here to go back to the info page.
[20]
Table of Contents
Pathology 3500
5. References
The clues strongly suggest ALL because they align with key risk factors and symptoms of the disease! Let's break it down:
- Targetted therapy drugs like Tyrosine-Kinase inhibitors
- Highdose chemotherapy with donor stem cell transplant
- Radiation Therapy
- Sugery options like a Splenectomy[18]
*Treatments often depend on the staging and phases of the diseaseMore on ALL
Lymphoid cells are B-cells and T-cells. It is the most common type of cancer in children, particularly affecting those between the ages of 2 and 5. The risk declines with age 75-80% of ALL is made of B-cells. B-cells produce antibodies to fight infections. B-cells play a role in humoral immune response by recognizing antigens and producing specific antibodies 20-25% of ALL is made of T-cells. T-cells help destroy infected or cancerous cells and support other immune cells. T-cells are involved in direct killing infected host cells, activating other immune cells and regulating the immune response [10,11]
Symptoms
- Initally clincally stable
Non-specific symptoms:- fever
- night sweats
- abdominal pain
- bone pain[17]
Hyperviscosity symptoms:- neruological dysfunction
- headaches
- strokes
- visual distrubances: retinal hemorrhages, papilledema; or pripaism[17]
End-Stage symptoms:- hepatomegaly and splenomegaly with a pallor appearance[17]
*Symtoms depend on the phase of the diseaseChronic phase
Accelerated phase
Blast phase
The clues point straight to Follicular Lymphoma, given that all the characteristic risk factors and symptoms of the disease all line up! Let's take a step back to understand everything:
More on DLBCL
DLBCL is an aggressive B-cell lymphoma caused by mutations in genes like BCL2, BCL6, and MYC, leading to uncontrolled cell growth and survival. Dysregulated pathways like NF-κB and PI3K/AKT further promote tumor progression.[9]Regarding its histology, DLBCL shows large, abnormal B cells in a diffuse pattern, replacing normal lymph tissue. Cells have prominent nucleoli and high mitotic activity.[9]
- Fatigue (due to anemia)
- Frequent infections
- Bruising & Bleeding
- Bone pains
- Swollen lymph nodes (neck, armpits, abdomen, groin)[11],[13]
*symptoms often appear suddenlyMore on CML
Regarding the histology, the bone marrow in CML is hypercellular, with a marked increase in granulocytic precursors at various stages of maturation. The myeloid-to-erythroid ratio is significantly elevated. The peripheral blood shows leukocytosis with an excess of neutrophils, basophils, and immature myeloid cells. In the chronic phase, blasts are low, but in the accelerated or blast phase, they increase significantly, resembling acute leukemia.[19]
More on Follicular Lymphoma
Follicular lymphoma is most common people over 50. It is slightly more common in men than women.[5] 50% of all people diagnosed are alive 20 years after diagnosis. It is said to respond especially well to radiation.[6] In about 40% of cases, follicular lymphoma can transform to diffuse large B-cell lymphoma.[6]Under the microscope, follicular lymphoma shows numerous well-defined follicles that vary in size and shape.[6]