Lymphoma: Types, Risk Factors, Diagnosis, and Management
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Questions and Answers

What are the two types of lymphoma?

Hodgkins Lymphoma and Non-Hodgkins Lymphoma

What are the major risk factors for Hodgkins Lymphoma?

Infections (e.g., EBV, HIV), age distribution, gender (more common in males), socioeconomic status, geographic location, and family history.

What are some clinical manifestations of Hodgkins Lymphoma?

Palpable, non-tender lymphadenopathy (often in cervical, supraclavicular, or axilla areas), anterior mediastinal mass, B-symptoms (unexplained weight loss, fever, night sweats), and possible extranodal sites involvement.

What cell is considered the hallmark cell of Hodgkins Lymphoma?

<p>Reed-Sternberg cell</p> Signup and view all the answers

What are some possible risk factors for Non-Hodgkins Lymphoma?

<p>All of the above</p> Signup and view all the answers

Diffuse large B cell lymphoma is a slow-growing type of NHL.

<p>False</p> Signup and view all the answers

______ lymphoma is the 2nd leading cause of NHL and tends to grow in a circular pattern in LNs.

<p>Follicular</p> Signup and view all the answers

Match the following types of B cell NHL with their descriptions:

<p>Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma = Cancer cells found in the blood and BM Burkett's lymphoma = Highly active, aggressive form of NHL Marginal zone B cell lymphoma = Most commonly found in the stomach Diffuse large B cell lymphoma = Most common histologic type of NHL</p> Signup and view all the answers

What is the origin of lymphoma?

<p>Clonal malignant disorders that are derived from lymphoid cells</p> Signup and view all the answers

Where can lymphomas originate in the body?

<p>In any organ of the body</p> Signup and view all the answers

What is the trend of incidence of Hodgkin lymphoma?

<p>Stable</p> Signup and view all the answers

What is the cell of origin in Hodgkin lymphoma?

<p>Germinal centre B-cell</p> Signup and view all the answers

What is the role of EBV in the development of Hodgkin lymphoma?

<p>It causes DNA changes in B lymphocytes</p> Signup and view all the answers

What is the characteristic of Reed-Sternberg cells in Hodgkin lymphoma?

<p>They have high proliferative activity</p> Signup and view all the answers

What is the ranking of lymphoma in terms of frequency of diagnosis in both sexes?

<p>5th</p> Signup and view all the answers

What is the trend of incidence of Non-Hodgkin lymphoma?

<p>Increasing</p> Signup and view all the answers

What percentage of Hodgkin's Lymphoma is classified as Nodular sclerosis?

<p>70%</p> Signup and view all the answers

Which of the following is a risk factor for Hodgkin's Lymphoma?

<p>Higher socioeconomic status</p> Signup and view all the answers

What is the most common location of palpable lymphadenopathy in Hodgkin's Lymphoma?

<p>Cervical or supraclavicular area</p> Signup and view all the answers

What percentage of normal spleens harbour tumor in Hodgkin's Lymphoma?

<p>25%</p> Signup and view all the answers

What is the percentage of Hodgkin's Lymphoma patients with B-symptoms in Ethiopia?

<p>70%</p> Signup and view all the answers

What is the characteristic of lymphadenopathy in Hodgkin's Lymphoma?

<p>Firm and non-tender</p> Signup and view all the answers

What percentage of Hodgkin's Lymphoma is limited to below the diaphragm?

<p>4%</p> Signup and view all the answers

What is the correlation between B-symptoms and disease prognosis in Hodgkin's Lymphoma?

<p>B-symptoms generally indicate a worse prognosis</p> Signup and view all the answers

What is the definition of a mediastinal mass in lymphoma?

<p>A mass in the mediastinum that is at least 1/3 of the chest</p> Signup and view all the answers

What is the most common histologic type of NHL?

<p>Diffuse large B cell lymphoma</p> Signup and view all the answers

What is the average age of patients with diffuse large B cell lymphoma?

<p>60</p> Signup and view all the answers

What percentage of patients with diffuse large B cell lymphoma have non-nodal sites involved?

<p>40%</p> Signup and view all the answers

What is the risk of CNS involvement in patients with diffuse large B cell lymphoma?

<p>Increased risk if BM, testis, breast, kidney, thyroid, liver, or skin are involved</p> Signup and view all the answers

What percentage of patients with diffuse large B cell lymphoma are cured after initial treatment?

<p>65%</p> Signup and view all the answers

What is the significance of unexplained weight loss of more than 10% in 6 months in Hodgkin Lymphoma?

<p>It is a B-symptom</p> Signup and view all the answers

What is the purpose of staging in Hodgkin Lymphoma?

<p>To determine the prognosis and decide treatment options</p> Signup and view all the answers

What is the most common type of biopsy used for Hodgkin Lymphoma?

<p>Excisional biopsy</p> Signup and view all the answers

What is the significance of a mediastinal mass in Hodgkin Lymphoma?

<p>It is a common finding on chest X-ray in Hodgkin Lymphoma</p> Signup and view all the answers

What is the purpose of a PET scan in Hodgkin Lymphoma?

<p>To stage Hodgkin Lymphoma</p> Signup and view all the answers

What is the definition of Stage I in the Ann Arbor staging system?

<p>HD is found in only 1 lymph node area or lymphoid tissues/organ</p> Signup and view all the answers

What is the significance of bulky disease in Hodgkin Lymphoma?

<p>It requires intensive therapy</p> Signup and view all the answers

What is the purpose of ESR and serum ferritin in the investigation of Hodgkin Lymphoma?

<p>To support the diagnosis of Hodgkin Lymphoma</p> Signup and view all the answers

What is the cure rate of Burkett's lymphoma if treated?

<p>95%</p> Signup and view all the answers

In which region is the endemic form of Burkett's lymphoma commonly found?

<p>Equatorial Africa and tropical regions</p> Signup and view all the answers

What is the primary method of diagnosing Non-Hodgkin lymphoma?

<p>Biopsies</p> Signup and view all the answers

Which of the following is a good prognostic indicator in Non-Hodgkin lymphoma?

<p>Younger age</p> Signup and view all the answers

What is the primary factor that the International Prognostic Index (IPI) depends on?

<p>Age and stage of the disease</p> Signup and view all the answers

What is a common symptom of Non-Hodgkin lymphoma?

<p>Early satiety</p> Signup and view all the answers

What is the term for the characteristic appearance of Burkett's lymphoma cells under the microscope?

<p>Starry sky appearance</p> Signup and view all the answers

In which group of patients is Burkett's lymphoma more common?

<p>Immune suppressed patients</p> Signup and view all the answers

Study Notes

Lymphoma: Definition and Classification

  • Lymphoma is a clonal malignant disorder derived from lymphoid cells (either precursor or mature T-cell or B-cell)
  • There are two types of lymphoma: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL)

Epidemiology of Lymphomas

  • 5th most frequently diagnosed cancer in both sexes
  • Males > females
  • Incidence: HL stable, NHL increasing (8-10 times more than HL)

Hodgkin's Lymphoma

  • Named after Thomas Hodgkin
  • Cancer of lymphocytes, almost always starts from B subtype
  • Can start at any lymphoid tissue, mostly in the upper part of the body
  • Spreads in contiguous manner, rarely hematogenous
  • Prototype cell is the Reed Sternberg cell
  • Cell of origin: germinal center B-cell
  • Etiology: infection (EBV) may cause DNA changes in B lymphocytes, leading to Reed-Sternberg cells

Classification of HL

  • Based on microscopic features
  • Different types may be treated differently
  • All types are malignant, no benign type
  • Generally, there are two types: Classic HD and Nodular lymphocytic predominant

Risk Factors for HL

  • Infections (e.g., EBV, HIV)
  • Age: bimodal distribution
  • Gender: more common in males
  • Socioeconomic status: higher status
  • Geographic location: more common in Western countries, less common in Asians
  • Family history: accounts for 5%, twins have a higher risk

Clinical Manifestations of HL

  • Variable severity: asymptomatic to extremely ill
  • Time course: evolution over weeks, months, or years
  • Most patients present with palpable, non-tender lymphadenopathy
  • Contiguous spread
  • The size may change spontaneously
  • Alcohol-induced pain at the site

Staging of HL

  • Used to determine the extent of spread, prognosis, and treatment options
  • Based on medical history, physical examination, blood tests, biopsy, and imaging tests
  • Ann Arbor staging system with Cotswold modification

Non-Hodgkin Lymphoma (NHL)

  • More than 60 types, including Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma, Marginal Zone B Cell Lymphoma, and Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma

Types of B Cell NHL

  • Diffuse Large B Cell Lymphoma (DLBCL): most common histologic type, appears large under the microscope, average age 60, majority present in advanced stage
  • Follicular Lymphoma: 2nd leading cause of NHL, grows in a circular pattern in LNs, average age 60, slow-growing
  • Marginal Zone B Cell Lymphoma: 2nd most common indolent lymphoma, 3 types: splenic MZL, Extranodal MZL of MALT, and nodal MZL

Diagnosis of NHL

  • History: progressively enlarged LNs, swollen abdomen, chest pain or pressure, SOB, B symptoms, and extreme tiredness
  • Physical examination: focuses on LN and spleen examinations
  • Biopsies: excisional/incisional biopsies, fine/core needle biopsies, bone marrow aspiration/biopsies, LP, effusion analysis
  • Lab tests: immuno-histochemistry tests, flow cytometer, cytogenetic, molecular genetic tests
  • Blood tests: LDH, HIV, HCV, HTLV-1, and HHV-8

Staging of NHL

  • Tests for staging: history, physical examination, biopsies, blood tests, imaging tests, and bone marrow studies
  • Ann Arbor staging system is also adopted for NHL

International Prognostic Index

  • Depends on age, stage, extension from the lymph node, performance in daily activities, and serum LDH level
  • Good prognostic indicators: age, low stage, and good performance status

Lymphoma Definition and Types

  • Lymphoma is a clonal malignant disorder that originates from lymphoid cells, either precursor or mature T-cell or B-cell.
  • There are two main types of lymphoma: Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL).

Epidemiology of Lymphomas

  • Lymphoma is the 5th most frequently diagnosed cancer in both sexes.
  • The incidence of lymphoma is higher in males than females.
  • Hodgkin's Lymphoma has a stable incidence, while Non-Hodgkin's Lymphoma is increasing (8-10 times HL).

Hodgkin's Lymphoma (HL)

  • Named after Thomas Hodgkin.
  • It is a cancer of lymphocytes, almost always originating from B subtype cells.
  • It usually starts in lymphoid tissues, mostly in the upper part of the body.
  • The course of the disease is variable, but prognosis has improved with modern treatment.
  • The prototype cell is the Reed Sternberg cell, which is a hallmark of HL.
  • Etiology is linked to infection, particularly EBV, which can cause DNA changes in B lymphocytes, leading to the development of Reed-Sternberg cells.

Classifications of HL

  • Classification is based on microscopic features.
  • There are four types of Classic HL: Nodular sclerosis, Mixed cellularity, Lymphocytic rich, and Lymphocytic depletion.
  • Nodular lymphocytic predominant HL is a rare type.

Risk Factors for HL

  • Infections, such as EBV and HIV.
  • Age (bimodal distribution).
  • Gender (more common in males).
  • Socioeconomic status (higher status).
  • Geographic location (more common in Western countries).
  • Family history (accounts for 5%, with twins having a higher risk).

Clinical Manifestations of HL

  • Variable severity, from asymptomatic to extremely ill.
  • Time course: evolution over weeks, months, or years.
  • Most patients present with palpable, non-tender lymphadenopathy.
  • Contiguous spread.
  • The size of the LAP may change spontaneously.
  • Alcohol-induced pain at the site.

Staging of HL

  • Used to determine the extent of spread, to assess prognosis, and decide treatment options.
  • Based on medical history, physical examination, blood tests, biopsy of LAP, BM aspiration and biopsies, and imaging tests.

Investigation and Diagnosis of HL

  • CBC: Mild to moderate anemia is common in HL.
  • ESR, serum ferritin, and haptoglobulin tests.
  • CXR: demonstrates mediastinal mass, hilar LAP, pleural effusion, and parenchymal lung lesions.
  • CT scan/PET scan: for staging.
  • Biopsy: excisional/incisional biopsy, core needle biopsy, and BM aspiration/biopsies.
  • Immuno-histocompatibility tests.

Ann Arbor Staging of HL

  • Stage I: HD found in only one lymph node area or lymphoid tissue/organ.
  • Stage II: HD found in two or more lymph node areas on the same side of the diaphragm.
  • Stage III: HD found in lymph node areas on both sides of the diaphragm.
  • Stage IV: Diffuse or disseminated involvement of ≥1 extranodal organs beyond that designated as E.

Non-Hodgkin's Lymphoma (NHL)

  • Types of B-cell NHL:
    • Diffuse large B-cell lymphoma (DLBCL): the most common histologic type of NHL.
    • Burkitt's lymphoma: a highly aggressive form of NHL, but with a high cure rate if treated.

Diagnosis of NHL

  • History: focused on LN, spleen examinations, and B symptoms.
  • P/E: focused on LN and spleen examinations.
  • Biopsies: excisional/incisional biopsies, fine/core needle biopsies, and BM aspiration/biopsies.
  • Lab tests: immuno-histochemistry, flow cytometer, cytogenetic, and molecular genetic tests.
  • Blood tests: LDH level.
  • Imaging: CXR, CT scan, MRI, PET, and bone scan.

Staging of NHL

  • Tests for staging: Hx, P/E, biopsies, blood tests, imaging tests, and bone marrow studies.
  • Ann Arbor staging is also adopted for NHL.

International Prognostic Index (IPI)

  • Depends on age, stage, extension from the lymph node, performance in daily activities, and serum LDH level.
  • Good prognostic indicators: age, stage, and performance in daily activities.

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