Lymphoma

Lymphoma

1. Lymphatic system

   • Lymphatic vessels absorb excess interstitial fluid and transport this fluid (LYMPH) to ducts that drain it to the veins
     • Lymph nodes and lymphoid tissues in the thymus, spleen, and tonsils produce lymphocytes involved in immunity
   • Lymph node histology

2. Types

   • Hodgkin's
     • Non-Hodgkin's
       • Burkitt lymphoma
         • t(8;14)—translocation, “Starry sky” appearance, sheets of lymphocytes with interspersed “tingible body” macrophages, associated with EBV. Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form.
         • Diffuse large B-cell lymphoma
           • Alterations in Bcl-2, Bcl-6, Most common type of non-Hodgkin lymphoma in adults.
           • Follicular lymphoma
             • t(14;18)—translocation, Indolent course; Bcl-2 inhibits apoptosis. Presents with painless “waxing and waning” lymphadenopathy.
             • Mantle cell lymphoma
               • t(11;14)—translocation, Very aggressive, patients typically present with late-stage disease.
               • Marginal zone lymphoma
                 • t(11;18), Associated with chronic inflammation (eg, Sjögren syndrome, chronic gastritis [MALT lymphoma]).
     • Derived from a specific lineage of B cells(Reed-Sternberg cells).
       • Manifestations are similar to Non-Hodgkin’s Lymphoma(fever, chills, wt. loss, & night sweats).
       • Presents at single site(rarely extranodal), in young adults or elderly
         • Spread is contiguous, Associated with Epstein-Barr virus
         • CD15+ and CD30+
           • Classification
             • Nodular sclerosis
               • Most common[70%], enlarging cervical or mediastinal lymph node, bands of sclerosis, lacunar appearance
               • Lymphocyte-rich (best prognosis)
                 • Mixed cellularity
                   • Associated with abundant eosinophils, IL-5
                   • Lymphocyte-depleted
                     • Most aggressive of all types

3. Neoplastic proliferation of lymphoid cells arising in a lymph node or in extra-nodal tissue

4. Stages

   • Stage 1
     • Stage 2
       • Stage 3
         • Stage 4

5. Investigations

   • CBC, ESR, LFT
   • Chest radiograph
     • CT SCAN
       • PET SCAN
         • STAGING LAPAROTOMY

6. Treatment

   • R-CHOP
     • Rituximab
       • Cyclophosphamide
         • Doxorubicin
         • Prednisolone
       • Vincristine
   • Prognosis
     • IPI score
       • 0-1 risk factors - 75%
         • 2-3 risk factors - 50%
           • 4-5 risk factors - 25%

Images and files in the map