Lymphomas (NHL)

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Lymphomas (NHL)

• Dr Mohamed Iqbal Musani, MD

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Lymphomas

• Malignant Tumours of Lymph Nodes.
• Arise in Peripheral lymphoreticular tissue.
• They are divided in to Two Types.
• Hodgkins Lymphoma ( HL)
• Non Hodgkins Lymphoma (NHL)
• General Features
• Painless LN enlargement
• Young individuals affected MF 21
• May Involve BM- may produce Anaemia
• May spill in to blood- leading to Lymphatic
  Leukemia
• Spread from one group of LN to others.

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Malignant Lymphoma

• Non-Hodgkin's lymphoma (NHL) is a malignant
  proliferation of lymphocytes, usually B cells.
• The aetiology of most cases of NHL is unknown.
• The incidence of NHL has increased recently.
• It is important to diagnose NHL as some cases are
  curable and most are treatable.
• A Non-Hodgkin's lymphoma is a mixture of
• transformed lymphocytes
• reactive lymphoid cells
• stroma
• 85 of lymphomas are derived from a clone of B
  cells, the remainder have a T cell origin.
• About 20 different types of lymphoma are
  recognised. Identification depends on special
  stains and cytological markers.

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Epidemiology

• peak incidence of non-Hodgkin's lymphoma occurs
  between 50 and 70 years (67 of of cases occur in
  patients aged over 60 years (1)). However all
  ages can be affected
• in adults aged 15 years in England and Wales in
  1992 - there were 6,888 new cases the number per
  annum per 2000 population was 0.27 (1)
• in Western Europe and the USA non-Hodgkin's
  lymphomas account for 55-60 of all malignant
  lymphomas
• presenting features include lymphadenopathy,
• hepatosplenomegaly,
• weight loss,
• fatigue and
• night sweats
• 40 of patients present with tumor outside lymph
  glands

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Ann Arbor Staging Criteria

• Stage I - involvement of a single lymph node area
• Stage II - involvement of two or more lymph node
  regions on same side of the diaphragm
• Stage III - involvement of lymph node regions on
  both sides of the diaphragm /- spleen
• Stage IV - disseminated extralymphatic spread
• Category A symptoms absent
• Category B - symptoms present
• Localised extralymphatic lesions with or without
  associated lymph node involvement are termed 'E'
  (extranodal) lesions.

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Clinical Features

• Non-Hodgkin's lymphoma (NHL) is typically
  disseminated at presentation,
• painless lymphadenopathy of NHL is often
  generalised. In contrast the lymphadenopathy of
  Hodgkin's disease is often localised to a single
  group of nodes. Visceral lymphadenopathy is
  common, often resulting in heavy tumour burden
  but with few symptoms.
• There is more extra nodal involvement seen in
  non-Hodgkin's lymphoma and there may be primary
  involvement of structures such as gut, nose and
  skin.
• symptoms are
• weight loss
• night sweats
• pyrexia
• Non-Hodgkin's lymphoma may also present with
  anaemia, infections or purpura.

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General Concept of NHL

• Origin is B Lymphocytes 80-85 Rarely T
  Lymphocytes
• Cell Size Morphology-Small, Large or Mixed
  cells, Cleaved Lymphocytes ( Indented) or Non
  Cleaved.
• Pattern may be Diffuse or Nodular ( follicular)
• Gross Appearance
• LN are enlarged
• Firm or fish flesh soft.
• Matted or adherent with pale grey cut surface.
• Microscopic Loss of LN architecture.
• Replacement of Normal
  Lymphocytes by malignant L
• Diff Types of Lymphocytes
  decided the type of Lymphoma.

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Follicular Lymphoma

• follicular lymphoma is a type of non-Hodgkin's
  lymphoma
• follicular lymphoma accounts for about 1 in 4 of
  all cases
• a cancer of the B-lymphocytes
• can occur any time during adulthood, the average
  age being in the 60s
• equally common in men and women
• a low-grade lymphoma and usually develops very
  slowly
• overall survival rate at 5 years is approximately
  75
• median survival is approximately 8-10 years.
• The histogical features of this lymphoma
• exhibit a follicular or nodular pattern of growth
  reminiscent of germinal centers - follicular
  pattern of growth contrasts with diffuse
  lymphomas, which usually are intermediate or
  high-grade neoplasms

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Investigations

• peripheral blood smear - often abnormal
  lymphocytes can be identified in the blood smear
• biochemistry including LDH, uric acid, liver
  function tests, and creatinine
• LDH
• is an indicator of tumor load
• raised LDH is a negative prognostic factor
• hyperuricaemia
• may occur at presentation and/or during treatment
• creatinine may be raised secondary to renal
  obstruction caused by lymphadenopathy
• bilirubinaemia and a raised alkaline phosphatase
  may ocurr if biliary obstruction due to
  lymphadenopathy
• imaging
• CXR, CT scan
• biopsy is essential to establish a diagnosis of
  lymphoma
• bone marrow biopsy