LYMPHOMAS:

Hodgkin & Non Hodgkin

Dr. Sookun Rajeev K

(MD)

Dept of General Medicine

Anna Medical College

Introduction

Introduction

Lymphoma originates in

Lymphocytes.

Lymphocytes a type of WBC in the

vertebrate immune system.

Lymphomas are part of the broad

group of diseases called

Hematological Neoplasms

DefinitionLYMPHOMA is basically solid tumours

of the lymphoreticular system

Histologically 2 main types:

1. Hodgkin’s disease, characterised by

the presence of multinucleated giant

cells (Reed–Sternberg cells); and

2. Non-Hodgkin’s lymphoma

Pathophysiology Hodgkin’s Lymphoma

The disease is characterised by the

presence of Reed-Sternberg cells.

Spreading in an orderly fashion to

contagious lymph nodes

The cure rate is about 93%, making

it one of the most curable form of

cancer

Red-Sternberg cells

Cells with mirror image nuclei and prominent,

eosinophilic, inclusion-like nuclei.

lacunar cell

(mixed cellularity) (nodular sclerosis) (lymphocyte

predominance)

RS Cell variants

7

EpidemiologyMost frequently (Bimodal)occur in

age group 15 to 35 and >50 yrs

More common in males except

Nodular Sclerosis which is more

common in females

Increase incidence in HIV

infections.

Staging Classification Stage Definition

I Involvement of a single lymph node region or

structure (e.g., spleen)

II Involvement of two or more lymph node regions on

the same side of the diaphragm

III Involvement of lymph node regions or structures on

both sides of the diaphragm

IV Involvement of extranodal site(s) beyond that

designated as ‘E,’ more than one extranodal deposit

at any location, any

involvement of liver or bone marrow

Staging Classification Stage Definition

A No symptoms

B Unexplained weight loss 10% of body weight in last 6 months

Unexplained fever 38°C in the previous month Recurrent

drenching night sweats in the previous month

X Bulky disease: 10 cm maximal diameter of a nodal mass,

mediastinal mass 1/3 chest diameter

E Localized solitary involvement of extralymphatic tissue except

liver and bone marrow: if this is the only site of disease, it is

stage IE

By limited direct extension from a known nodal site Single-

discrete site proximal to a regional involved nodal site (IIE)

Stage I Stage II Stage III Stage IV

Staging of Lymphoma

A: absence of B symptoms

B: fever, night sweats, weight loss

Risk Factors Hodgkin

• Family History

• Environmental – wood workers,

farmers, meat workers

• Diseases- Mononucleosis (EBV

infection), AIDS, Bone marrow

transplant.

Signs & Symptoms Hodgkin1. Painless Lymphadenopathy –

involving superficial lymph nodes

of cervical and supraclavicular

nodes)

• The lymph nodes are swollen and

have a rubbery feeling.

Signs & Symptoms Hodgkin

2. Systemic Symptoms

a) Fevers, Night Sweats and

Weight Loss

b) Pruritus

c) Pel-Ebstein Fever

Signs & Symptoms Hodgkin

3. Pain

a) Alcohol – induced pain

b) Abdominal Pain

c) Bone Pain

d) Neurogenic Pain

e) Back Pain

Non HodgkinThe neoplastic transformation of either

B or T cell lineages of lymphatic cells.

NHL causes the accumulation of

neoplastic cells in both the lymph

nodes as well as more often diffusely

in extralymphatic organs and the

bloodstream.

Absent Reed-Sternberg cells.

Risk Factors Non Hodgkin

i. Diseases- Infections

(HIV,EBV,HepC V,H.Pylori),

RA, SLE, Sjogren’s

syndrome, mixed

Cryoglubulinemia, IBD,

Inherited immune defects

ii. Age > 60

Symptoms Non Hodgkin1. Mass Effect – Lymphadenopathy

(occipital,Posterior auricular,

preauricular, mandibular, submental,

cervical, supra & infraclavicular,

Waldeyer’s ring, Axillary, inguinal,

Popliteal, Hepatosplenimegaly,

mediastinal,Abdominal,Pelvic,testicular,

CNS masses.

Symptoms Non Hodgkin2. Hematologic – Anemia,

Thrombocytopenia,

lymphocytosis

3. Constitutional B-Symptoms-

Fatigue,Anorexia,Pruritus.

4. Paraneoplastic Syndromes

Physical Examination

Evaluate for:

Hepatosplenomegaly

Presence of Effusion

Evidence of Neuropathy

Signs of Obstruction (Extremity

edema, SVC syndrome, Spinal Cord

Comp,Hollow viscera dysfunction)

Physical Examination

Evaluate for:

Lymph Node chains including

Submental, Supraclavicular,

infraclavicular, Infraclavicular,

epitrochlear, iliac, femoral &

popliteal nodes.

Physical Examination

1. Lymph nodes examination for:

i. Size

ii. Multiplicity

iii. Consistency

iv. Tenderness

Physical Examination

2. Tonsils and Oropharynx

Waldeyer’s ring involvement

mandates complete evaluation

of the nasopharynx,

Oropharynx and Hypopharynx

by endoscopy

Investigations

1. Hematologic Tests (Basics)

FBC, Peripheral smear,

Electrolytes, Urea, Creatinine,

AST,ALT, ALP, Bilirubin,

Ca,LDH,ESR, Albumin,Serum

protein electrophoresis, HepC

V,HepB V,HIV

Investigations

1. Hematologic Tests

i. Diagnostically Abnormal

Circulating lymphoid cells or

lymphocytosis

ii. Acute-Phase reactant

iii. Liver function tests

Investigations

iv. Renal Function Tests

v. Serum Uric Acid

vi. Hypercalcemia

vii. Serum Lactate

Dehydrogenase

viii.Serum Immunoglobulins

Investigations

2. Biopsy

i. Peripheral Node Biopsy

ii. Inguinal Lymph Nodes Biopsy

iii. Bone Marrow Biopsy

iv. Endoscopic Gastric Biopsy

v. Trucut Biopsy of Retroperitoneal

& Mesenteric masses

Investigations

3. Mediastinoscopy or Limited

Thoracotomy

4. Laparotomy

5. Laparoscopy

6. Endoscopic Gastroscopy

Investigations

7. Evaluation of the Chest

i. Chest Radiograph

ii. CT Scans

iii. Thoracocentesis and Pleural

Biopsy

Investigations

8. Evaluation of the Abdomen

and Retroperitoneum

i. CT Scans

ii. Bipedal Lymphangiography

iii. Abdominal Ultrasonography

Investigations

9. Evaluation of the

Gastrointestinal Tract

i. Barium Enema

ii. Endoscopic Examination

iii. Biopsy of accessible

abnormalities

Investigations

10. Evaluation of the CNS

i. Spinal Fluid Examination

ii. CT

iii. MRI

Investigations

11. Nuclear Scans

i. Positron Emission

Tomography (PET) scan

ii. Gallium Scans

Treatment

i. Surgery

ii. Radiotherapy

iii. Chemotherapy

iv. Combined Chemotherapy.

v. Autologous stem cell

transport