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Lymphomas (NHL)

Lymphomas (NHL). Dr Mohamed Iqbal Musani, MD. 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

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Lymphomas (NHL)

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  1. Lymphomas (NHL) Dr Mohamed Iqbal Musani, MD

  2. 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 M:F 2:1 • May Involve BM- may produce Anaemia • May spill in to blood- leading to Lymphatic Leukemia • Spread from one group of LN to others.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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

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