LYMPHOMA

= malignant proliferation of the lymphoid

system

2 Histological Types
Hodgkins

Non-Hodgkins
Incidence 15/100,000

Incidence 3/100,000

(UK & North

America)
Age 20-34, and >70
?EBV aetiology (40%

patients)
Mostly B-cell

derived, rarely T-cell

Reed-Sternberg cell

(developed countries)
Age >50 years, except

high-grade common in
children
?EBV (20% patients)
B cell (90%) or T cell in

origin
Many subtypes such as

Burkitts

Presentation
Painless
lymphaden
opathy

Extranodal
symptom
s

Signs &
Symptom
s

Systemic
B
symptoms

Hepatosplenome
galy

B Symptoms
Fever
Night sweats
Weight loss

Differential
Autoimmune
eg. rheumatoid
arthritis,
sarcoidosis,
Kawasakis

Primary lymph
node
malignancy
(inc. leukemia)
Secondary
malignancy eg.
Thyroid,
laryngeal, lung,
breast, stomach

Chronic
infection eg.
TB, syphilis,,
HIV

Acute infection
eg. CMV, EBV,
cat-scratch,
toxoplasmosis

Neck
Lum
p

Drugs eg.
Phenytoin

Investigations
Bloods
FBC anaemia,

lymphopenia, neutropenia,
thrombocytopenia
ESR - raised
U&E renal impairment due

to ureteric obstruction
(NHL)
LFT hepatic involvement
Serum uric acid raised
LDH raised, prognostic
Serum immunoglobulins -

low in NHL

Imaging
CXR mediastinal

widening, lung
involvement eg. hilar
lymphadenopathy,
staging
CT staging,

involvement of thoracic,
abdominal or pelvic
lymph nodes

Lymph node biopsy

PET - staging

Lymph Node Biopsy

Excisional or large sample from core biopsy

Histology
Cytology
Immunophenotyping

Hodgkins or Non-Hodgkins?
T-cell or B-cell?
Primary site?

DIAGNOSTIC

Ann Arbor Staging

Stage 1 localised single area

of lymph nodes
Stage 2 2 or more areas of

lymph nodes, either above or

below diaphragm
Stage 3 involvement of areas

of lymph nodes on both sides

of the diaphragm or spleen
involvement
Stage 4 multiple nodal areas

plus involvement of an extranodal area eg. lung, liver

X / A/ B

Hodgkins
Cervical nodes
Chest
Pruritis
Fatigue
Anorexia

Hodgkins
Nodular lymphocyte predominant
Classical (90%)
Nodular sclerosis (70%)
Lymphocyte-rich (5%)
Mixed cellularity
Lymphocyte-depleted

Hodgkins

Hodgkins
Management
Almost always treat to

cure
Chemotherapy (ABVD)
Leukemia
IHD
Breast & lung cancer
Long-term infertility

Radiotherapy
Close surveillance for

recurrence

Adverse prognostic:
Presence of B

symptoms
Low serum albumin
Low haemoglobin
Age (45) & Sex (M)
Stage 4
Leucocytosis
Lymphopenia

Non-Hodgkins
Peripeheral

lymphadenopathy
More

commonly
extranodal
(40%) eg. GI,
brain, testes,
thyroid, skin
Hepato-

splenomegaly
Bone marrow

involvement

Non-Hodgkins
High grade vs. Low grade
2 commonest types DLBCL & follicular
EBV, HIV, H. Pylori
Pesticides

Non-Hodgkins
Bleeding
, DIC
Cardiac
problem
s

Pain

Bowel
obstruction
,
perforation

Complicatio
ns
SVC
obstruction

Neurological
problems

Spinal cord
compression

Non-Hodgkins
Management
Varies with cytological

type
Watchful waiting in low-

grade asymptomatic
Chemotherapy
Radiotherapy
Immunotherapy
Surgery limited to local

disease and complication

management

Adverse prognostic:
Age >60 years
Stage III or IV
High serum LDH
ECOG status 2 or

higher
>1 extranodal site

involved

Non-Hodgkins MALT
Aetiology

Presentation

Gastric ALT

H. Pylori

Dyspepsia, epigastric
discomfor, gastric
bleeding

Skin ALT

?B. Burgdorferi

Multiple
pink/red/purple
macule/plaque/nodul
es on trunk and arms

Lung MALT (BALT)

Sjogrens, RA

Incidental on CXR,
hameoptysis, cough,
dypsnoea

Thyroid MALT

Hashimotos

Thyroid mass,
obstructive
symptoms

Ocular MALT

C. Psittaci

Painless conjunctival
injections,
photophobia, orange
mass in fornices

HIV
NHL 2nd most common cancer occurring in

patients with HIV

Correlation between declining CD4 count

and risk of developing NHL

Also at higher risk of Hodgkins lymphoma
HIV chronically stimulates B-cell

reproduction and activation

Patients taking HAART are at a lower risk of

developing it

Immunotherap
y
Monoclonal antibody
therapy Rituximab (antiCD20) treatment of
choice in follicular NHL,
and is being increasingly
used in other sub-types,
usually alongside
chemotherapy