LYMPHOMA

Non-Hogekin Lymphoma

Diffuse large B-cell lymphoma(aggressive) Follicular lymphoma (indolent) Marginal zone B-cell lymphoma of mucosaassociated Small lymphocytic lymphoma Peripheral T-cell lymphoma, unspecified Mantle cell lymphoma

Risk factors : age, EBV/HIV infection, immunocompromised

Diffuse Large B-Cell Lymphoma : DLBCL

Aggressive NHL Clinical Presentation : - symptomatic enlarging nodal mass, either centrally or peripherally located. ~ 20% stage I or stage IE disease ~40% stage II ~20% stage III ~ 40% stage IV B symptoms malaise / fatigue

Diffuse Large B-Cell Lymphoma : DLBCL

Common extranodal sites of origin : GI tr, thyroid, bone, brain, testis, soft tissue, kidney, liver, breast, skin Common extranodal dissemination sites : liver, kidney, bone, lung, bone marrow

Burkitt Lymphoma

Highly aggressive mature B-Cell Extremely high rate of cellular proliferation with very high mitotic activity and dysregulation of c-myc Rare Strong male preponderance Intensive combination therapy with intrathecal prophylaxis (due to high risk CNS recurrence)

Classical HL

First peak in third decade of life Second peak in 50 year Reedstenbergs cells Risk factors : age, EBV infection, immunocompromised Typical presentations: - painless enlarged superficial LN, - on imaging shows contiguous nodal chains, predictable - mostly supradiaphragmatic : cervical, supraclavicular, axillar, mediastinum - 10 15% involve extranodal organs : bone ,bone marrow, lung, liver (CNS involvement rare)

Poor prognostic factors for Early-Stage

male sex Age > than 40 years B symptoms Erythrocyte sedimentation rate greater than 50 Large mediastinal mass, extranodal disease, infradiaphragmatic disease involvement of three or four lymph node stations.

Advanced-Stage HL: Poor Prognostic Factors

Age > 45 years male gender serum albumin less than 4 hemoglobin less than 10.5 WBC count >15,000 Absolute lymphopenia Z (<600) stage IV disease.

Diagnosis

Gold standard: Excisional LN Biopsy

Staging
Stage

I
II

Involve only one LN group or lymphoid tissue

Multiple LN groups ipsilateral to the diaphragm or localized involvement of one extranodal organ

III
IV

Involve LN groups both above and below the diaphragm

A - No symptoms B - Fever > 38 oC, night sweats, wt loss > 10% in 6 months X Bulky (> 10cm long axis or > 1/3 of transverse AP at 5th or 6th ICS T vertebral body.

Noncontiguous extranodal involvement (e.g. lung, BM)

Staging

CT chest and whole abdomen Bone marrow biopsy LP (when the disease involves testis, paranasal sinuses, bone marrow, epidural space which may result in CNS involvement)

Treatment :NHL

CMT : CHOP regimen - cyclophosphamide - doxorubicin - vincristin - prednisolone R-CHOP with rituximab added x 3-4 cycles + consolidative IFRT for early favorable stage x 6 cycles for bulky or advanced stage

Treatment :HL

SVC Syndrome

Caused by invasion or external compression from : - right lung pathology - LN - mediastinal structures - thrombosis in the vessel Obstructed SVC results in collateral veins to allow for alternative pathway to return bl to rt atrium : azygos, internal mammary, lateral thoracic, paraspinous and esophageal venous systems Collateral veins develop over weeks

Manifestation

Dyspnea Facial swelling, head fullness exacerbated by bending forward or lying down Arm swelling Cough Chest pain Dysphagia Cerebral edema (confusion, headache)

Physical examination

Facial edema Venous distension in the neck and chest wall Arm edema cyanosis Facial plethora