Hodgkin and non-hodgkins lymphoma.pptx

Hodgkin and non-hodgkins lymphoma

1. HODGKIN LYMPHOMA & NON HODGKIN LYMPHOMA DR. J. N. PATEL RHMC

2. HODGKIN LYMPHOMA Hodgkin’s disease (HD) is a malignant disorder of lymphoreticular system ; a lymphoreticular neoplasm primarily of B cell lineage involving lymph nodes and the lymphatic system has unique molecular, histologic, immune phenotypic and clinical features.

3. WHO CLASSIFICATION Nodular lymphocytic-predominant Hodgkin lymphoma (NLPHL) Classical Hodgkin lymphoma

4. NLPHL (NODULAR LYMPHOCYTIC PREDOMINANT HL) Patients with NLPHL generally present with localized, non-bulky disease. The only symptom for most people with NLPHL is one or more lumps. These are enlarged lymph nodes (swollen glands). They are often in only one place in the body. A few people have other general symptoms of lymphoma, like night sweats, weight loss and fevers.

5. Classical Hodgkin lymphoma The hallmark of classic Hodgkin lymphoma is the Reed- Sternberg cell. This is a binucleated or multinucleated giant cell that is often characterized by a bilobed nucleus, with two large nucleoli, giving an owl’s eye appearance to the cells.

6. CAUSES Variation in the incidence of HD in different ethnic groups and association with human leukocyte antigen suggests that inherited susceptibility plays an important role in the pathogenesis. Environmental factors such as Epstein-Barr virus infection, Familial clustering of cases and Higher incidence in twins may be some of the other contributing factors.

7. SIGN AND SYMPTOMS Lymphadenopathy, usually in the cervical, supraclavicular, and mediastinal areas; mediastinal presentation common in adolescents and young adults; (significant mediastinal adenopathy may cause cough, dyspnea, or superior vena cava syndrome) Painless, movable lymph nodes in tissues surrounding involved area Unexplained fever Weight loss Drenching night sweats Malaise Painless cervical or supraclavicular lymphadenopathy

8. S T AGES STAGES DESCRIPTION I Involvement of single lymph node region (I) or of single extralymphatic or site (IE) by direct extension II Involvement of two or more lymph node regions on the same side of diaphragm or localized involvement of an extra-lymphatic organ or site and of one or more lymph node regions on the same side of the diaphragm III1 Involvement of lymph node regions on both sides of the diaphragm Abdominal disease is limited to the upper abdomen (i.e. spleen, splenic hilar nodes, celiac nodes, porta hepatitis nodes) III2 Involvement of lymph node regions on both side of the diaphragm Abdominal disease includes paraaortic, mesenteric, and iliac involvement with or without disease in the upper abdomen. IV Disseminated involvement of one or more E x t r a lym p hati c o r g an s o r tiss u e s w it h o r w i th o u t a s so ciate d ly m ph no d e disease.

9. STAGES OF HODGKIN LYMPHOMA

10. DIAG N OS I S Complete blood count—diagnostic (anemia may indicate advanced disease) Erythrocyte sedimentation rate (ESR)—may be elevated at diagnosis Serum co p pe r , ir o n , calcium , an d a l kalin e p ho s p h a t ase levels—also may be elevated at diagnosis Live r an d renal fun c t io n tes t s— t o a s se s s or g an involvement Urinalysis—to determine renal involvement

11. DIAG N OS I S Ches t r a diograp h i c study — t o dete r m i ne me d i a sti n a l or hilar node involvement Comput e d to m ography — t o e v a l uat e me d ia s t inal, pulmonary, and abdominal disease Gallium and/or positron emission tomography (PET) scan to determine the extent of involvement Excisional lymph node biopsy—essential to diagnosis and staging Bone marrow biopsy if patient has stage 3 or 4 disease according to imaging studies

12. TRE A TMENT Treatment modalities have varied from total nodal radiation therapy to chemotherapy to combination of chemotherapy and radiotherapy with significant improvement in survival rate throughout the last three decades. All children generally receive combination chemotherapy as initial treatment.

13. TRE A TMENT Radiation therapy can cause profound musculoskeletal growth retardation and increase the risk for cardiovascular disease and secondary solid malignancies in children. The volume of radiation and the intensity/duration of chemotherapy are determined by prognostic factors at presentation, including presence of constitutional symptoms, disease stage, and bulk.

14. NON HODGKIN LYMPHOMA

15. NON-HODGKIN LYMPHOMA Non-Hodgkin’s Lymphoma (NHL) is neoplasm of a wide range of cell types that comprise the immune system. NHL most commonly occurs during the second decade of life and occurs less frequently in children less than three years of age. Pediatric NHL are high grade, diffuse and aggressive with propensity for dissemination

16. Three Therapeutically Categories B-cell NHL (Burkitt lymphoma/leukemia and diffuse large B-cell lymphoma); Lymphoblastic lymphoma (primarily precursor T-cell lymphoma and, less frequently, precursor B-cell lymphoma); Anaplastic large cell lymphoma (T cell or null-cell lymphomas).

17. CAUSES 1. B cells B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin's lymphoma arises from B cells. Subtypes of non- Hodgkin's lymphoma that involve B cells include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma.

18. CAUSES 2. T cells T cells are involved in killing foreign invaders directly. Non-Hodgkin's lymphoma occurs less often in T cells. Subtypes of non-Hodgkin's lymphoma that involve T cells include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.

19. SIGN AND SYMPTOMS 1. Intraabdominal Involvement Possible symptoms mimicking appendicitis (pain, right lower quadrant tenderness) Ovarian, pelvic, retroperitoneal masses Ascites Vomiting Diarrhea Weight loss

20. SIGN AND SYMPTOMS 2. Mediastinal Involvement Pleural effusion Tracheal compression Superior vena cava syndrome Coughing, wheezing, dyspnea, respiratory distress Edema of upper extremities Mental status changes

21. SIGN AND SYMPTOMS 3. Primary Nasal, Paranasal, Oral, and Pharyngeal Involvement Nasal congestion Rhinorrhea Epistaxis Headache Proptosis Irritability

22. S T AGES STAGE DESCRIPTION I Single tumor (extranodal)Single anatomic area (nodal) excluding mediastinum or abdomen II Single tumor (extranodal) with regional node involvement. Primary gastro intenstinal tumor with or without involvement of mesentric node.or On same side of diaphragm: Two or more nodal areas Two single extranodal tumors with or without regional node involvement III All primary intrathoracic tumors. All extensive primary intra-abdominal disease. Two or more nodal or extranodal areas on both sides of diaphragm IV Any of the above with CNS or bone marrow

23. S T AGES

24. DIAG N OS I S Bone marrow biopsy—to identify malignant cells with bone marrow involvement Lumbar puncture—to determine presence of malignant cells in CNS Complete blood count—diagnostic for bone marrow dysfunction; may show elevated white blood cell count, decreased hemoglobin level, hematocrit, and platelet count Liver and kidney function tests—liver function test values may be elevated with liver involvement; kidney function test values may be elevated with kidney involvement

25. DIAG N OS I S Lactate dehydrogenase level—elevated owing to tumor lysis Serum uric acid level—elevated owing to cellular tumor load Epstein-Barr virus test—positive result has been associated with NHL Bone scan—to determine the presence of metastases in the bone Chest radiograph—to determine the presence of metastases in the lung Computed tomography and magnetic resonance imaging— to determine the presence of metastases in other areas of the body

26. TRE A TMENT Childhood NHL is an extremely chemosensitive disease. Surgery plays a very limited role, mainly for arriving at a diagnosis. Radiation of primary sites is used very rarely in emergency situations. Hence, multi-agent chemotherapy directed to the histologic subtype and stage of the disease remains the cornerstone of therapy.