Lymphomas: Hodgkin & Non Hodgkin by Dr. Sookun Rajeev Kumar

Lymphomas: Hodgkin & Non Hodgkin

1. LYMPHOMAS: Hodgkin & Non Hodgkin Dr. Sookun Rajeev K (MD) Dept of General Medicine Anna Medical College

2. Introduction

3. 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

4. Definition LYMPHOMA is basically solid tumours of the lymphoreticular system Histologically 2 main types: Hodgkin’s disease, characterised by the presence of multinucleated giant cells (Reed–Sternberg cells); and N on-Hodgkin’s lymphoma

5. 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

6. Red-Sternberg cells Cells with mirror image nuclei and prominent, eosinophilic, inclusion-like nuclei .

7. lacunar cell (mixed cellularity) (nodular sclerosis) (lymphocyte predominance) RS Cell variants 7

8. Epidemiology Most 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.

9. 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

10. 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)

11. Stage I Stage II Stage III Stage IV Staging of Lymphoma A: absence of B symptoms B: fever, night sweats, weight loss

12. Risk Factors Hodgkin Family History Environmental – wood workers, farmers, meat workers Diseases - Mononucleosis (EBV infection), AIDS, Bone marrow transplant.

13. Signs & Symptoms Hodgkin Painless Lymphadenopathy – involving superficial lymph nodes of cervical and supraclavicular nodes) The lymph nodes are swollen and have a rubbery feeling.

14. Signs & Symptoms Hodgkin 2. Systemic Symptoms Fevers, Night Sweats and Weight Loss Pruritus Pel-Ebstein Fever

15. Signs & Symptoms Hodgkin 3 . Pain Alcohol – induced pain Abdominal Pain Bone Pain Neurogenic Pain Back Pain

16. Non Hodgkin The 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.

17. Risk Factors Non Hodgkin Diseases - Infections ( HIV,EBV,HepC V,H.Pylori ), RA, SLE, Sjogren’s syndrome, mixed Cryoglubulinemia , IBD, Inherited immune defects Age > 60

18. Symptoms Non Hodgkin 1. 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.

19. Symptoms Non Hodgkin Hematologic – Anemia, Thrombocytopenia, lymphocytosis Constitutional B-Symptoms- Fatigue,Anorexia,Pruritus . Paraneoplastic Syndromes

20. Physical Examination Evaluate for: Hepatosplenomegaly Presence of Effusion Evidence of Neuropathy Signs of Obstruction ( Extremity edema, SVC syndrome , Spinal Cord Comp,Hollow viscera dysfunction)

21. Physical Examination Evaluate for: Lymph Node chains including Submental , Supraclavicular, infraclavicular , Infraclavicular , epitrochlear , iliac, femoral & popliteal nodes.

22. Physical Examination 1. Lymph nodes examination for: Size Multiplicity Consistency Tenderness

23. Physical Examination 2. Tonsils and Oropharynx Waldeyer’s ring involvement mandates complete evaluation of the nasopharynx, Oropharynx and Hypopharynx by endoscopy

24. Investigations 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

25. Investigations 1. Hematologic Tests Diagnostically Abnormal Circulating lymphoid cells or lymphocytosis Acute-Phase reactant Liver function tests

26. Investigations Renal F unction Tests Serum Uric Acid Hypercalcemia Serum Lactate Dehydrogenase Serum Immunoglobulins

27. Investigations 2. Biopsy Peripheral Node Biopsy Inguinal Lymph Nodes Biopsy Bone Marrow Biopsy Endoscopic Gastric Biopsy Trucut Biopsy of Retroperitoneal & Mesenteric masses

28. Investigations 3. Mediastinoscopy or Limited Thoracotomy 4. Laparotomy 5. Laparoscopy 6. Endoscopic Gastroscopy

29. Investigations 7. Evaluation of the Chest Chest Radiograph CT Scans Thoracocentesis and Pleural Biopsy

30. Investigations 8. Evaluation of the Abdomen and Retroperitoneum CT Scans Bipedal Lymphangiography Abdominal Ultrasonography

31. Investigations 9. Evaluation of the Gastrointestinal Tract Barium Enema Endoscopic Examination Biopsy of accessible abnormalities

32. Investigations 10. Evaluation of the CNS Spinal Fluid Examination CT MRI

33. Investigations 11. Nuclear Scans Positron Emission Tomography (PET) scan Gallium Scans

34. Treatment Surgery Radiotherapy Chemotherapy Combined Chemotherapy. Autologous stem cell transport

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