7/30/2019 2.3.3. Lymphoma

1/18

Lymphoma

EXPERT LECTURE

FACULTY OF MEDICINE

UNIVERSITY OF BRAWIJAYA MALANG

7/30/2019 2.3.3. Lymphoma

2/18

Lymphoma

The incidence of Hodgkin's disease appears fairlystable, with ~7800 new cases diagnosed in 2004 inthe United States.

Hodgkin's disease is more common in whites than inblacks and more common in males than in femal

Incidence

Superficial lymphadenopathy with cervicalnodes

Fever and drenching night sweats

ClinicalFeatures

Eestablished by review of an adequatebiopsy specimen and depends on findingmultinucleated Reed-Sternberg (RS) cell

Diagnosis

7/30/2019 2.3.3. Lymphoma

3/18

Reed-sternberg cell(Owls eyes)

7/30/2019 2.3.3. Lymphoma

4/18

Fig. The right cervical and axillar lymphadenopathy

7/30/2019 2.3.3. Lymphoma

5/18

Non Hodgkin

Lymphoma

Most NHLs are neoplasm of B-lymphocyte originwith characteristic cell membrance surfacemarkers. NHL are more frequent in the elderly and morefrequent in men.

Incidence

Superficial lymphadenopathy, with cervicalnodes being most common

Fever, weight loss and night sweats

ClinicalFeatures

Lactate dehydrogenase (LDH)2-microglobulinUric acidCreatinine

LaboratoryFeatures

7/30/2019 2.3.3. Lymphoma

6/18

Non Hodgkin Lymphoma

The diagnosis of NHL requires adequate tissueand experienced hematopathologist. Most often,

it is necessary to perform biopsies of peripherallymph nodes rather than rely on needleaspirates because the architecture of the tissueis important to the classification of NHL.

Diagnosis

7/30/2019 2.3.3. Lymphoma

7/18

1.Describe histologic classification of Hodgkins

disease !

2.Describe in brief The Ann Arbor Staging System for

Hodgkins Disease !

3.Describe clinical features and laboratory findings todiagnose Hodgkins disease !

4.Describe in brief the treatment of Hodgkins disease !

5.Describe etiology of non-Hodgkins lymphoma !

6.Describe clinical features and laboratory findings to

diagnose non-Hodgkins lymphoma !7.Describe in brief The International Prognostic Index

for non-Hodgkins lymphoma !

MODULE TASK

7/30/2019 2.3.3. Lymphoma

8/18

Question 1.

Describe histologic classification of Hodgkins

disease !

7/30/2019 2.3.3. Lymphoma

9/18

1. Lymphocyte-predominat HD limited disease (stage I or II) in the neck

2. Nodular sclerosis HD : the most common subtype,

associated with mediastinal mass & hilar

lymphadenopathy in addition to disease in the neck3. Mixed cellularity HD

4. Lymphocyte-depleted HD

The mixed cellularity HD & lymphocyte-depleted HD aremore common in constitusional symptom and advace

disease.

Histologic classification

7/30/2019 2.3.3. Lymphoma

10/18

Question 2.

Describe in brief The Ann Arbor Staging

System for Hodgkins Disease!

7/30/2019 2.3.3. Lymphoma

11/18

Stage Definition

I Involvement of a single lymph node region or lymphoid structure (e.g., spleen,

thymus, Waldeyer's ring)

II Involvement of two or more lymph node regions on the same side of the diaphragm

(the mediastinum is a single site; hilar lymph nodes should be considered

lateralized and, when involved on both sides, constitute stage II disease)

III Involvement of lymph node regions or lymphoid structures on both sides of the

diaphragm

III1 Subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes,or portal nodes

III2 Subdiaphragmatic involvement includes paraaortic, iliac, or mesenteric nodes plus

structures in III1

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

A No symptoms

B Unexplained weight loss of >10% of the body weight during the 6 months before

staging investigation

Unexplained, persistent, or recurrent fever with temperatures >38C during the

previous month

Recurrent drenching night sweats during the previous month

E Localized, solitary involvement of extralymphatic tissue, excluding liver and bone

marrow

Table 1. The Ann Arbor Staging System for Hodgkins Disease

7/30/2019 2.3.3. Lymphoma

12/18

Question 3.

Describe clinical features and laboratory

findings to diagnose Hodgkins disease !

7/30/2019 2.3.3. Lymphoma

13/18

CLINICAL FEATURES

Superficial lymphadenopathy with cervical nodesUsually begins in the neck and spreads to adjacent lymph nodes

with occasional spread to nonlymphoid structure e.g. the

mediastinum into the lung

The lymph nodes are usualy nontender and firm or rubbery

Fever (>38o C), drenching night sweats and/or weight loss of> 10% of usual weight a poor prognosis

Pruritus and alcohol-induced pain in areas of disease involment

LABORATORY FINDINGS

In the peripheral blood : anemia, neutrophilia, eosinophilia,

monocytosis, lymphocytopenia, and trombocytosis or

thrombocytopenia

Liver function test may be abnormal, the LDH may be elevated

Hodgkins Disease

7/30/2019 2.3.3. Lymphoma

14/18

DIAGNOSIS

Biopsy specimen : multinucleated Reed-Sternberg (RS) cellsRS cells or their variants are usually large cells with 2 nuclei,

each with a prominent nucleolus that sometime give it an owls

eyes appearance (Figure 1).

FNA is inadequate for initial diagnosis

Determination of an accurate anatomic stage is an importantpart of the evaluation. The staging system is the Ann Arbor

staging system originally developed for Hodgkin disease

Hodgkins Disease..(contd)

7/30/2019 2.3.3. Lymphoma

15/18

Question 4.

Describe in brief the treatment of Hodgkins

disease !

7/30/2019 2.3.3. Lymphoma

16/18

Localized Hodgkin's disease are cured >90%

Extended field radiotherapy in patients with goodprognostic

factors a high cure rate

Chemotherapy initial therapy in all stages of Hodgkin's

disease

Combination chemotherapy and radiotherapy

Relapse after primary therapy of Hodgkin's disease can

frequently still be cured.

Autologous bone marrow transplantation can cure half of

patients who fail effective chemotherapy regimens

Treatment of Hodgkins Disease

7/30/2019 2.3.3. Lymphoma

17/18

Question 5.

Describe histologic classification of Hodgkins

disease !

7/30/2019 2.3.3. Lymphoma

18/18