by
Prof.Dr Shaza Abdel Wahab
Clinical case :
A 30 years old man referred for evaluation of p
ainless cervical and axillary lymph nodes enlar
gement with fever ,sweating and loss of weight
. O/E : hepatosplenomegaly was elicited .
What is the possible diagnosis ?
Lymphomas :
Clonal disease arises from malignant transformation of
mature and immature lymphocytes (B,T,and NK natural
killer cells .
It comprises 30 subtypes according to the WHO classi
fication.
Broadly can be classified into Hodgkin and Non
Hodgkin lymphoma .
Risk factors :
1-EBV
2-HIV: predisposes to EBV associated HL
WHO classification of HL :
I Classic Hodgkin Lymphoma (cHL) :
Nodular sclerosis
Mixed cellularity
Lymphocyte rich
Lymphocyte deplete
Clinical features :
typical presents with painless lymph node enla
rgement starts in 1 group and spread in a conti
guous pattern .
o The cervical lymph node commonly involved.
Diagnosis :
I Clinical features above
II-diagnostic testing :
1- excisional LN biopsy with morphological ,immunohistochemical staining to
differentiate cHL from NLPHL.
2-BM examination is essential for staging
3-Complete Blood picture with differential and
ESR and S.uric acid ,LDH and albumin level.
Treatment :
Early HL ( stage Ia, IIa )
Advanced HL (stage I b ,IIb ,stage III and IV )
or bulky disease.
Early stages have a good prognosis and surviv
al with combined chemo-radiotherapy.
Advanced disease : chemotherapy (ABVD)
6 cycles radiotherapy for bulky disease.
Relapsed HL :
o Stage I or localized relapse radiotherapy
o Advanced relapse intensive high dose salvage che
motherapy followed by ASCT.
NLPHL :
a distinct type of HL behaves as indolent B Lympho
ma.
Treatment of stage Iradiotherapy or rituximab
For advanced disease chemotherapy.
Classifications :
I. The WHO classifications subdivide NHL bas
ed on morphological,immunophenotyping
genetic and clinical features.
II. The subtypes are generally divided into precu
rsor lymphoid neoplasms , mature B neoplas
m ,mature T and NK neoplasm based on their
resemblance to normal stage of maturation .
Clinical picture :
1) Painless lymphadenopathy
2) B-symptoms
3) Extranodal involvement in bone marrow ,skin
GIT,tests ,liver ,spleen,involvement of Waldy
ers ring and CNS involvement .
Diagnosis :
Lab: CBC if BM involved cytopenia
complete metabolic profile as s.uric acid,
s.K ,Ca ,ph and s.LDH.
Imaging : CT-scan neck ,chest and abdomen
for staging .
PET/CT-scan for monitoring disease
response.
LN biopsy : with morphology and immunohistochemistry.
Treatment Overview :
Depends on stage and grade (type ) of NHL.
In indolent lymphoma and aggressive lympho
ma ,limited stage combined modality RT(ra
diotherapy +chemotherapy ).
Advanced stage indolent lymphoma (asympt
omatic ) wait and watch . For symptomatic
chemotherapy.