Lymphoma

Anatomyhistology of lymph nodes
1. Kidney shaped encapsulated bodies
2. Located along the lymphatic vessels
3. Histologic parts
  1. Cortex
    1. Contains lymphoid follicles
    2. B cells
    3. Receive lymph from afferent vessels
  2. Medulla
    1. Plasma cells
    2. Medullary sinuses
      1. Drain lymph into efferent vessels
      2. Macrophages
  3. Parasortex
    1. T cells
Risk factors/Causes
1. Viruses
  1. EBV
  2. HIV
  3. HHV-8
2. Weakened immune system
  1. Genetic condition
  2. Immunosuppressants
    1. Cyclosporine
3. Age
  1. Young adults (15-25 yrs)
  2. Elderly >55 yrs
4. Family history
  1. Genetic mutations/chromosomal abnormalities
5. Exposure to radiation
Investigations
1. CBC
  1. Anemia, thrombocytopenia, leukopenia, lymphocytosis
2. Peripheral blood smear
  1. Atypical cells
3. Chemistry panel
  1. Exclude
    1. Tumor lysis syndrome
    2. Ureteral obstruction by retroperitoneal lymphadenopathy
4. Serology for infectious disease
  1. HBV, HIV, etc.
5. ANA antibody
  1. +SLE is associated with increased risk of death
6. Hemoccult bleeding
  1. Exclude GI bleeding and anemia
7. Chest X-ray
  1. Hilar or mediastinal adenopathy
8. Immunohistochemistry and flow cytometry
  1. Check for immunophenotype expression
9. CT scan
  1. Evaluate enlarged lymph nodes
10. Bone marrow aspiration
11. LDH and B2-microglobulin
  1. Prognostic factors
  2. Elevated LDH
    1. High tumor burden
Classification
1. Hodgkin's lymphoma
  1. Classical
    1. Nodular sclerosis
      1. CD15+/CD30+
      2. Fibrous bands that divide areas into nodules
      3. Lacunar cells
        Variant of RS cells
        Cells contained within a lacuna
    2. Mixed cellularity
    3. Lymphocyte-rich
    4. Lymphocyte-depleted
  2. Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)
    1. CD15-/CD30-
    2. L&H cells (Popcorn cells)
      1. Multilobulated nucleus
  3. Histologic features of affected lymph nodes
    1. Reed Sternberg cells (RS cells)
      1. Large multinucleated lymphocytes
      2. Owl eye appearance
    2. Polymorphous cellular background
2. Non-hogkin's lymphoma
  1. Aggressive (high grade)
    1. Diffuse large B-cell lymphoma
      1. Genetic cause
        Translocation or mutation in BCL6 gene
        Chromosome 3
        t(14;18) with rearrangement of BCL2 (10%)
        MYC oncogene activation (5%)
      2. Environmental exposure
        Infectiouns (EBV/HIV/HHV-8)
    2. Anaplastic large-cell lymphoma
    3. Burkitt lymphoma
    4. Mantle cell lymphoma
  2. Indolent (low grade)
    1. Follicular lymphoma
    2. Cutaneous T-cell lymphoma
    3. Lymphoplasmacytic lymphoma
    4. Marginal zone B-cell lymphoma
Staging
1. Grade I
  1. Only one group of lymph nodes affected anywhere in the body
2. Grade II
  1. Two or more groups of lymph nodes affected, all on the same side of the diaphragm (either above or below)
3. Grade III
  1. Lymph nodes affected on both sides of the diaphragm
4. Grade IV
  1. Spread to at least one body organ outside the lymphatic system
Management
1. Chemotherapy
  1. ABVD
    1. Doxorubicin (Adriamycin)
    2. Bleomycin
    3. Vinblastine
    4. Dacarbazine
  2. Stanford V
    1. Doxorubicin + Vinblastine + Mechlorethamine + Etoposide + Vincristine + Bleomycin+ Prednisone
  3. BEACOPP
    1. Bleomycin + Etoposide + Adriamycin + Cyclophosphamide + Vincristine (Oncovin) + Procarbazine + Prednisone
2. Radiation therapy
  1. Total nodal
  2. Regional nodal
  3. Involved field
  4. Involved site

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Lymphoma

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