{"id":5478,"date":"2021-05-17T21:14:34","date_gmt":"2021-05-17T19:14:34","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/hematological-oncology\/lymphomas\/"},"modified":"2021-05-22T00:37:41","modified_gmt":"2021-05-21T22:37:41","slug":"lymphomas","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/lymphomas\/","title":{"rendered":"Lymphomas"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Lymphomas are a large group of blood cancers in which there is a malignant proliferation of lymphoid-derived cells within extramedullary lymphatic and extralymphatic tissues.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>They generally create swellings, hence the \u201coma\u201d in lymphoma.<\/li><li>Compared to leukemias (where cells are in the bone marrow and blood), lymphomas are found in lymphatic and extra-lymphatic tissues with a relatively scarce appearance of malignant cells in the circulation.<\/li><li>Generally classified into <strong>Hodgkin&#8217;s <\/strong>and <strong>Non-Hodkin&#8217;s lymphomas<\/strong>.<\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Non-Hodkin&#8217;s lymphomas<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Generally, NHLs are divided into <strong>indolent<\/strong> (slow-growing but incurable) and <strong>aggressive<\/strong> (rapidly-growing but curable).<\/li><li>Waldeyer&#8217;s tonsillary ring and diffuse lymphadenopathy, as well as extra lymphatic involvement (bone marrow, liver, GI, skin, brain, testis), are common.<\/li><li>Associated with a variety of infections (EBV, HHV8, HTLV1, HIV).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Cells<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">85% are B-cell tumors; 15% are T and NK.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-74dcb7af-fa18-4c5c-88bf-1a48e0e31433\"><li>B-cell lymphomas can be divided into those resembling precursor B cells, those which resemble germinal center (GC) cells, or post-GC cells.<\/li><li>T-cell lymphomas resemble precursor T cells in the bone marrow and thymus or peripheral mature T cells.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification systems<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Historically:<ul><li>Rappaport NHL classification (1966): divided by morphology &#8211; nodular or diffuse, and the cell types.<\/li><li>Kiel classification (1974): based on cell morphology and the surrounding cells.<\/li><li>Working formulation classification (1982): divided by aggressiveness into low, intermediate, and high-grade.<\/li><li>REAL classification (1994): divided based on immunophenotyping and genetics.<\/li><\/ul><\/li><li><strong>Current WHO classification (2016)<\/strong><ul><li><strong>B-cell neoplasms<\/strong><ul><li>Precursor B-cell neoplasms<\/li><li>Mature B-cell neoplasms<\/li><\/ul><\/li><li><strong>T-cell and NK-cell neoplasms<\/strong><ul><li>Precursor T-cell neoplasms<\/li><li>Mature T-cell and NK-cell<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Clinical presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>&#8220;B-symptoms&#8221;: fever, night sweats, weight loss (more common in NHL than HL)<\/li><li>Anemia, purpura, bleeding, and recurrent infections in bone marrow involvement<\/li><li>Sore throat in Waldeyer&#8217;s tonsillary ring involvement<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>History and present complaints (&#8220;B symptoms&#8221;)<\/li><li>CBC (anemia, thrombocytopenia, and leukocytopenia and bone marrow involvement)<\/li><li>Blood smear (&#8220;lymphoma cells&#8221; = blast cells)<\/li><li>Biopsy: core\/open<\/li><li>Cytology: <strong>ONLY <\/strong>in case of relapse to differentiate between solid tumor<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Differential diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Reactive lymphadenopathy:<\/strong> viral infections (EBV), tuberculosis, toxoplasmosis, autoimmune diseases, tumor-draining node; generally, the lymph nodes are painful (due to the rapid expansion, compared to the slow expansion in malignancies).<\/li><li><strong>Metastasis: <\/strong>secondary to carcinoma, melanoma, or sarcoma.<\/li><li>Hodgkin&#8217;s lymphoma<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Biopsy and investigations of the expression of either \u03ba or \u03bb light chains confirms clonality and distinguishes the disease from a reactive node.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Staging<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">The stage can be determined based on physical, radiological, and nuclear investigations (PET-CT), based on the metabolism (SUVmax) and size (Dmax).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>Lugano staging classification<\/strong> based on the older <strong>Ann Arbor classification<\/strong> (the same system used for HL) is the lymphoma staging system that is most commonly used in clinical practice currently, ranging from stage I to IV.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Prognosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">The ECOG performance status is an scoring system that quantifies patient&#8217;s general well-being and activities of daily life; it ranges from 0 (no symptoms) to 5 (fatal).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other scores:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>IPI<\/li><li>FLIPI (follicular lymphoma)<\/li><li>MIPI (mantle cell)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\">Depending on the aggressiveness and stage, the goal of the treatment can either <strong>curative<\/strong>, <strong>effective control<\/strong>, <strong>minimal toxicity<\/strong>, <strong>palliative care<\/strong>, or <strong>watchful waiting<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Examples for common protocols are included below; the exact treatment for each lymphoma type is discussed in the appropriate article.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>R (rituximab)<\/li><li>CHOP (cyclophosphamide, adariblastine, vincristine, prednisolone)<\/li><li>CVP (cyclophosphamide, vincristine, prednisolone)<\/li><li>DHAP (dexamethasone, high dose Ara-C, cisplatin)<\/li><li>ICE (Ifosfamide, carboplatin, etopozide + MESNA)<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Non-Hodkin&#8217;s lymphomas<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Cells<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification systems<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Clinical presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Differential diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Staging<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Prognosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Lymphomas are a large group of blood cancers in which there is a malignant proliferation of lymphoid-derived cells within extramedullary lymphatic and extralymphatic tissues. They generally create swellings, hence the \u201coma\u201d in lymphoma. Compared to leukemias (where cells are in the bone marrow and blood), lymphomas are found in lymphatic and extra-lymphatic tissues with a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5331,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5478","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lymphomas &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/lymphomas\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/lymphomas\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/lymphomas\\\/\",\"name\":\"Lymphomas &#8211; 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