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Malignant Lymphoma: 1. Diagnosis and Pathologic Classification

This document summarizes malignant lymphoma, which is characterized by the proliferation of lymphoid cells. It describes the two main types as Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by orderly spread and systemic symptoms, while non-Hodgkin's lymphoma is a heterogeneous group lacking the Reed-Sternberg cells of Hodgkin's. The document outlines classifications, signs and symptoms, diagnosis, staging, treatment approaches including chemotherapy regimens and radiation therapy, and prognosis for the different types and stages of lymphoma.

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44 views3 pages

Malignant Lymphoma: 1. Diagnosis and Pathologic Classification

This document summarizes malignant lymphoma, which is characterized by the proliferation of lymphoid cells. It describes the two main types as Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by orderly spread and systemic symptoms, while non-Hodgkin's lymphoma is a heterogeneous group lacking the Reed-Sternberg cells of Hodgkin's. The document outlines classifications, signs and symptoms, diagnosis, staging, treatment approaches including chemotherapy regimens and radiation therapy, and prognosis for the different types and stages of lymphoma.

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ohsnapitslei
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© © All Rights Reserved
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Malignant Lymphoma

Malignant Lymphoma-is a group of malignancies characterized by


the proliferation of cells native to the lymphoid tissues
A. Hodgkin's lymphoma is characterized by the orderly spread of
disease from one lymph node group to another and by the
development of systemic symptoms with advanced disease.
B. Non-Hodgkin's lymphoma a heterogeneous group of malignant
lymphomas, the only common feature being an absence of the
giant Reed-Sternberg cells characteristic of Hodgkin's disease.
Classifications
1. Hodgkin Lymphoma (HL)
- The cell of origin in HL is a B-cell

-Association between HL and Epstein-Barr Virus (EBV)
2. Non-Hodgkin Lymphoma (NHL)
- NHLs are a heterogenous group of diseases that represent a clonal
expansion of lymphoid cells
- Most common subtypes are diffuse large B-cell (30%) and follicular
lymphoma (20%)
Signs and Symptoms
Anorexia
Dyspnea
Fatigue
Fever of unknown origin
Lymphadenopathy
Night sweats
Itching
Weight loss
1. Diagnosis and Pathologic Classification
-The diagnosis of malignant lymphoma requires the presence of
malignant lymphocytes in a biopsy of lymph node or extra-lymphatic
tissue.
- An excisional lymph node biopsy is essential for complete diagnostic
assessment. If a whole lymph node is not obtainable, sufficient incised
tissue from an extra-lymphatic site can be diagnostic but is less
desirable.
-Fine needle aspiration biopsy is not sufficient for the initial diagnosis of
malignant lymphoma.

Grade B-cell T-cell
Indolent Small lymphocytic*
Lymphoplasmacytic**
Follicular, grade 1, 2 or 3
A
Mycoses fungoides
Marginal zone
MALT***
nodal
splenic

Aggressive Follicular, grade 3 B
Mantle cell
Diffuse large cell
+
, any
type
Burkitt-like (small
noncleaved cell)
Peripheral T cell, unspecified
Peripheral T-cell, specified
Angioimmunoblastic (AIL)
Nasal T/NK cell
Subcutaneous panniculitic
Enteropathy associated
Anaplastic large cell (CD30
positive) including null cell
Special Burkitt Lymphoblastic

2. Staging
Stage Involvement
1 Single lymph node region (1) or one extralymphatic site (1E).
2 Two or more lymph node regions, same side of the diaphragm
(2) or local extralymphatic extension plus one or more lymph
node regions same side of the diaphragm (2E)
3 Lymph node regions on both sides of diaphragm (3) which
may be accompanied by local extralymphatic extension (3E)
4 Diffuse involvement of one or more extralymphatic organs or
sites
Symptoms
A
=
no B symptoms
B = presence of at least one of these:
1) unexplained weight loss > 10% baseline during 6 months prior
to staging
2) unexplained fever > 38
o
C/font>
3) night sweats
Bulk
Bulky = any tumour diameter > 10 cm
Non bulky = all tumour diameters < 10 cm
For treatment planning purposes patients with malignant lymphoma
are divided into two groups by stage:
Limited Stage:
Stage 1 or
Stage 2 confined to 3 or fewer adjacent lymph node regions
No B symptoms and
Non-bulky tumour (<10 cm)
Advanced Stage:
Stage 2 with disease beyond 3 adjacent lymph node regions or
Stage 3 or 4 or
B symptoms or
Bulky tumour (> 10 cm)

Treatment
1. Hodgkin Lymphoma (HL)
a. Nodular Lymphocyte-Predominant HL:
- most present with early stage disease
-treated with involved-field radiation (IFRT) i.e. radiation to involved
nodal region only
- chemotherapy not indicated in early stage disease

b. Classic HL
Early stage, good prognostic features (Stage I-IIA)
-ABVD chemotherapy x 2 cycles + IFRT
- ABVD = adriamycin, bleomycin, vinblastine, dacarbazine
Advanced stage, poor prognostic features (Stage IB-IV)
- ABVD x 6-8 cycles
-radiotherapy (RT) to areas of bulky disease or to areas of partial
response after chemo


c. Recurrent/Resistant HL
-high dose chemotherapy and stem cell transplant + RT Prognosis of
Classic Hodgkins Disease
Stages I and IIA 5 year relapse-free survival is > 90%
Stages IIB and IIIA 5 year relapse-free survival between 75-85%
Stages IIIB and IV 5 year relapse-free survival is 30 to 50%

2. Non-Hodgkins Lymphoma (NHL)
a. Low Grade:
- Represent 30-40% of all lymphomas and most present as
advanced stage disease.
-Follicular lymphoma is most common.
- Clinical course is indolent.
- Spontaneous remissions and transformation into intermediate or
high grade lymphoma can occur.
-Limited stage (Stage I and IIA)
-Treatment with involved field radiation can result in long-term
disease free survival and potential cure.
-Advanced Stage Disease (Stages III and IV)
- Early treatment does not alter overall survival. Therefore,
asymptomatic patients are closely followed with no active
treatment.

b. Intermediate Grade
- 50% of these patients are potentially curable.
- Most common is large B-cell lymphoma.
-Limited stage (Stage I and IIA, non-bulky disease <10cms.)
- Treatment is with combination chemo and ritaxumab (a CD-20
targeted therapy) and radiation. CHOP-R x 3 cycles followed by
involved-field radiation (IFRT).
- CHOP-R = Cyclophosphamide, Adriamycin, Vincristine,
Prednisone, Rituximab Advanced Stage (Stage III and IV, bulky
disease, B-symptoms)
- Standard of care is Anthracycline based chemotherapy (CHOP to
complete remission + 2 extra cycles for a maximum of 8 cycles).
-Adjuvant radiation to sites of bulky disease or partial response
Refractory or relapsed disease
-High dose chemotherapy followed by stem cell transplant.

c. High Grade
-grow quickly and require urgent and aggressive chemotherapy
- treated similar to acute lymphoblastic leukemia (ALL)

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