LYMPHOMAS:

Hodgkin & Non Hodgkin

Dr. Sookun Rajeev K

(MD)
Dept of General Medicine
Anna Medical College
Introduction
 Introduction
Lymphoma originates in
Lymphocytes.
Lymphocytes a type of WBC in the
vertebrate immune system.
Lymphomas are part of the broad
group of diseases called
Hematological Neoplasms
 Definition
LYMPHOMA is basically solid tumours
of the lymphoreticular system

Histologically 2 main types:

1. Hodgkin’s disease, characterised by
the presence of multinucleated giant
cells (Reed–Sternberg cells); and
2. Non-Hodgkin’s lymphoma
Pathophysiology Hodgkin’s Lymphoma
The disease is characterised by the
presence of Reed-Sternberg cells.
Spreading in an orderly fashion to
contagious lymph nodes
The cure rate is about 93%, making
it one of the most curable form of
cancer
 Red-Sternberg cells
Cells with mirror image nuclei and prominent,
eosinophilic, inclusion-like nuclei.
 RS Cell variants

lacunar cell
(mixed cellularity) (nodular sclerosis) (lymphocyte
predominance)
7
 Epidemiology
Most frequently (Bimodal)occur in
age group 15 to 35 and >50 yrs
More common in males except
Nodular Sclerosis which is more
common in females
Increase incidence in HIV
infections.
 Staging Classification
Stage Definition

I Involvement of a single lymph node region or

structure (e.g., spleen)
II Involvement of two or more lymph node regions on
the same side of the diaphragm
III Involvement of lymph node regions or structures on
both sides of the diaphragm
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
 Staging Classification
Stage Definition

A No symptoms

B Unexplained weight loss 10% of body weight in last 6 months

Unexplained fever 38°C in the previous month Recurrent
drenching night sweats in the previous month
X Bulky disease: 10 cm maximal diameter of a nodal mass,
mediastinal mass 1/3 chest diameter

E Localized solitary involvement of extralymphatic tissue except

liver and bone marrow: if this is the only site of disease, it is
stage IE
By limited direct extension from a known nodal site Single-
discrete site proximal to a regional involved nodal site (IIE)
 Staging of Lymphoma
Stage I Stage II Stage III Stage IV

A: absence of B symptoms
B: fever, night sweats, weight loss
 Risk Factors Hodgkin
• Family History
• Environmental – wood workers,
farmers, meat workers
• Diseases- Mononucleosis (EBV
infection), AIDS, Bone marrow
transplant.
 Signs & Symptoms Hodgkin
1. Painless Lymphadenopathy –
involving superficial lymph nodes
of cervical and supraclavicular
nodes)
• The lymph nodes are swollen and
have a rubbery feeling.
 Signs & Symptoms Hodgkin
2. Systemic Symptoms
a) Fevers, Night Sweats and
Weight Loss
b) Pruritus
c) Pel-Ebstein Fever
 Signs & Symptoms Hodgkin
3. Pain
a) Alcohol – induced pain
b) Abdominal Pain
c) Bone Pain
d) Neurogenic Pain
e) Back Pain
 Non Hodgkin
The neoplastic transformation of either
B or T cell lineages of lymphatic cells.
NHL causes the accumulation of
neoplastic cells in both the lymph
nodes as well as more often diffusely
in extralymphatic organs and the
bloodstream.
Absent Reed-Sternberg cells.
 Risk Factors Non Hodgkin
i. Diseases- Infections
(HIV,EBV,HepC V,H.Pylori),
RA, SLE, Sjogren’s
syndrome, mixed
Cryoglubulinemia, IBD,
Inherited immune defects
ii. Age > 60
 Symptoms Non Hodgkin
1. Mass Effect – Lymphadenopathy
(occipital,Posterior auricular,
preauricular, mandibular, submental,
cervical, supra & infraclavicular,
Waldeyer’s ring, Axillary, inguinal,
Popliteal, Hepatosplenimegaly,
mediastinal,Abdominal,Pelvic,testicular,
CNS masses.
 Symptoms Non Hodgkin
2. Hematologic – Anemia,
Thrombocytopenia,
lymphocytosis
3. Constitutional B-Symptoms-
Fatigue,Anorexia,Pruritus.
4. Paraneoplastic Syndromes
 Physical Examination
Evaluate for:
Hepatosplenomegaly
Presence of Effusion
Evidence of Neuropathy
Signs of Obstruction (Extremity
edema, SVC syndrome, Spinal Cord
Comp,Hollow viscera dysfunction)
 Physical Examination
Evaluate for:
Lymph Node chains including
Submental, Supraclavicular,
infraclavicular, Infraclavicular,
epitrochlear, iliac, femoral &
popliteal nodes.
 Physical Examination
1. Lymph nodes examination for:
i. Size
ii. Multiplicity
iii. Consistency
iv. Tenderness
 Physical Examination
2. Tonsils and Oropharynx
Waldeyer’s ring involvement
mandates complete evaluation
of the nasopharynx,
Oropharynx and Hypopharynx
by endoscopy
 Investigations
1. Hematologic Tests (Basics)
FBC, Peripheral smear,
Electrolytes, Urea, Creatinine,
AST,ALT, ALP, Bilirubin,
Ca,LDH,ESR, Albumin,Serum
protein electrophoresis, HepC
V,HepB V,HIV
 Investigations
1. Hematologic Tests
i. Diagnostically Abnormal
Circulating lymphoid cells or
lymphocytosis
ii. Acute-Phase reactant
iii. Liver function tests
 Investigations
iv. Renal Function Tests
v. Serum Uric Acid
vi. Hypercalcemia
vii. Serum Lactate
Dehydrogenase
viii.Serum Immunoglobulins
 Investigations
2. Biopsy
i. Peripheral Node Biopsy
ii. Inguinal Lymph Nodes Biopsy
iii. Bone Marrow Biopsy
iv. Endoscopic Gastric Biopsy
v. Trucut Biopsy of Retroperitoneal
& Mesenteric masses
 Investigations
3. Mediastinoscopy or Limited
Thoracotomy
4. Laparotomy
5. Laparoscopy
6. Endoscopic Gastroscopy
 Investigations
7. Evaluation of the Chest
i. Chest Radiograph
ii. CT Scans
iii. Thoracocentesis and Pleural
Biopsy
 Investigations
8. Evaluation of the Abdomen
and Retroperitoneum
i. CT Scans
ii. Bipedal Lymphangiography
iii. Abdominal Ultrasonography
 Investigations
9. Evaluation of the
Gastrointestinal Tract
i. Barium Enema
ii. Endoscopic Examination
iii. Biopsy of accessible
abnormalities
 Investigations
10. Evaluation of the CNS
i. Spinal Fluid Examination
ii. CT
iii. MRI
 Investigations
11. Nuclear Scans
i. Positron Emission
Tomography (PET) scan
ii. Gallium Scans
 Treatment
i. Surgery
ii. Radiotherapy
iii. Chemotherapy
iv. Combined Chemotherapy.
v. Autologous stem cell
transport