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Lymphomas

Lymphomas. Ismail M. Siala. Objectives:. The types of lymphoma. Clinical Presentation of lymphomas Diagnosis of lymphomas Investigations of lymphomas. Staging of lymphomas Treatment options of Lymphomas. Lymphomas. Definition Neoplasms of lymphoid tissues

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Lymphomas

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  1. Lymphomas Ismail M. Siala

  2. Objectives: The types of lymphoma. Clinical Presentation of lymphomas Diagnosis of lymphomas Investigations of lymphomas. Staging of lymphomas Treatment options of Lymphomas.

  3. Lymphomas Definition • Neoplasms of lymphoid tissues • Typically causes lymphadenopathy.

  4. Epidemiology of lymphomas • A common cancer 5th most frequently diagnosed cancer • Males >Females

  5. Classification of Lymphomas

  6. Lymph Node Bone Marrow Bx Other Tissue • Routine microscopic examination • Immunological examination

  7. Reed-Sternberg Cell Large malignant lymphoid cell Bi-nucleated B-cell origin Present in small numbers Surrounded by reactive T-cells, plasma cells and eosinophils.

  8. Reed Sternberg Cell The pathology report • Based on the pathological findings: • Hodgkin lymphoma • Non Hodgkin lymphoma Hodgkin Lymphoma Non-Hodgkin Lymphoma

  9. Hodgkin’s Lymphoma Thomas Hodgkin (1798-1866)

  10. Hodgkin Lymphoma All are B-Cells

  11. Hodgkin Lymphoma=Reed-Sternberg cell

  12. EpidemiologySex > : 1.5 1

  13. EpidemiologyAge • A bimodal peaks: the 3rd and the 6th decades. 20s >50s a bimodal age-incidence curve

  14. EpidemiologyAetiology • Unknown • Well-educated background • Small families. • Past history of infectious mononucleosis, no proven link to EB virus yet.

  15. Clinical FeaturesSymptoms

  16. Clinical Features of Hodgkin LymphomaSymptoms Painless Neck Swelling

  17. Large Mediastinal MassNodular Sclerosing disease Dry Cough Breathlessness

  18. Clinical Features of Hodgkin LymphomaSystemic Symptoms • Weight loss • Sweating • Itching • Fever

  19. Clinical FeaturesPhysical Signs

  20. Lymphadenopathy • Painless, Rubbery • Usually at neck and supraclavicularareas • 10% sub-diaphragmatic

  21. Sites of LN involvment in HL • Peripheral LN • Cervical, supraclavicular and axillary LN (70%) • Generalized lymphadenopathy is not typical in HL • Thorax • Anterior mediastinum in NS HL • Others, Rare: • Lung • Pleural effusion • Pericardial effusion • SVC obstruction • Abdomen • Hepatosplenomegaly. • Retroperitoneal LN.

  22. Differential Diagnosis of Lymph-adenopathy Infections Autoimmune disorders Haematological Lymphomas Leukemias AIDS Metastases Benign

  23. Hepatosplenomegaly Could be because of: • Disease infiltration. • Reactive ( no infiltration).

  24. Spread to other LN groups CONTIGUOUS SPREAD From one LN to the next.

  25. Extranodal Disease Rare Extranodal Disease: • Bone • Brain • Skin

  26. Investigations of HL

  27. Hodgkin lymphoma Treatment depends on: • Histological Subtype • Clinical Stage

  28. Investigations of HL Confirm the Diagnosis Histological Subtype Staging Hodgkin Lymphoma Blood Tests Radiology Other biopsies • Lymph Node Biopsy • Biopsy from other tissues

  29. Lymph Node BiopsyTaking the biopsy? Surgical excision Percutaneous needle biopsy under radiological guidance

  30. Hodgkin lymphoma - Histological subtypesThe WHO classification • Nodular lymphocyte predominant HL (5%) • Slow growing • Localized • Rarely Fatal • Classical Hodgkin lymphoma (95%) • nodular sclerosingyoung, F>M • mixed cellularity Elderly • lymphocyte-rich Men • lymphocyte depleted ?NHL

  31. Investigations of HL Confirm the Diagnosis Histological Subtype Staging Hodgkin Lymphoma Blood Tests Radiology Other biopsies • Lymph Node Biopsy • Biopsy from other tissues

  32. Blood Investigations

  33. Complete blood count • May be Normal • Normochromic, normocyticanaemia • Lymphopenia ( A bad sign) • Eosinophilia • Neutrophilia • ESR, may be raised

  34. Liver function tests • May be Normal • Abnormal • With infiltraion or without infiltraion • Obstructive pattern  enlarged LN at portahepatis. • Renal function tests, need to be normal before Rx. • Serum LDH • Reflect level of tumor bulk and turnover • Not of great significance in HL

  35. Blood Investigations Radiological Investigations

  36. Chest X-Ray

  37. Abdominal UltrasoundEvaluation of the abdomen and retroperitoneumLymph NodesLiver, Spleen, Kidneys

  38. CT-Scan of Chest, Abdomen and Pelvis

  39. Blood Investigations Radiological Investigations Bone Marrow Biopsy

  40. Bone Marrow biopsy • Indications • 1- Hodgkin Lymphoma when bone marrow involvement is suspected • abnormal full blood count • advanced stage of the disease. • 2-ALL cases of Non Hodgkin Lymphoma.

  41. Stage I Stage II Stage III Stage IV Staging of lymphomaAnn Arbor classification

  42. Bulky Disease • Mediastinal mass >⅓ of the maximum transverse diameter of the chest • Presence of nodal mass with a maximal dimension > 10cm

  43. LYMPHOMASTAGING “B” symptoms • Unexplained Fever > 38oC • Unexplained Weight loss > 10% body weight within the preceding 6 months. • Drenching night sweets • Stage A  No B symptoms • Stage B  any one of the B symptoms

  44. Stages of Lymphoma

  45. Management of Hodgkin Lymphoma

  46. HODGKIN`S LYMPHOMAMANAGEMENT INTENTION OF TREATMENT IS CURE With appropriate treatment: • 90% of Stage IA are cured • 70% of other stages are cured

  47. Hodgkin lymphoma Treatment depends on: • Histological Subtype • Clinical Stage

  48. Treatment of HL Stage I-II Stage III-IV Radiotherapy ONLY Chemotherapy (ABVD) 8 courses • Stage IA-IIA Nodular Lymphocyte Predominant HL Radiotherapy ONLY FOR: Chemotherapy (ABVD) 2-6 courses + Involved Field Radiotherapy (IFRT) 1- Bulky disease 2- Residual disease

  49. ABVD

  50. Long term complications of treatment • Infertility • sperm banking should be discussed • premature menopause • secondary malignancy • skin, AML, lung, MDS, NHL, thyroid, breast... • cardiac disease

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