Lymphoma
Non-Hodgkin Lymphoma (NHL):
- 85% derived from B-cell malignant transformation
- Usually develops in lymph nodes but can arise from any tissue
- More common in males
- 50% of cases occur in those >70 years
- Presentation: incidental mediastinal mass on CXR, painless peripheral lymphadenopathy, abdominal mass, nodular spleen, weight loss, night sweats, unexplained fevers
- Investigations: FBC (may be normal without marrow involvement), monospot
(especially if <30 with persistent symptoms to exclude EBV), ESR (usually raised)
- Initial management: urgent oncology referral if unexplained lymphadenopathy, nodes >2cm/increasing size, widespread lymphadenopathy +/- weight loss/night sweats/splenomegaly
- Specialist treatments: watch and wait (low grade), chemotherapy, radiotherapy, stem cell transplants, monoclonal antibodies +/- immunotherapy
Common NHL Types:
High Grade:
- Diffuse large B-cell (48% of NHL): median age 70, rapid lymphadenopathy, possible marrow involvement
- Anaplastic large cell: affects children/adults, more common in females, reddishbrown skin nodules/ulcerations
- Burkitt’s lymphoma: 30-40% of childhood lymphomas, more common in males o Endemic: African, EBV-associated, peak age 5-10 o Sporadic: worldwide, affects children/adults
Low Grade:
- Follicular (19% of NHL): adults, mean age 65, can transform to diffuse large B-cell
- Small lymphocytic: similar to CLL, distinguished by lymph tissue vs blood/marrow involvement
- Mantle cell
- Marginal zone (B-cell origin):
o Types: extranodal, splenic, MALT o Associations: H.pylori (gastric MALT), Hashimoto’s thyroiditis (thyroid MALT)
- Lymphoplasmacytic: B-cell lymphoma, which can spread to the lung/GI tract, associated with IgM paraproteinemia
Hodgkin Lymphoma:
- Peak age 15-35, second peak 65-85
- Derived from B lymphocytes
- Types: Classical (95%, Reed-Sternberg cells), Nodular lymphocyte predominant (5%, popcorn cells)
- Presentation: painless lymphadenopathy (70-95% cervical nodes, usually on the left), weight loss, night sweats, unexplained fevers, pruritus, splenomegaly (30% cases) Ann Arbor staging: Stage 1-2 (90% survival), Stage 3-4 (75-90% survival)