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    Lymphoma: David Lee MD, FRCPC

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    Marc Andrew
    This document provides an overview of lymphoma, including its classification, biology, epidemiology, clinical presentation, diagnosis, and staging. It discusses three important types of lymphoma - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is the most common indolent lymphoma, diffuse large B-cell lymphoma is the most common aggressive lymphoma, and Hodgkin lymphoma involves Reed-Sternberg cells in affected tissues.

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    Lymphoma: David Lee MD, FRCPC

    Uploaded by

    Marc Andrew
    22 views36 pages
    This document provides an overview of lymphoma, including its classification, biology, epidemiology, clinical presentation, diagnosis, and staging. It discusses three important types of lymphoma - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is the most common indolent lymphoma, diffuse large B-cell lymphoma is the most common aggressive lymphoma, and Hodgkin lymphoma involves Reed-Sternberg cells in affected tissues.

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    Loma (1)

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    This document provides an overview of lymphoma, including its classification, biology, epidemiology, clinical presentation, diagnosis, and staging. It discusses three important types of lymphoma - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is the most common indolent lymphoma, diffuse large B-cell lymphoma is the most common aggressive lymphoma, and Hodgkin lymphoma involves Reed-Sternberg cells in affected tissues.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    22 views36 pages

    Lymphoma: David Lee MD, FRCPC

    Uploaded by

    Marc Andrew
    This document provides an overview of lymphoma, including its classification, biology, epidemiology, clinical presentation, diagnosis, and staging. It discusses three important types of lymphoma - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is the most common indolent lymphoma, diffuse large B-cell lymphoma is the most common aggressive lymphoma, and Hodgkin lymphoma involves Reed-Sternberg cells in affected tissues.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 36

    Lymphoma

    David Lee MD, FRCPC

    Overview
    Concepts, classification, biology pidemiology Clinical presentation Diagnosis !taging "hree important types of lymphoma

    Concept#ali$ing lymphoma
    neoplasms of lymphoid origin, typically ca#sing lymphadenopathy le#%emia vs lymphoma lymphomas as clonal e&pansions of cells at certain developmental stages

    'LL

    CLL
    nave

    Lymphomas

    MM

    *+lymphocytes Plasma cells "+lymphocytes

    Lymphoid progenitor

    'ML
    (ematopoietic stem cell Myeloid progenitor

    Myeloproliferative disorders
    )e#trophils osinophils *asophils Monocytes Platelets Red cells

    *+cell development
    stem cell lymphoid progenitor progenitor+*

    CLL

    mat#re naive *+cell

    germinal center *+cell

    memory *+cell

    MM DLBCL, FL, HL

    ALL

    pre+* immat#re *+cell

    plasma cell

    Classification
    Biologically rational classification
    Diseases that have distinct morphology imm#nophenotype genetic feat#res clinical feat#res

    Clinically useful classification


    Diseases that have distinct clinical feat#res nat#ral history prognosis treatment

    Lymphoma classification
    ,-../ 0(O1
    *+cell neoplasms
    2 prec#rsor 2 mat#re
    )on+ (odg%in Lymphomas

    "+cell 3 )4+cell neoplasms


    2 prec#rsor 2 mat#re

    (odg%in lymphoma

    ' practical way to thin% of lymphoma


    Category Survival of untreated patients 6ears Curability To treat or not to treat

    )on+ (odg%in lymphoma

    5ndolent

    7enerally not c#rable C#rable in some C#rable in some C#rable in most

    Generally defer Rx if asymptomatic "reat

    'ggressive

    Months

    8ery aggressive (odg%in lymphoma 'll types

    0ee%s

    "reat

    8ariable 2 months to years

    "reat

    Mechanisms of lymphomagenesis
    7enetic alterations 5nfection 'ntigen stim#lation 5mm#nos#ppression

    pidemiology of lymphomas
    9th most fre:#ently diagnosed cancer in both se&es males ; females incidence
    2 )(L increasing 2 (odg%in lymphoma stable

    5ncidence of lymphomas in comparison with other cancers in Canada


    age ad>#sted incidence?/..,...?yr C. B. 9. A. @. -. /. . /<=9 /<<. /<<9 6ear
    )(L (odg%in lymphoma l#ng colorectal breast

    -...

    5ncidence?/..,...?ann#m /.. -. A. B. =. .

    'ge distrib#tion of new )(L cases in Canada

    'ge ,years1

    .+/ /+A 9+< /.+/A /9+/< -.+-A -9+-< @.+@A @9+@< A.+AA A9+A< 9.+9A 99+9< B.+BA B9+B< C.+CA C9+C< =.+=A =9D

    incidence?/..,...?ann#m . / @ A 9 B

    'ge distrib#tion of new (odg%in lymphoma cases in Canada

    'ge ,years1

    .+/ /+A 9+< /.+/A /9+/< -.+-A -9+-< @.+@A @9+@< A.+AA A9+A< 9.+9A 99+9< B.+BA B9+B< C.+CA C9+C< =.+=A =9D

    Ris% factors for )(L


    imm#nos#ppression or imm#nodeficiency connective tiss#e disease family history of lymphoma infectio#s agents ioni$ing radiation

    Clinical manifestations
    8ariable
    severityE asymptomatic to e&tremely ill time co#rseE evol#tion over wee%s, months, or years

    !ystemic manifestations
    fever, night sweats, weight loss, anore&ia, pr#ritis

    Local manifestations
    lymphadenopathy, splenomegaly most common any tiss#e potentially can be infiltrated

    Other complications of lymphoma


    bone marrow fail#re ,infiltration1 C)! infiltration imm#ne hemolysis or thrombocytopenia compression of str#ct#res ,eg spinal cord, #reters1 ple#ral?pericardial eff#sions, ascites

    Diagnosis re:#ires an ade:#ate biopsy


    Diagnosis sho#ld be biopsy+proven before treatment is initiated )eed eno#gh tiss#e to assess cells and architect#re
    2 open b& vs core needle b& vs F)'

    !taging of lymphoma
    !tage 5 !tage 55 !tage 555 !tage 58

    'E absence of * symptoms *E fever, night sweats, weight loss

    "hree common lymphomas


    Follic#lar lymphoma Diff#se large *+cell lymphoma (odg%in lymphoma

    Relative fre:#encies of different lymphomas


    )on+(odg%in Lymphomas

    Diff#se large *+cell (odg%in lymphoma )(L Follic#lar Other )(L


    F=9G of )(L are *+lineage

    Follic#lar lymphoma
    most common type of HindolentI lymphoma #s#ally widespread at presentation often asymptomatic not c#rable ,some e&ceptions1 associated with *CL+- gene rearrangement Jt,/AK/=1L cell of originE germinal center *+cell

    defer treatment if asymptomatic ,Hwatch+and+waitI1 several chemotherapy options if symptomatic median s#rvivalE years despite HindolentI label, morbidity and mortality can be considerable transformation to aggressive lymphoma can occ#r

    Diff#se large *+cell lymphoma


    most common type of HaggressiveI lymphoma #s#ally symptomatic e&tranodal involvement is common cell of originE germinal center *+cell treatment sho#ld be offered c#rable in F A.G

    (odg%in lymphoma

    "homas (odg%in ,/C<=+/=BB1

    Classical Hodgkin Lymphoma

    (odg%in lymphoma
    cell of originE germinal centre *+cell Reed+!ternberg cells ,or R! variants1 in the affected tiss#es most cells in affected lymph node are polyclonal reactive lymphoid cells, not neoplastic cells

    Reed+!ternberg cell

    R! cell and variants

    classic R! cell
    ,mi&ed cell#larity1

    lac#nar cell
    ,nod#lar sclerosis1

    popcorn cell
    ,lymphocyte predominance1

    ' possible model of pathogenesis


    transforming event,s1 EBV? loss of apoptosis

    cytokines germinal centre * cell R! cell

    inflammatory response

    (odg%in lymphoma (istologic s#btypes


    Classical (odg%in lymphoma
    2 nod#lar sclerosis ,most common s#btype1 2 mi&ed cell#larity 2 lymphocyte+rich 2 lymphocyte depleted

    pidemiology
    less fre:#ent than non+(odg%in lymphoma overall M;F pea% incidence in @rd decade

    'ssociated ,etiologicalM1 factors


    *8 infection smaller family si$e higher socio+economic stat#s ca#casian ; non+ca#casian possible genetic predisposition otherE (58M occ#pationM herbicidesM

    Clinical manifestationsE
    lymphadenopathy contig#o#s spread e&tranodal sites relatively #ncommon e&cept in advanced disease H*I symptoms

    "reatment and Prognosis


    Stage Treatment Failure free survival C.+=.G !verall " year survival =.+<.G

    5,55

    '*8D & A 3 radiation '*8D & B

    555,58

    B.+C.G

    C.+=.G

    Long term complications of treatment


    infertility
    2 MOPP ; '*8DK males ; females 2 sperm ban%ing sho#ld be disc#ssed 2 premat#re menopa#se

    secondary malignancy
    2 s%in, 'ML, l#ng, MD!, )(L, thyroid, breastNNN

    cardiac disease

    Overview
    Concepts, classification, biology pidemiology Clinical presentation Diagnosis !taging "hree important types of lymphoma

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