Lymphoma

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Lymphoma
Lymphoma ExEx.jpg
Lymph node: Malignant Lymphoma Large Cell Type: Gross natural color excellent view of cut mesentery showing massively enlarged mesenteric nodes with focal hemorrhages case diagnosed several years ago as reticulum cell sarcoma excellent demonstration of nodes with lymphoma.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Lymphoma Main Page

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Patient Information

Overview

Classification

Non-Hodgkin lymphoma
Hodgkin lymphoma

Differentiating Lymphoma from other Diseases

Epidemiology and Demographics

Case Studies

Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ross Bonander, Aditya Ganti M.B.B.S. [2]

Overview

Lymphoma is a type of cancer that originates in lymphocytes (a type of white blood cell in the vertebrate immune system). There are many types of lymphoma. Lymphomas are part of the broad group of diseases called hematological neoplasms. In the 19th and 20th centuries the affliction was called Hodgkin's Disease, as it was discovered by Thomas Hodgkin in 1832. Colloquially, lymphoma is broadly categorized as Hodgkin's lymphoma and non-Hodgkin lymphoma (all other types of lymphoma). Scientific classification of the types of lymphoma is more detailed. Although older classifications referred to histiocytic lymphomas, these are recognized in newer classifications as of B, T or NK cell lineage. Histiocytic malignancies are rare and are classified as sarcomas.[1]

Classification

 
 
 
 
 
 
 
 
 
 
 
 
Lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Hodgkin lymphoma
 
 
 
 
 
 
 
 
 
 
 
Hodgkin's Lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Classical
 
Nodular sclerosis
 
Lymphocyte rich
 
Mixed cellularity
 
Lymphocyte depleted
 
Nodular lymphocyte
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B-cell Lymphoma
 
 
 
 
 
 
 
T cell Lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Precursor B cell
 
 
 
 
 
Peripheral B cell
 
 
Precursor B cell
 
 
 
 
 
Peripheral B cell
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute Lymphobalstic lymphoma
 
 
 
 
 
Small Lymphocytic lymphoma (SLL)
Chronic lymphocytic leukemia
Mantle cell lymphoma
Follicular Lymphoma
Marginal zone lymphoma
Diffuse large B cell lymphoma
Burkitt lymphoma
 
 
Acute Lymphobalstic lymphoma
 
 
 
 
 
Anaplastic large cell T lymphoma
Peripheral T cell lymphoma
Mycosis fungoidies
 
 
 

Differentiating Lymphoma From Other Diseases

Differentiating diagnosis of Lymphoma Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings
Lymphoma Increase ESR, increased LDH Night sweats, constant fatigue
Brucellosis Relative lymphocytosis Night sweats, often with characteristic smell, likened to wet hay
Typhoid fever Decreased hemoglobin Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F)
Malaria Microcytosis,

elevated LDH

"Tertian" fever: paroxysms occur every second day
Tuberculosis Mild normocytic anemiahyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Mumps Relative lymphocytosis, serum amylaseelevated Parotidswelling/tenderness
Rheumatoid arthritis ESR and CRP elevated, positive rheumatoid factor Morning stiffness
SLE ESR and CRP elevated, positive ANA Fatigue
HIV Constant fatigue

CNS lymphoma must be differentiated from other causes of seizures, headache, and fever in immunocompromised patients such as disseminated tuberculosis and disseminated aspergillosis.

Disease Differentiating signs and symptoms Differentiating tests
CNS lymphoma[2]
Disseminated tuberculosis[3]
Aspergillosis[4]
Cryptococcosis
Chagas disease[5]
CMV infection[6]
HSV infection[7]
Varicella Zoster infection[8]
Brain abscess[9][10]
Progressive multifocal leukoencephalopathy[11]
  • Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms

Epidemiology and Demographics

  • According to the U.S. National Institutes of Health, lymphomas account for about five percent of all cases of cancer in the United States.
  • Hodgkin's lymphoma in particular accounts for less than one percent of all cases of cancer in the United States

References

  1. Pathology and Genetics of Haemo (World Health Organization Classification of Tumours S.). Oxford Univ Pr. ISBN 92-832-2411-6. 
  2. Gerstner ER, Batchelor TT (2010). "Primary central nervous system lymphoma". Arch. Neurol. 67 (3): 291–7. PMID 20212226. doi:10.1001/archneurol.2010.3. 
  3. von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K (2011). "Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality". Int. J. Tuberc. Lung Dis. 15 (8): 1087–92. PMID 21740673. doi:10.5588/ijtld.10.0517. 
  4. Latgé JP (1999). "Aspergillus fumigatus and aspergillosis". Clin. Microbiol. Rev. 12 (2): 310–50. PMC 88920Freely accessible. PMID 10194462. 
  5. Rassi A, Rassi A, Marin-Neto JA (2010). "Chagas disease". Lancet. 375 (9723): 1388–402. PMID 20399979. doi:10.1016/S0140-6736(10)60061-X. 
  6. Emery VC (2001). "Investigation of CMV disease in immunocompromised patients". J. Clin. Pathol. 54 (2): 84–8. PMC 1731357Freely accessible. PMID 11215290. 
  7. Bustamante CI, Wade JC (1991). "Herpes simplex virus infection in the immunocompromised cancer patient". J. Clin. Oncol. 9 (10): 1903–15. PMID 1919640. doi:10.1200/JCO.1991.9.10.1903. 
  8. Hambleton S (2005). "Chickenpox". Curr. Opin. Infect. Dis. 18 (3): 235–40. PMID 15864101. 
  9. Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR (2013). "Brain abscess: Current management". J Neurosci Rural Pract. 4 (Suppl 1): S67–81. PMC 3808066Freely accessible. PMID 24174804. doi:10.4103/0976-3147.116472. 
  10. Patel K, Clifford DB (2014). "Bacterial brain abscess". Neurohospitalist. 4 (4): 196–204. PMC 4212419Freely accessible. PMID 25360205. doi:10.1177/1941874414540684. 
  11. Tan CS, Koralnik IJ (2010). "Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis". Lancet Neurol. 9 (4): 425–37. PMC 2880524Freely accessible. PMID 20298966. doi:10.1016/S1474-4422(10)70040-5. 

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