Lymphoma

Question 1

Define lymphoma

Answer 1

Neoplasms of lymphoid cells originating in the lymph nodes or other lymphoid tissues
Hodgkin’s – mature B cell malignancy characterised by presence of Reed Sternberg cells
Non-Hodgkin’s – 85% B cell (including Burkitt), 15% T cell and NK cell

Question 2

What are the causes/risk factors of lymphoma?

Answer 2

Hodgkin’s
Unknown aetiology; likely to be the result of an environmental trigger in
a genetically susceptible individual
• Infectious mononucleosis (EBV)
• Family history

Non-Hodgkin’s
Abnormal gene mutations -> growth advantage and expansion of malignant monoclonal
lymphocytes
• Radiotherapy
• Chemotherapy
• Immunosuppressants
• Viruses e.g. HIV, HBV/HCV, HHV8, HTLV-1
• Autoimmune diseases e.g. SLE, Sjörgren’s, coeliac disease
• Immunodeficiency syndrome

Question 3

What are the symptoms of lymphoma?

Answer 3

• Painless swelling in neck, (axilla, or groin)
• Fever > 38C
• Night sweats
• Weight loss >10% in last 6 months

Symptoms of intrathoracic/mediastinal disease
• Dyspnoea
• Cough
• Chest pain

Hodgkin’s
• May experience pain on
drinking alcohol
• Pruritus (10%)

Non-Hodgkin's
• Fatigue/malaise
• Abdominal discomfort
• Skin rashes
• Headache
Symptoms of anaemia
Symptoms of hypercalcaemia

Question 4

What are the signs of lymphoma?

Answer 4

• Non-tender lymphadenopathy:
cervical, supraclavicular, (axillary,
inguinal)
• Splenomegaly +/- hepatomegaly

Signs of intrathoracic/mediastinal disease
• SVCO (facial plethora, oedema)

Hodgkin’s
• Skin excoriations

Non-Hodgkin’s
• Mycosis fungoides
• Pallor
• Purpura

Question 5

What investigations are carried out for lymphoma?

Answer 5

• FBC - anaemia (ACD) and Thrombocytopaenia.
- Leucocytosis or Leukopaenia with Neutrophilia, eosinophils. Lymphopaenia with advanced disease.
• ESR - elevated
• CXR - may show a mediastinal mass; large mediastinal adenopathy.
• Other Scans - CT of thorax, abdomen and pelvis, gallium scan, PET scans to evaluate the lymphadenopathy and spread of disease.
• Lymph node biopsy - pathological diagnosis: Reed-Sternberg cell
- The Reed–Sternberg cell is pathognomonic. It is a large cell with abundant pale cytoplasm and two or more oval lobulated nuclei containing prominent ‘owl-eye’ eosinophilic nucleoli (can appear as lacunar or ‘popcorn’ cells).
• Bone Marrow Biopsy - unnecessary in patients with stage IA to stage IIA disease, because the risk of bone marrow involvement is low (<1%). In patients with B symptoms or stage III to stage IV disease, a bone marrow biopsy has traditionally been recommended.
- If there is bone marrow involvement, then there are Hodgkin Cells found in the biopsy.