Malignant disease - Lymphomas

Question 1

Lymphomas

Hodgkin lymphoma

Answer 1

Lymphomas are malignancies of the cells of the immune system and can be divided into Hodgkin and non-Hodgkin lymphoma (NHL). NHL is more common in childhood, while Hodgkin lymphoma is seen more frequently in adolescence.

Question 2

Lymphomas

Hodgkin lymphoma

Clinical features

Answer 2

Classically presents with painless lymphadenopathy, most frequently in the neck. Lymph nodes are much larger and firmer than the benign lymphadenopathy commonly seen in young children. The lymph nodes may cause airways obstruction. The clinical history is often long (several months) and systemic symptoms (sweating, pruritus, weight loss and fever – the so-called ‘B’ symptoms) are uncommon, even in more advanced disease.

Question 3

Lymphomas

Hodgkin lymphoma

Investigations

Answer 3

Lymph node biopsy, radiological assessment of all nodal sites and bone marrow biopsy is used to stage disease and determine treatment.

Question 4

Lymphomas

Hodgkin lymphoma

Management

Answer 4

• Combination chemotherapy with or without radiotherapy. Positron emission tomography (PET) scanning is used in the UK to monitor treatment response and guide further management
• About 80% of all patients can be cured. Even with disseminated disease, about 60% can be cured.

Question 5

Lymphomas

Non-Hodgkin lymphoma

Answer 5

• T-cell malignancies may present as acute lymphoblastic leukaemia or non-Hodgkin lymphoma, with both being characterised by a mediastinal mass with varying degrees of bone marrow infiltration.
• The mediastinal mass may cause superior vena caval obstruction.
• B-cell malignancies present more commonly as non-Hodgkin lymphoma, with localised lymph node disease usually in the head and neck or abdomen.
• Abdominal disease presents with pain from intestinal obstruction, a palpable mass or even intussusception in cases with involvement of the ileum

Question 6

Lymphomas

Non-Hodgkin lymphoma

Investigations and Management

Answer 6

Investigations
Biopsy, radiological assessment of all nodal sites (CT or MRI) and examination of the bone marrow and CSF.

Management
Multi-agent chemotherapy. The majority of patients now do well and survival rates of over 80% are expected for both T- and B-cell disease.

Question 7

Differences between

Hodgkins and non Hodgkins lymphomas

Answer 7