Non-hodgkin's lymphoma

Question 1

Define:

Answer 1

Malignancy of the lymphoid cells originating in the lymph nodes or other lymphoid tissues without reed-sternberg cells

Range from stable to indolent to aggressive disease

Question 2

Aetiology:

Answer 2

Complex process involving many gene mutations

Associated with oncogenic viruses such as Burkitts and EBV

Question 3

Risk factors:

Answer 3

EBV, HIV, and HCV
Radiotherapy 
Immunosuppressive agents 
Chemotherapy 
SLE (connective tissues diseases)

Question 4

Epidemiology:

Answer 4

More common in males and in the west

Incidence increases with age

Question 5

Symptoms:

Answer 5

Painless enlarging superficial lymphadenopathy mainly in the neck, groin and axilla

Fever

Weight loss >10% loss in 6 months

Night sweats

Hypercalacemia symptoms - stones, psychic groans and abdo moans

Extranodal - more common in NH:
>Headaches
>Skin rashes 
>Sore throat
>testicular swelling 
>Abdo discomfort

Question 6

Signs:

Answer 6

Painless firm rubbery lymphadenopathy
Skin rashes - mycosis fungoides (T cell cutaneous lymphoma)
Abdo mass
Hepatosplenomegaly
BM involvement (pallor, infections and purpura)

Question 7

Investigations:

Answer 7

o FBC
• Anaemia
• Neutropaenia
• Thrombocytopaenia

High ESR and CRP

Raised LDH

Calcium may be raised

HIV, HBV and HCV serology

Blood Film
o Lymphoma cells may be visible in some patients

Bone Marrow Aspiration and Biopsy

Imaging - CXR, CT, PET

Lymph Node Biopsy - allows histopathological evaluation, immunophenotyping and cytogenetics
• Staging - Ann-Arbor