Investigations of lymphoma
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Investigations of lymphoma. FBE / CBC U&E LFT ESR LDH Beta 2 microglobulin Protein electrophoresis HIV and HTLV II serology. General blood tests. Look for:anaemia ,  WCC, lymphopenia , neutrophilia / neutropenia , eosinophilia. FBE.

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General blood tests

FBE / CBC

U&E

LFT

ESR

LDH

Beta 2 microglobulin

Protein electrophoresis

HIV and HTLV II serology

General blood tests


Look for:anaemia, WCC, lymphopenia, neutrophilia/ neutropenia, eosinophilia

FBE


  • Check serum creatitine and renal function: ureteric obstruction secondary to lymph node enlargement can cause renal impairment

  • Check calcium, phosphate, and sodium

  • Check renal function prior to treatment

U&E



ESR

LDH

  • Bad prognosis if it is increase in Hodgkin’s disease and NHL




Hiv and htlv ii serology

HIV and HTLV II serology


Imaging

  • Structural imaging disease outcomes in HIV-positive patients in NHL and HD. (Conventional method of staging)

    • CT (neck to pelvis)

    • MRI

    • CXR

  • Functional imaging

    • PET scan

    • Gallium scan

    • Bone scan

Imaging


Ct neck to pelvis

  • It is the most widely used test for initial staging, assessing treatment response, and conducting follow-up care

  • Possible abnormal findings include enlarged lymph nodes, hepatomegaly and/or splenomegaly, lung nodules or infiltrates, and pleural effusions.

  • Mediastinallymphadenopathy, is a very common finding in classic Hodgkin disease, although it is uncommon in NodularLymphocyte-PredominantHodgkin'sDisease

CT (neck to pelvis)


Ct s showed lypmhadenopathy in the left inguinal node and the left iliac fossa
Ct's showed assessing treatment response, and conducting follow-up care lypmhadenopathy in the left inguinal node and the left iliac fossa


MRI


  • CXR is more indicated for NHL assessing treatment response, and conducting follow-up care eg for identification of hilar or mediastinaladenopathy, pleural or pericardial effusions, and parenchymal involvement

CXR


Pet scan

PET scan


Pet scan1

  • Appears to be sensitive for detecting NHL in disease extranodal sites

  • Reliability to detect bone marrow involvement is questioned

  • Better than gallium and equal to CT to detect disease sites in intermediate to high grade NHL and Hodgkin’s

  • PET scan has a higher predictive value for relapse than classic CT scan imaging

  • Scarce availability so x always practical

PET scan


Gallium scan nuclear medicine

Gallium scan (nuclear medicine)



Bone scan

  • It is done if suspected BM involvement treatmenteg bone pain or elevated ALP

  • In NHL, one lesions are particularly associated with the acute form of adult T-cell lymphoma-leukemia and diffuse large B-cell lymphomas

Bone scan


Histology

Histology



Histology1

  • Lymph diagnosisnode sample

    • Fine needle aspiration

    • Needle-core biopsy / incisional biopsy

    • Excision biopsy

  • Bone marrow sample

    • Trephine / biopsy

    • Aspirate

  • Biopsy of extranodal sites

  • Lumbar puncture

  • Staging laparotomy

  • Pleural effusion sampling

Histology



Histopathologic diagnosis image of Hodgkin's lymphoma. CD30 (Ki-1) immunostain.


Histopathologic diagnosis image of Hodgkin's lymphoma. Lymph node biopsy. H & E stain.


Malignant B-cell lymphocytes seen in diagnosisBurkitt's lymphoma, stained with hematoxylin and eosin (H&E) stain




Bone marrow sample trephine aspirate

  • lymphoma in the bone marrow is often patchy, so bilateral bone marrow biopsies is indicated

  • HD:

    • Bone marrow involvement is more common in elderly individuals, in patients with advanced-stage disease, in the presence of systemic symptoms, and in patients with a high-risk histology.

    • A bone marrow biopsy can be omitted in patients with stage I Hodgkin disease (Hodgkin's lymphoma) and some patients with stage II disease without hematologic abnormalities. 

  • For NHL, bone marrow sampling is done for staging rather than diagnosis

Bone marrow sample (trephine/aspirate)


Bone marrow trephine

  • Sensitive for the presence of lymphoma at light microscopy level when there are sufficient cells to be identified by the pattern they form or number of cells present

  • Sensitivity can be increased by using CD marker to identify subgroup of lymphocytes, but because lymphocytes are normally present in BM, the pattern and number are important.

  • PCR to detect presence of translocation or oncogenes can increase the sensitivity and give better measure of prognosis

Bone marrow trephine


Biopsy of extranodal sites

  • In some patients with NHL, the level when there are sufficient cells to be identified by the pattern they form or number of cells presentextranodal sites are the primary presenting sites, and the most common site is the GI tract.

Biopsy of extranodal sites


Lumbar puncture if symptoms or signs of cns involvement are present

  • CNS involvement with Hodgkin disease (Hodgkin's lymphoma) is exceedingly rare

  • In patient with NHL, it should be performed if

    • Diffuse aggressive NHL with bone marrow, epidural, testicular, paranasal sinus, nasopharyngeal involvement, or patient with two or more extranodal sites of disease.

    • High-grade lymphoblastic lymphoma

    • High-grade small noncleaved cell lymphomas (eg, Burkitt and non-Burkitt types)

    • HIV-related lymphoma

    • Primary CNS lymphoma

    • Patients with neurologic signs and symptoms

Lumbar puncture (if symptoms or signs of CNS involvement are present)


Staging laparotomy

involves lymphoma) is exceedingly rare splenectomy with biopsies of the liver and lymph nodes in the para-aortic, mesenteric, portal, and splenichilar regions.

Rarely done

Staging laparotomy


Pleural effusion sampling

  • Sampling of a pleural effusion by lymphoma) is exceedingly rare thoracentesis and examination of the cells obtained may be useful in the evaluation of Hodgkin disease (Hodgkin's lymphoma).

Pleural effusion sampling


Staging ann arbor classification
Staging: Ann Arbor classification lymphoma) is exceedingly rare


In patients with stage I or II disease, the following factors are considered unfavourableand, if present, will increase the intensity of the recommended initial therapy:

  • Large mediastinaladenopathy

  • An ESR result (a general marker of inflammation) 50 mm/h or higher, if the patient is otherwise asymptomatic OR ESR > 30 if hv B symptoms

  • More than 3 sites of disease involvement

  • The presence of B symptoms

  • The presence of extranodal disease

  • Age above 50 at diagnosis


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