LYMPHOMA. Dr Bruce Covell. Each year in the UK about about 1500 people develop Hodgkin's disease, usually between 15-25 years of age. It can also develop later in life in people over 60. In younger people the numbers of men to women are about the same but overall Hodgkin's affects more men.
Dr Bruce Covell
Each year in the UK about about 1500 people develop Hodgkin's disease, usually between 15-25 years of age. It can also develop later in life in people over 60. In younger people the numbers of men to women are about the same but overall Hodgkin's affects more men.
Between 7000 and 7500 people develop non-Hodgkin's lymphoma each year. It is more common over the age of 60 and affects slightly more men than women.
At present the cause of most lymphomas is unknown.
English physcian and pathologist, born August 17, 1798, in Pentonville, St. James Parish, Middlesex; died April 5, 1866, Jaffa, Palestine [now Tel Aviv-Yafo, Israel].
members of "The Society of Friends"
The castle walls-first line of defence is the skin and the mucosa
The foot soldiers -macrophages Complement, and other immune cells send out chemical messengers to call for reinforcements.
The cavalry-neutrophils -small, short-lived immune cells ,swallow the invaders and kill them
The SAS-Antibodies recognise and stick to foreign material.B lymphocytes exist to produce antibodies. infection is over, most of the B cells die, but some live on as memory cells.
The generals-T lymphocytes major histocompatibility complex (MHC), Helper T cells Cytotoxic T cells recognise cells with foreign proteins attached to MHC on their surface and destroy them directly.
Lymphoid tumors that present as mature B-cellsmay have arisen as a result of the interplay between geneticlesions and normal processes that govern lymphoid tolerance,homeostasis and function
“Nowhere in pathology has a chaos of names clouded clear concepts as inthe subject of lymphoid tumors”
Willis R.A.: Pathology of tumors, Mosby 1948
B Cells Nodular sclerosing 50%
Mixed cellularity –30-40%
% Of Lymphomas
Age of Incidence
With appropriate treatment, more than 80% of people with stage I or II Hodgkin's survive for at least 10 years. With widespread disease, the treatment is more intense and the 5-year survival rate is about 60%.1.
Nodular sclerosing -
50% commonest of all types of Hodgkin's lymphoma.
Commonest in women in their 20’s and 30’s.
less favourable prognosis than the lymphocyte predominant
usually picked up at an early stage from enlarged lymph nodes in the neck.
Mixed cellularity - .
30 – 40%-
Commonest in older people.
2. Nodular lymphocyte predominance
most favourable prognosis
% Of Lymphomas
Age of Incidence
Diffuse large B-cell lymphoma (DLBCL):
40% to 50% are cured
2 kinds Genetics One serious
60. rare in very young
5-year survival rate60% to 70%.
can (transform) into a fast growing diffuse B-cell lymphoma.
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL):
live well over 10 years
not considered curable
are slow growing can transform into a more aggressive type of lymphoma
Mantle cell lymphoma:
Men most often affected. average age 63
very serious. 20% of patients survive at least 5 years.
Extranodal marginal zone B-cell lymphomas - mucosa-associated lymphoid tissue (MALT) lymphomas
average age about 60
slow growing lymphoma often curable in its early stages.
stomach Helicobacter pylori.
Nodal marginal zone B-cell lymphoma:
slow growing cured if diagnosed in early stages.
cells are small.
Splenic marginal zone B-cell lymphoma
often elderly and male
Primary mediastinal B-cell lymphoma
two thirds women. 30s.
About half of patients can be cured. fast growing
mediastinum closely related to Hodgkin disease
90% of patients are male, and the average age is about 30
half of patients are cured by aggressive chemotherapy.
medium size fast growing African jaws d US, abdomen,
Lymphoplasmocytic lymphoma (Waldenstrom macroglobulinemia
not curable, most live longer than 5 years.
slow growing Thick blood Symptoms
Hairy cell leukemia:
Patients are older in general.
slow growing, some patients never need treatment
Primary central nervous system (CNS) lymphoma:
patients with AIDS
poor. 30% 5 years.
called primary brain lymphoma
Age of Incidence
Precursor T-lymphoblastic lymphoma/leukaemia:
(75%) men, average age 25
No bone marrow cure quite good. involve bone marrow, 20% cured.
lymphoma or leukaemia. fast growing,
Peripheral T-cell lymphomas:,
There are several kinds of peripheral T-cell lymphomas
Cutaneous T-cell lymphoma (mycosis fungoides, Sezary syndrome):
50s or 60s
survival at 5 years ranges 58% slow-growing lymphomas 5% faster growing ones
Skin Sezary syndrome spread all over the body OR mushroom-like (so first named mycosis fungoides
Angioimmunoblastic T-cell lymphoma:
Extranodal natural killer/T-cell lymphoma, nasal type
Enteropathy type T-cell lymphoma
outlook is poor
Subcutaneous panniculitis-like T-cell lymphoma
cannot be cured
Anaplastic large T/null-cell lymphoma
T Cell Lymphoma
Average age is 27.7 with two age peaks, the major one between 15 and 24 with a lesser peak after age 55.
Average age is about 67.
Chance of getting in all people over an entire lifetime
Men 0.23%Women 0.20%
Men 2.12%Women 1.79%
About 15% of all lymphomas
About 85% of all lymphomas
The disease occurs most often in lymph nodes above the collar bone. In Hodgkin's it is also more likely to appear in the chest cavity between the lungs (the mediastinum), particularly in younger patients.Only about 15% to 20% of cases are found in areas below the diaphragm.Disease occurs outside the nodes in about 4% of cases.
In NHL it is more likely to appear in the nodes in the abdomen (called the mesenteric nodes).The disease occurs in the chest cavity in less than 40% of patients. (An exception, lymphoblastic lymphoma, which is seen most often in young people, is likely to first appear in the chest.)Disease occurs outside the nodes in about 23% of patients. Slow-growing lymphomas are common in the liver and bone marrow.
Affected Lymph Cells
B-Lymphocytescharacterized by the Reed-Sternberg Cell
B-Lymphocytes, T-Lymphocytes or Natural Killer (NK) Cells depending on the subtype
More likely than NHL (40%) to have systemic ("B") symptoms (such as fever and night sweats) at the time of diagnosis.
Less likely than HL to have systemic ("B") symptoms (27%) at the time of diagnosis.
Less likely than NHL to be diagnosed in stage IV (10%). Hodgkin's disease usually progresses in an orderly way from one lymph node region to the next. This process may be slow, particularly in younger people, or very aggressive. The disease typically spreads downward from the initial site. If it spreads below the diaphragm, it usually reaches the spleen first; the disease then may spread to the liver and bone marrow. If the disease starts in the nodes in the middle of the chest, it may spread outward to the chest wall and areas around the heart and lungs.
More likely than HD to be diagnosed in stage IV (36%) but this will vary by NHL subtype.
The Non-Hodgkin's lymphomas are less predictable in their course than Hodgkin's and they are more apt to spread.
Anne Arbor staging for Hodgkin's disease - Virginia.edu
Extranodal means 'beyond nodal' - sites are identified by the following notation:
Ann Arbor staging further classifies patients with lymphoma into A or B categories:
A = without symptoms
B = with symptoms including unexplained weight loss (10% in 6 months prior to diagnosis, unexplained fever, and drenching night sweats.
Disease Staging may also be accompanied by local involvement of an extranodal organ or site.
Example involving spleen and Ann Arbor notation: Stage IIIS A
TreatmentLymphomas are usually treated by a combination of chemotherapy, radiation, surgery, and/or bone marrow transplants. The cure rate varies greatly depending on the type of lymphoma and the progression of the disease.
(Used at various doses, with, or without radiation)
Evidence for a possible role of outside agent in lymphomagenesis:
Autoimmunity and lymphoid neoplasia may represent differentparts of a single disease-spectrum: