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Lymphomas: Impact, Classification, and Treatment Options

Explore the world of lymphomas, a group of malignant neoplasms derived from lymphoid tissue, involving lymph nodes, and lymphoid organs. Learn about the classifications, etiology, clinical features, oral manifestations, histopathology, and treatments for different types of lymphomas like Non-Hodgkin’s and Hodgkin Lymphoma.

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Lymphomas: Impact, Classification, and Treatment Options

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  1. Lymphomas

  2. MALIGNANT LYMPHOMA • GROUP OF NEOPLASM'S OF VARYING DEGREES OF MALIGNANCY DERIVED FROM BASIC CELLS OF LYMPHOID TISSUE • LYMPHOCYTES IN ANY OF THEIR DEVELOPMENT STAGES

  3. NON-HODGKIN’S LYMPHOMA • HETEROGENOUS GROUP OF LYMPHOPROLIFERATIVE MALIGNANCIES WHICH CAN INVOLVE BOTH LYMPH NODES & LYMPHOID ORGANS AS WELL AS EXTRANODAL ORGANS & TISSUES

  4. CLASSIFICATION WORKING FORMULATION CLASSIFICATION • LOW GRADE • INTERMEDIATE • HIGH GRADE

  5. RAPPAPORT CLASSIFICATION • NODULAR • DIFFUSE • LYMPHOCYTIC • HISTIOCYTIC

  6. REAL [ REVISED EUROPEAN – AMERICAN LYMPHOMA] • B- CELL NEOPLASMS • T- CELL – NK CELL NEOPLASMS • HODGKIN LYMPHOMA

  7. Etiology: • 1) genetic abnormality • 2) environmental factors like chemicals- pesticides, herbicides, wood preservatives, organic chemicals. • 3) viruses: EBV , HHV 8, • 4) immunodeficiency state: congenital immuodeficiency state like ataxia telengiectasia & • Aquired immunodeficiency state like HIV

  8. Clinical features • High grade and small cell lymphomas are seen in children. • Where as NHL is older than 50 years. • NHL common in males. • Lymphadenopathy followed by systemic symptoms like fever, night sweats, weight loss, fatigue, pruritus noticed.

  9. Oral manifestation • Swelling which may grow rapidly and ulcerate • Pain • Underlying bone is involved • Tooth mobility.

  10. Histopathology • Nodular • Diffuse • IN nodular type there is neoplastic cells tend to aggregate in large cluster. • IN diffuse type monotonous distribution of cells with no evidence of nodularity or germinal center. • Nodular type is seen in adults with better prognosis than the diffuse type.

  11. Follicular /Nodular lymphoma • 22% of non hodgkin’s lymphomas • Predominant growth pattern is seen in lymph node. • 2 principle cell types are observed. • Centrocytes: small cell with irregular or cleaved nuclear contour with scanty cytoplasm. • Centroblast: larger cells with open nuclear chromatin, several nucleoli with moderate amount of cytoplasm.

  12. Diffuse large B cell lymphoma • 31 % of all non Hodgkin’s lymphoma. • Large cell size with diffuse growth pattern. • Tumor cells have a round or oval nucleus, which is vesicular because of margination of chromatin at the nuclear membrane.

  13. BURKITT’S LYMPHOMA • TUMOUR OF CHILDREN OF TROPICAL AFRICA • DENIS PARSONS BURKIT • ENDEMIC & NON ENDEMIC FORM • FASTEST GROWING MALIGNANCY IN HUMANS

  14. C/F • MAX OR MAND • SPORADIC FORM – ABDOMINAL ORGANS

  15. ETIOLOGY • EBV • MALARIA – IMMUNOSUPRESSION – INADEQUATE T CELL RESPONSE AGAINST B CELLS INFECTED LATENTLY WITH EBV.

  16. AFRICAN FORM • SWELLING OF AFFECTED JAW OR OTHER FACIAL BONES • LOOSENING OF TEETH • SWELLING OF LYMPH NODE • NON TENDER & RAPIDLY GROWING IN NECK OR BELOW JAW • ABDOMINAL PRESENTATION – LESS COMMON

  17. SPORADIC FORM • ABDOMINAL TUMOURS • SWELLING & PAIN • BOWEL OBSTRUCTION • METABOLIC DERANGEMENT & RENAL FUNCTION IMPAIRMENT

  18. MAJOR SIGNS • INVOLVEMENT OF JAWS OR FACIAL BONES • ENLARGED CERVICAL LYMPH NODES • ABDOMINAL MASSES • ASCITIS

  19. ‘STARRY SKY APPEARANCE’ • SEEN IN AFRICAN JAW LYMPHOMA • SCATTERED MACROPHAGES WITH CLEAR CYTOPLASM OFTEN PHAGOCYTIC CELLULAR DEBRIS

  20. TREATMENT • COMBINATION CHEMOTHERAPY & CNS PROPHYLAXIS

  21. HODGKIN’S DISEASE • MAIN TYPES OF MALIGNANT LYMPHOMA • THOMAS HODGKIN • POTENTIALLY CURABLE MALIGNANT LYMPHOMA

  22. ETIOLOGY • EBV • ASSOCIATED WITH AIDS • GENETIC PREDISPOSITION

  23. C/F • BIMODAL DISTRIBUTION [ 15-34 - >55 YRS] • MALES • COMMON IN WHITES • PAINLESS ENLARGEMENT OF ONE OR MORE CERVICAL L.N • FIRM, RUBBERY IN CONSISTENCY • OVERLYING SKIN NORMAL

  24. UNEXPLAINED WT.LOSS • FEVER • NIGHT SWEATS • CHEST PAIN • SHORTNESS OF BREADTH • PRURITUS • BACK, ABDOMEN, BONE PAIN

  25. O.M • SECONDARY INVOLVEMENT OF MAND & ALVEOLAR MUCOSA

  26. H/P HISTOPATHOLOGICAL VARIANTS: • NODULAR SCLEROSIS • MIXED CELLULARITY • LYMPHOCYTE DEPLETED • NODULAR LYMPHOCYTE – PREDOMINANT H.D

  27. H/P • NODULAR SCLEROSIS : 60 – 80% • NODULAR PATTERN • FIBROSIS DIVIDING IT INTO NODULES • THE CELL TYPE IS LACUNAR TYPE RS CELL. • LACUNAR TYPE: Mono lobulated or multi lobulated nucleus, abundant & pale cytoplasm, small nucleolous • ADOLESCENTS & YOUNG ADULTS • IT INVOLVES MEDIASTINUM & SUPRADIAPHRAGMATIC SITE.

  28. Mixed cellularity: Comprises of 15-30 % of cases. RS are of classic type(large with bilobate double or multiple nuclei, eosinophilihc inclusion like nucleus ). • It commonly affects abdominal lymph nodes and spleen.

  29. Lymphocyte depleted: less than 1%.hypocellular, with large number of RS cells. • It is associated with older age group & HIV patients.

  30. Lymphocyte rich classic hodgkin’s disease: 5 % of the cases. RS cells of classic or lacunar type with a background of lymphocytes.

  31. Nodular lymphocyte predominant HD: 5 % of the cases. Popcorn cells a variant of RS cell is seen within the background of inflammatory cells.

  32. TREATMENT • RADIATION THERAPY & COMBINATION CHEMOTHERAPY

  33. MULTIPLE MYELOMA • MALIGNANCY OF PLASMA CELLS • SUBSET OF B CELLS

  34. PATHOGENESIS • MUTATION OF TERMINALLY DIFFERENTIATED B CELLS • ETIOLOGY -RADIATION -CHEMICAL -OCCUPATION

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