Lymphoma Summary

Classification

  • Hodgkin Lymphoma (HL): Reed-Sternberg cells present
  • Non-Hodgkin Lymphoma (NHL): No Reed-Sternberg cells
  • Based on histological examination

Hodgkin Lymphoma

  • Peak incidence in young adults
  • 2:1 male predominance
  • Cervical nodes (60-70%)
  • Contiguous spread pattern
  • 85% cure rate

Non-Hodgkin Lymphoma

  • 85% B-cell origin
  • 15% T/NK cell origin
  • Irregular spread pattern
  • Extranodal involvement common
  • More variable presentation

Common Symptoms

  • Painless lymphadenopathy
  • Fever, night sweats, weight loss
  • Pruritus (HL specific)
  • Alcohol-induced pain (HL)
  • Fatigue, weakness, anorexia

Key Investigations

  • Lymph node biopsy (definitive)
  • PET/CT imaging
  • Blood tests (FBC, ESR, LDH)
  • Bone marrow biopsy
  • Immunophenotyping

Management

  • Chemotherapy ± radiotherapy
  • Monoclonal antibodies (NHL)
  • Stem cell transplantation
  • Stage-dependent treatment

Prognosis

  • HL: 85% cure rate overall
  • Depends on stage, histology, age
  • NHL: More variable prognosis
  • Response monitored by PET/CT

Lymphoma

Malignant disorders of lymphocytes characterized by lymphadenopathy and systemic symptoms

Overview

Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy.

Key Classification: The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) based on the histological presence of Reed-Sternberg cells present in HL.

Classification Overview

Type Key Feature Incidence Spread Pattern
Hodgkin Lymphoma Reed-Sternberg cells present Young adults peak Contiguous lymphatic spread
Non-Hodgkin Lymphoma No Reed-Sternberg cells All ages, increases with age Irregular, extranodal common

Hodgkin Lymphoma (HL)

Epidemiology

  • Can present at any age but rare in children
  • Peak incidence in young adults
  • Almost 2:1 male predominance
  • Distinct bimodal age distribution

Pathological Hallmark

  • Reed-Sternberg cells - distinctive multinucleate polypoid cells
  • Present in 95% of classic HL cases
  • Central to diagnosis of four classic types

Clinical Features

Lymphadenopathy

  • Painless, asymmetrical, firm and discrete enlargement
  • Cervical nodes: 60-70% of cases
  • Axillary nodes: 10-15% of cases
  • Inguinal nodes: 6-12% of cases
  • Typically localized initially to single peripheral lymph node region
  • Progression by contiguity within lymphatic system

Systemic Involvement

  • Splenomegaly: 50% of patients during disease course
  • Hepatomegaly: May occur
  • Mediastinal involvement: Up to 10% at presentation
  • Cutaneous HL: ~10% as late complication

Constitutional Symptoms

Prominent in patients with widespread disease:

  • Fever: Occurs in 30% of patients
  • Pruritus: Occurs in 25% of patients
  • Alcohol-induced pain in areas where disease is present
  • Weight loss, night sweats, fatigue, weakness, anorexia, cachexia

Complications

  • Pleural effusions with mediastinal involvement
  • Superior vena cava obstruction
  • Bone marrow failure in advanced disease
  • Loss of cell-mediated immunity

Hodgkin Lymphoma Investigations

Laboratory Findings
  1. Normochromic normocytic anaemia (most common)
  2. Neutrophilia in one-third of patients
  3. Eosinophilia frequent
  4. Lymphopenia in advanced disease
  5. Platelet count: Normal/increased early, reduced later
  6. ESR and CRP usually raised (ESR useful for monitoring)
  7. Serum LDH raised in 30-40% of cases initially

Diagnostic Approach

Definitive Diagnosis

  • Histological examination of excised lymph node
  • Identification of Reed-Sternberg cells
  • Four classic types of HL (95% of cases)

Staging Investigations

  • PET and CT scans
  • Clinical examination and history
  • Blood tests
  • Bone marrow biopsy in selected cases

Hodgkin Lymphoma Management & Prognosis

Treatment Approach

Selection of appropriate treatment depends on the stage and grade of the disease.

Treatment Modalities

  • Chemotherapy alone or
  • Combination chemotherapy with radiotherapy
  • Response monitored by CT and PET scans
  • Disease relapse: Chemotherapy ± stem cell transplantation

Monitoring

  • Regular clinical assessment
  • Serial imaging (PET/CT)
  • Blood tests (ESR, LDH)
  • Assessment for treatment complications

Prognosis

Overall approximately 85% of patients are cured.

  • Depends on age, stage and histology
  • Better prognosis in younger patients
  • Early stage disease has excellent outcomes
  • Advanced stage requires more intensive treatment

Non-Hodgkin Lymphoma (NHL)

Classification

  • 85% B-cell origin
  • 15% T or NK (natural killer) cell origin
  • Large group of clonal lymphoid tumours
  • More variable clinical presentation and natural history than HL

Spread Characteristics

  • Irregular pattern of spread
  • Significant proportion develop extranodal disease
  • Often presents with widespread involvement

Clinical Features

Common Presentations

  • Superficial lymphadenopathy (typically asymmetric and painless)
  • Constitutional symptoms (fever, night sweats, weight loss)
  • Oropharyngeal involvement (sore throat, noisy or obstructed breathing)
  • Symptoms due to cytopenias (anaemia, neutropenia, thrombocytopenia)

Extranodal Involvement

  • Abdominal disease: Hepatosplenomegaly, retroperitoneal or mesenteric nodes
  • Infiltration of other organs: Skin, brain, testis or thyroid
  • Bone marrow involvement common
  • GI tract involvement in certain subtypes

NHL Investigations & Management

Diagnostic Approach

Definitive Investigations
  1. Whole lymph node biopsy or
  2. Trucut biopsy of lymph node or other involved tissue
  3. Bone marrow biopsy or extranodal tissue biopsy
  4. Morphological examination with immunophenotypic analysis
  5. Genetic analysis in some cases

Additional Investigations

  • Blood tests (FBC, LDH, renal/liver function)
  • PET/CT imaging for staging
  • Lumbar puncture if CNS involvement suspected
  • HIV testing (associated with certain NHL types)

Specialized Testing

  • Flow cytometry for immunophenotyping
  • Cytogenetic analysis
  • Molecular studies for specific translocations
  • Assessment of proliferation index

Management

Treatment approach depends on NHL subtype, stage, and patient factors.

Standard Approach

  • Combination chemotherapy with
  • Monoclonal antibody directed against tumour cells
  • Radiotherapy for localized disease
  • Stem cell transplantation for high-risk or relapsed disease

Emerging Therapies

  • Various new drugs in development
  • Targeted therapies
  • Immunotherapy approaches
  • CAR-T cell therapy

Note: Management of NHL is rapidly evolving with new therapeutic options becoming available regularly. Treatment should be guided by latest evidence and specialist multidisciplinary input.

Comparison: HL vs NHL

Feature Hodgkin Lymphoma Non-Hodgkin Lymphoma
Reed-Sternberg cells Present Absent
Age distribution Bimodal (young adults + elderly) Increases with age
Spread pattern Contiguous lymphatic spread Non-contiguous, extranodal common
Cell of origin B-cell (germinal center) B-cell (85%), T/NK-cell (15%)
Extranodal disease Rare at presentation Common at presentation
B symptoms Common in advanced disease Variable by subtype
Treatment response Generally good Variable by subtype
Overall prognosis ~85% cure rate Highly variable