commoner compared to leukaemia

incraseing in incidence

mostly characterised by lymphomatous growth

primary extranodal in 20% NHL

classified on basis of histological appearance

Differential diagnosis of cervical LN enlargement

• Infections

  • acute

    • pyogenic infections

    • EBV

    • toxoplasmosis

    • CMV

    • infected eczema

    • cat scratch fever

    • viral…

• chronnic

  • Tb

  • syphilis

  • sarcoidosis

  • HIV

• Autoimmune

  • RA

• Drug reactions

  • Phenytoin

• Primary lymph node malignancies

• Secondary malignancy

• Kawasaki syndrome

Hodgkin’s lymphoma

• rare disease

• 3 / 100 000

• M>F

• epidemological data - links EBV with HL

• Reed-Sternberg cell in lymph node biopsy

  • usually B-cells but occ. T cells (periphery)

• symptoms / signs

  • Lymph node enlargement

  • hepatoplenomegaly

  • systemic “B” symptoms

  • other constitutional symptoms

    • pruritis

    • fatigue

    • anorexia

  • etoh induced pain at site of enlarged lymp nodes

    • symptoms due to involvement of other organs

• investigations

  • LN biopsy

  • blood count

  • ESR

    • indicator of disease activity

  • LFTs

  • lactaate dehydrongenase (LDH)

    • raised = adverse prognostic factor

  • uric acid

  • CXR

  • BM aspirate/trephine

non-Hodkin’s lymphoma

• most (70%) of b-cell origin

• 30% T-cell origin

• associated with EBV 10-30% of tumours

• clinical features

  • peripheral lymphaedeonpathy

  • systemic symptoms

  • extranodal presentation

    • more common compared to HL

    • abdominal = hepatosplenomegaly

    • skin =

      • mycosis fungoides

        • T-cell lymphoma

        • dermnet

      • Sezary syndrome

        • AKA redman syndrome

• prognostic factors:

  • age >60

  • advanced disease

  • High serum LDH

  • ECOG 2>

  • more than one extranodal site involvement

• most common AIDS defining malignancy

  • Burkitt’s

Follicular lymphoma

• 20%

• most present feeling well

• remitting and recurring disease

Diffuse large B cell lymphoma

• most common

• almost invariably fatal without therapy within months

• >50% young people cured

• CHOP + R

Burkitt’s lymphoma

• uncommon lymphoma in western world

• endemic to afriva - mosquito belt

• Close association to EBV

• very high proliferative index

  • rapidly fatal

• clincial presentation = lymphadenopathy

• CNS involvement common

T-cell lymphoma

• much less common than b-cell