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Lymphoma short note by S.

Wichien (SNG KKU)


WHO system of NHL 1.DLBCL (55%) 2.MALT (40%) 3.Burkitt lymphoma (3%) -aggressive, asso EBV GI lymphoma -20% of NHL -stomach (50%), smb, colon, pancreas -B-systemfever, night sweat, wt loss -anemia (50%)chronic blood loss Criteria for Dx GI lymphoma 1.grossly confine to affect viscus 2.no palpable lymphadenopathy 3.no mediastinal lymphadenopathy 4.normal BM biopsy 5.normal peripheral blood smear Gastric lymphoma -2% of ca stomach -50% of GI lymphoma -60-70 year -antrum -bleeding, epigastrium pain Dx 1.upper endoscope+Bx -nodular with enlarge gastric fold -submucosal lesion -diffuse infiltration 2.EUS -tumor infiltration -perigastric node Gastric MALT lymphoma -H.pylori infection 90% -multifocal 1.low grade MALT -H.pylori eradication -endoscopic surveillance+Bx :s/p Tx 2 mo then q 6 mo -relapse or persistRT 2.hi grade MALT -chemo RT -I/C for Sx :residual disease post chemo RT :c/pbleeding, perforate SMB lymphoma -<10, >50 years -terminal ileumobstruct, intuss, perforate Tx -localizesegmental resection 10 cm margin -diffusechemo Appendiceal lymphoma -as appendicitis -incidental finding (from patho) -CT>2.5cm, soft tissue thickening Tx -localizeappendectomy -caecum/mesentery extensionRHC+CMT Colorectal lymphoma -rare -caecum -bleeding, obstruction (as adenoca) Tx -localizesx resection+CMT -advancedCMT Pancreatic lymphoma -vague abdo pain, wt loss (as adenoca) -large mass, many LN -biopsyEUS, percutaneous, laparo Bx Tx -CMTstd Tx -stenting if OJ (Sx is not indicated) Post transplant lymphoma -95%B cell lymphoma -riskimmunosup drug, anti T cell, EBV Tx -dec dose immunosup drug -CMT, anti CD20 Breast lymphoma -<40 Burkitt, >40 yearB cell lymphoma Tx -localizelumpectomy/mastectomy -recur/advancedchemo RT Thyroid lymphoma -B cell lymphoma -chronic lymphocytic / Hashimoto thyroiditis -DxFNAB Tx -chemo RT -lobectomy +/- LNDfail chemo RT CNS lymphoma -1 or 2 -s/p transplant, HIV patient -CThyperdense lesion with enhancement -Dxstereotactic needle Bx Tx -steroidwhole brain RT+CMT -+/- intrathecal MTX (Sx is not indicated)