LYMPHOMA

Types, Classification, Steps in

Diagnosis and
Treatment.

Presenters:
Dawn DeNobrega
Demi Moore
Teanna Phillips
 TABLE OF CONTENTS

01 02
Introduction Hodgkin lymphoma (HL)

03 04
Non-Hodgkin lymphoma (NHL) HL VS NHL
 LYMPHOMA
● Lymphoma is a type of cancer that
starts in the lymphatic system.

● It produces white blood cells called

lymphocytes, which fight off
pathogens.

● There are two main types of

lymphocytes: T cells and B cells.

● Lymphoma occurs when these

lymphocytes grow and multiply
uncontrollably.

● Abnormal cells can build up and form

tumors in the lymph nodes.

● Lymph nodes are present throughout

the body.

(Mayo Clinic, 2022)

Types Of Lymphoma

(Hexahealth Care Team, 2023)

Hodgkin’s Lymphoma
 Hodgkin lymphoma (HL)
A cancer that affects the lymphatic system, which is
part of the body's immune system

● It is one of the most curable forms of cancer

● It is named for Dr. Thomas Hodgkin who, in
1832, described several cases of people with
symptoms of cancer involving the lymph nodes.
The disease was called "Hodgkin's disease" until
it was officially renamed "Hodgkin lymphoma" in
the late 20th century.
Updated 19th century portrait of
physician Thomas Hodgkin.
(Geller & Taylor, 2017)
 Hodgkin lymphoma (HL)
Hodgkin lymphoma (disease) is a malignancy that most often arises in lymph nodes and
is characterized by the presence of Reed-Sternberg cells and variants with a
background of varying numbers of benign lymphocytes, plasma cells, histiocytes, and
eosinophils (American Cancer Society, 2021).
 Hodgkin lymphoma (HL)
Hodgkin lymphoma can start in lymph tissue

anywhere in the body.

 Types of Hodgkin lymphoma (HL)
There are two types of Hodgkin lymphoma:

1. Classical Hodgkin lymphoma (accounts for approximately 95% of all HL and

sub-divided into 4 types)
● Nodular Sclerosis Hodgkin Lymphoma (NSHL)
● Mixed cellularity Hodgkin Lymphoma (MCHL)
● Lymphocyte-rich Hodgkin Lymphoma (LRHL)
● Lymphocyte-depleted Hodgkin Lymphoma (LDHL)

2. Nodular lymphocyte-predominant Hodgkin Lymphoma (NLP-HL)

 Classical Hodgkin Lymphoma Subtype
Nodular Sclerosis Hodgkin Lymphoma (NSHL)

● It's most common in teens and young adults, but it can occur in people of any age. It
tends to start in lymph nodes in the neck or chest.
● It is characterized by the presence of nodular sclerosing bands within the affected
lymph nodes.
● Symptoms include Persistent fatigue, Fever, especially at night, Unexplained weight
loss, Itchy skin or rash and Pain or discomfort in the lymph node areas after
consuming alcohol.
● Treatment typically involves chemotherapy and radiation therapy and in some cases
targeted therapy.
 Classical Hodgkin Lymphoma Subtype
Diagram showing Nodular Sclerosis Hodgkin Lymphoma (NSHL)
 Classical Hodgkin Lymphoma Subtype
Mixed cellularity Hodgkin Lymphoma (MCHL)

● This is the second most common, occurring in approximately 40% of cases. This type is
frequently found in individuals who are infected with HIV, as well as in children or elderly
persons.
● It may begin in any lymph node, but it typically appears in the upper half of the body and
characterized by a mixed cellular composition with numerous inflammatory cells and
Reed-Sternberg cells.
● Symptoms include Enlarged lymph nodes, commonly in the upper body, Fatigue and
weakness, Fever and chills, Night sweats, Unexplained weight loss, Itchy skin.
● Chemotherapy is the primary treatment approach for MCHL.
Classical Hodgkin Lymphoma Subtype
Diagram showing Mixed cellularity Hodgkin Lymphoma (MCHL)
 Classical Hodgkin Lymphoma Subtype
Lymphocyte-rich Hodgkin Lymphoma (LRHL)

● This specific subtype is uncommon and typically affects the upper half of the body. It
usually only appears in a few lymph nodes.
● LRHL is characterized by a predominance of lymphocytes and few Reed-Sternberg
cells.
● Symptoms include enlarged but painless lymph nodes, typically in the neck, armpits, or
groin, Fatigue, Night sweats, Unexplained weight loss, Itchy skin, Fever.
● Treatment may involve radiation therapy or chemotherapy.
Classical Hodgkin Lymphoma Subtype
Diagram showing Lymphocyte-rich Hodgkin Lymphoma (LRHL).
 Classical Hodgkin Lymphoma Subtype
Lymphocyte-depleted Hodgkin Lymphoma (LDHL)

● This is a rare type of Hodgkin's disease, which is typically observed in elderly individuals and
people infected with HIV.
● It is more aggressive than other forms of HL and is likely to be diagnosed at an advanced stage
characterized by a scarcity of lymphocytes and a high number of Reed-Sternberg cells. Generally,
it affects lymph nodes in the abdomen, as well as in the spleen, liver, and bone marrow.
● Symptoms: Rapidly growing painless lymph nodes, fever, night sweats, weight loss, fatigue, loss of
appetite, itchy skin, shortness of breath or cough.
● It is often diagnosed at an advanced stage and requires intensive chemotherapy or stem cell
transplantation for treatment.
 Classical Hodgkin Lymphoma Subtype
Diagram showing Lymphocyte-depleted Hodgkin Lymphoma (LDHL)
 Types of Hodgkin lymphoma (HL)

2. Nodular lymphocyte-predominant (NLP-HL).

● Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a type of cancer

that accounts for approximately 5% of cases.

● The cancer cells in NLPHL are large popcorn-like cells, also known as lymphocytic
and histolytic (L&H) cells, which are variants of Reed-Sternberg cells.
 Types of Hodgkin lymphoma (HL)
● This type of HL is commonly found in the lymph nodes under the arm and in the
neck and can affect people of any age, although men are more likely to get it than
women.

● Symptoms: Fatigue and weakness, Night sweats, Unexplained weight loss, Fever
(less common compared to CHL), Itchy skin.

● Treatment may include radiation therapy or observation, as it tends to have a good

prognosis.(American Cancer Society, 2021).
Types of Hodgkin lymphoma (HL)
Non-Hodgkin Lymphoma
 Non-Hodgkin Lymphoma (NHL)

● Non-Hodgkin lymphomas are a large group of clonal lymphoid

tumors.
● Approximately 85% are of B-cell origin and 15% derive from T or NK
cells.
● The Non-Hodgkin lymphomas are divided into low-grade and
high-grade disease.
● Low-grade disorders are typically slowly progressive, respond well to
chemotherapy but are difficult to cure.
● High-grade lymphomas are aggressive and need urgent treatment
but are more often curable.
(A Victor Hoffbrand & Moss, 2016)
 Non-Hodgkin Lymphoma (NHL)

● The Low-grade non-Hodgkin lymphoma includes:

- Lymphoplasmacytoid lymphoma (Waldenström’s macroglobulinemia)
- Marginal zone lymphomas
- Follicular lymphoma
- Mantle cell lymphoma
 Lymphoplasmacytoid lymphoma (Waldenström’s macroglobulinemia)
● This condition is quite uncommon but tends to be most
frequent in men over 50 years of age.
● It arises from the post-germinal center B cell and has the
characteristics of an IgM-bearing memory B cell.
● Common symptoms include fatigue and weight loss.
● There is no required treatment for patients who are
asymptomatic, but treatment should begin if a patient
presents features like organomegaly, symptomatic anemia,
Microscopic image showing
or hyperviscosity. Lymphoplasmacytoid lymphoma
● A combination treatment with an anti- CD20 antibody and associated with Waldenström’s
macroglobulinemia.
chemotherapy is given
 Marginal Zone Lymphomas

● Arise from the marginal zone of B-cell germinal

follicles.
● Mucosa-associated lymphoid tissue (MALT)
lymphomas normally arise from the respiratory
tract, salivary glands, stomach, and skin.
● Splenic marginal zone lymphoma is associated
with circulating “villous” lymphocytes.
● Local radiotherapy is used to cure the localized Microscopic image showing Gastric
stage of the disease. mucosa-associated lymphoid tissue
(MALT) lymphoma
 Follicular Lymphoma

● This type of disease is associated with translocation of

t(14;18) in the majority of the cases.
● Patients that have stage I of the disease may achieve a
cure with radiotherapy alone.
● Persons who have stage II–IV of the disease and are
asymptomatic are not treated until complications occur.
● The therapy is based on monthly courses of rituximab in
Microscopic image showing
combination with cyclophosphamide, vincristine, and follicular lymphoma
prednisolone (R-CVP), with an anthracycline added for
patients with more aggressive cases.
 Mantle cell Lymphoma
● The mantle cell lymphoma arises from the pre-germinal center cells that are localized in the
primary follicles or in the mantle region of secondary follicles.
● The t(11;14) translocation, which connects the cyclinD1 gene to the immunoglobulin
heavy-chain gene, results in enhanced cyclin D1 expression.
● Some of the clinical presentations include lymphadenopathy, and oftentimes there is bone
marrow infiltration.
● There are three treatment regimes that are used: chemotherapy, bortezomib and Ibrutinib

Microscopic image showing Mantle

cell lymphoma
 Non-Hodgkin Lymphoma (NHL)

The High-grade non-Hodgkin lymphoma includes:

- Diffuse large B-cell lymphomas (DLBCL)
- Burkitt lymphoma
- Primary central nervous system lymphoma
- Lymphoblastic lymphomas
 Non-Hodgkin Lymphoma (NHL)

T cell High-grade non-hodgkin lymphoma includes:

- Peripheral T-cell non-Hodgkin lymphoma

- Angioimmunoblastic lymphadenopathy
- Mycosis fungoides
- Sézary syndrome
- Enteropathy-associated T-cell lymphomas
- Anaplastic large cell lymphoma
 Diffuse large B-cell lymphomas (DLBCL)

● The DLBCL can be diagnosed by the presence of large

tumor cells with prominent nuclei that are subdivided
into ‘germinal center’ (GCB) and ‘activate B cell’ (ACB).
● Clinical presentations include rapid progressive
lymphadenopathy.
● The ideal treatment is rituximab in combination with the
CHOP chemotherapy regimen, which includes Microscopic image showing diffuse
cyclophosphamide, hydroxydaunorubicin, vincristine large B-cell lymphoma which
(Oncovin), and prednisolone. stains positive for CD10
 Burkitt Lymphoma
● Endemic Burkitt lymphoma is most commonly seen in areas that are
exposed to chronic malaria and is associated with the Epstein-Barr
virus (EBV) infection.
● Children are the ones mostly affected, and they present with
massive lymphadenopathy of the jaw that is very responsive to
chemotherapy.
● Sporadic Burkitt lymphoma occurs anywhere, and the EBV infection
is seen in 20% of cases, with a high incidence in patients affected by
HIV.
● Chemotherapy regimes that include high doses of methotrexate,
cytosine arabinoside, and cyclophosphamide have a very good
prognosis.
 Primary central nervous system lymphoma

● Primary central nervous system (CNS) lymphoma is a

disease in which malignant (cancer) cells form in the
lymph tissue of the brain and/or spinal cord.
● This type of lymphoma is classified as a rare tumor that
is seen in older patients and people who have HIV.
● Treatment is done using high doses of methotrexate
and cytosine arabinoside.
● Whole-brain radiotherapy is also considered a form of
treatment.
 Lymphoblastic lymphomas

● B- or T-cell lymphoblastic lymphomas are often seen in children and young

adults.
● This type of lymphoma is clinically and morphologically merged with acute
lymphoblastic leukemia (ALL).
● In ALL cells, terminal transference is positive, while in B and T cell lymphoblastic
lymphomas, the test is negative.
● Treatment protocols are the same.
 T cell High-grade non-hodgkin lymphoma
Peripheral T-cell ● Derives from T cells at various differentiation stages.
non-Hodgkin lymphoma ● Patients presenting with this type of lymphoma are treated with
combined chemotherapy.

Angioimmunoblastic ● Prevalent in elderly patients who have lymphadenopathy,

lymphadenopathy hepatosplenomegaly, skin rashes, and a polyclonal increase in serum
IgG.
● These patients can be treated with either chemotherapy or histone
deacetylase inhibitors.

Mycosis fungoides ● Presented with severe pruritus and psoriasis-like lesions that affect deep
organs.
● Patients with this type of chronic cutaneous T-cell lymphoma are treated
with either chemotherapy or phototherapy.
 T cell High-grade non-hodgkin lymphoma
Sézary syndrome ● Patients present with dermatitis, lymphadenopathy, erythroderma, and
circulating T-lymphoma cells that are CD4+ and appear to have a folded
nuclear chromatin.
● Treatment begins with topical chemotherapy or photochemotherapy.

Enteropathy-associated ● Linked to coeliac disease and tends to respond poorly to treatment.

T-cell lymphomas ● To date, trials using high-dose methotrexate and autografts are ongoing.

● Frequently found in children

● Normally associated with t(2;5) (p23;q35) translocation, which leads to the
Anaplastic large cell
overexpression of anaplastic lymphoma kinase (ALK).
lymphoma
● Crizotinib is a selective inhibitor of ALK activity, it is an effective treatment.
SUMMARY HL VS. NHL
 References

● A Victor Hoffbrand, & Moss, P. A. H. (2016). Hoffbrand’s essential haematology (7th ed., pp. 205–213, 214–227).
John Wiley & Sons.
● American Cancer Society. (2021). Hodgkin lymphoma. Retrieved from
https://www.cancer.org/cancer/hodgkin-lymphoma.html
● Geller, S. A., & Taylor, C. R. (2017). Hodgkin, Thomas (1798–1866). Encyclopedia of Pathology, 251–257.
https://doi.org/10.1007/978-3-319-41995-4_547
● Hexahealth Care Team. (2023, December 15). Difference between Hodgkin and Non Hodgkin Lymphoma.

Www.hexahealth.com. https://www.hexahealth.com/blog/difference-between-hodgkin-and-non-hodgkin-lymphoma

● Mayo Clinic. (2022, December 14). What is lymphoma? An expert explains. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/lymphoma/multimedia/vid-20522470#:~:text=There%20are%20two

%20types%20of
 References

● Klimm, B., Goergen, H., Fuchs, M., von Tresckow, B., Böll, B., Meissner, J., Glunz, A., Diehl, V.,
Eich, H. T., Engert, A., & Borchmann, P. (2013). Impact of risk factors on outcomes in early-stage
Hodgkin's lymphoma: an analysis of international staging definitions. Annals of oncology : official
journal of the European Society for Medical Oncology, 24(12), 3070–3076.
https://doi.org/10.1093/annonc/mdt413

● American Cancer Society. (2021). Hodgkin lymphoma. Retrieved from

https://www.cancer.org/cancer/hodgkin-lymphoma.html
 References

● PDQ Pediatric Treatment Editorial Board. Childhood Hodgkin Lymphoma Treatment (PDQ®):
Health Professional Version. 2023 Dec 18. In: PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-. [Table], Table 6. Chemotherapy
Regimens for Children and Adolescents With Hodgkin Lymphoma. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK65726/table/CDR0000062933__578/

● Hodgkin lymphoma. National Comprehensive Cancer Network.

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439. Accessed March. 15,
2021.
 References

● Hodgkin lymphoma. National Comprehensive Cancer Network.

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439. Accessed March. 15,
2021.
● Adult Hodgkin lymphoma treatment (PDQ) — patient version. National Cancer Institute.
https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq. Accessed March.
15, 2021.
● Kaseb H, Babiker HM. Hodgkin Lymphoma. [Updated 2023 June 26]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499969/