This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology

Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

Reem al-mutairi 425201510

 Introduction of lymphoma  Classification of lymphoma  Hodgkin's lymphoma: i. Introduction ii. Symptoms iii. Signs iv. Diagnosis v. Staging vi. Management vii. Complication of treatment viii. Prognosis ix. Systemic involved  non-hodgkin’s lymphoma  Stem cell transplantation

Introduction of lymphoma
 The

lymphomas are malignant tumors of lymphoid tissue ,characterized by the abnormal proliferation B or T cells in lymphoid tissue .

Classification of lymphoma lymphoma Hodgkin’s lymphoma Non hodgkin’s lymphoma .

-Hodgkin lymphoma has a bimodal age distribution with one peak in the 20s and 30s.Hodgkin lymphoma (formerly called Hodgkin's disease) is a group of cancers characterized by Reed-Sternberg cells in an appropriate reactive cellular background. An important clinical feature is its tendency to arise within lymph node areas and to spread in an orderly fashion to contiguous areas of lymph nodes .Hodgkin’s lymphoma  Introduction: . . vascular invasion leads to widespread hematogenous dissemination. Late in the course of the disease. and a second peak over the age of 50.


Pathological classification of hodgkin’s lymphoma Lymphocyte predominant Nodular sclerosing Mixed cellularity (neutrophils. eosinophils. plasma cell)-common Lymphocyte depleted .

Loss of appetite IV.lethargy .Pruritus VI.Night sweats V. Fever II.Symptoms of hodgkin’s lymphoma:  General symptoms: I.Weight loss III.

The mechanism is unknown. non-tender. Enlarged. patients with Hodgkin’s lymphoma complain of severe pain following alcohol ingestion. The pain typically occurs within a few minutes after the ingestion of even a small amount of alcohol. painless. .Alcohol-induced pain ‫ــــ‬Rarely. Local symptoms: I. superficial lymph nodes II.

cough. Symptoms related to mass: Mediastinal mass: retrosternal chest pain. . Retroperitoneal lymphadenopathy discomfort and pain in the paravertebral or loin regions. particularly in the supine position. 1. 2. or shortness of breath.

 Signs of HL: 1. Lymph node enlargement Cachexia Anemia Splenomegaly Hepatomegaly Jundice. 2. 4. 5. rarely . 3. 6.

abdominal.  Chest X-ray. Ca. LFT. LDH. CT of thorax. Urate . Film. image guided needle biopsy. pelvis and bone marrow biopsy‫ـــــــ‬staging of HL .)  Lymph node excision biopsy .Diagnosis  BLOOD: (FBC. ESR.

liver or bone marrow.staging Confined to single lymph node region II.g. Involvement of two or more nodal areas on the same side of the diaphragm III. Involvement of nodes on both sides of diaphragm. . Spread beyond the lymph nodes e. IV. each stage is subdivided into A and B I.

Vinblastine and Dacarbazine)  II-A with more than 3 areas involved through TO IV-B Radiotherapy & long course of chemotherapy  In relapsed disease : high dose of chemotherapy and peripheral stem cell transplantation .Management  I-A and II-A : Radiotherapy & short course of chemotherapy ( ABVD: Adriamycin. Bleomycin.

IHD. infection. alopecia and AML  Due to both of them : NHL & infertility . nausea. Hypothyroidism and lung fibrosis  Due to chemotherapy: Myelosupperssion.Complications of treatment  Due to radiotherapy: Second malignancies-solid tumors .

Prognosis of HL  Depends on stage : >95% in I-A of HL ‫-5ــــــــ‬year survival <40% with IV-B of HL ‫-5 ــــــــ‬year survival .

necrotizing lesions. acrokeratosis (Bazex syndrome). urticaria. erythema multiforme. erythema nodosum. and skin infiltration . These include ichthyosis. hyperpigmentation.Systemic involved  Skin lesions — A variety of skin lesions have been associated with Hodgkin lymphoma.

ichthyosis .

acrokeratosis .

urticaria .

Erythema nodosum .

Hyperpigmentation of skin .

necrotizing lesion .

 Nephrotic syndrome — The nephrotic syndrome can occur as a paraneoplastic syndrome in patients with early stage Hodgkin lymphoma. possibly due to secretion of a toxic lymphokine. such as IL-13. also can occur . The usual pathologic pattern is that of minimal change disease but focal glomerulosclerosis. which represent a more severe manifestation of the same pathologic process.

 Age greater than or equal to 40 years  Two or more supradiaphragmatic sites  Male sex .Hodgkin’s lymphoma  splenic involvement Risk factors for splenic involvement  CS III-IV disease  B symptoms  Mixed cellularity or lymphocytic depletion histology.

. limbic encephalitis.Hodgkin’s lymphoma  Neurology system : These include paraneoplastic cerebellar degeneration. and subacute lower motor neuronopathy. chorea. . neuromyotonia. subacute sensory neuronopathy.

more than HL. HIV infection.g drugs .  B lymphocyte more than T lymphocyte.  The extranodal involvement is common.  Causes of it’s congential and acquired immunodeficiency e.pylori infection .Non-hodgkin’s lymphoma  This is lymphoma without of Reed-Sternberg cell. H.

Diffuse lymphocytic non hodgkin’s lymphoma .

Over time. . They tend to cause few symptoms. They tend to cause severe symptoms. Lymphomas may be grouped by how quickly they are likely to grow:  Indolent (also called low-grade) lymphomas grow slowly. many indolent lymphomas become aggressive lymphomas.  Aggressive (also called intermediate-grade and highgrade) lymphomas grow and spread more quickly.

Low grade non Hodgkin's lymphomas  Small cell lymphocytic  Follicular (it is the most common type of lymphoma)  Mantle cell  Splenic marginal zone lymphoma  MALT lymphoma  Lymphoplasmacytic NHL .

 High grade non Hodgkin's lymphomas  Diffuse large B cell  Diffuse mixed cell lymphoma  Burkitt's lymphoma  Anaplastic large cell lymphoma  Diffuse mixed cell lymphoma .

image guided needle biopsy. abdominal. pelvis and bone marrow biopsy‫ـــــــ‬staging of NHL . CT of thorax.Clinical manifestations : as HL Diagnosis :  Blood  Lymph node excision biopsy .  Chest X-ray.

Stages of NHL :  Stage I: The lymphoma cells are in one lymph node group or in only one part of a tissue or organ (such as the lung).  Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). It also may be found in one part of a tissue or an organ near these lymph node groups. Or. or bone marrow each stage is subdivided into A and B . it is in the liver.  Stage III: The lymphoma is in lymph nodes above and below the diaphragm.  Stage II: The lymphoma cells are in at least two lymph node groups on the same side of the. blood. Diaphragm Or.

biological therapy &Radiotherapy High dose of chemotherapy &stem cell transplanted Relapse disease Watchful waiting localizes diffuse Radiotherapy Radiotherapy chemotherapy & biological therapy .Treatment Low grade Without symptoms With symptoms grade High grade Chemotherapy (CHOP) .

advanced stage. raised LDH and T cell lymphoma are poor prognostic signs  5-years survival for treated patients > 50% for low grade 30% for high grade . concomitant disease.prognosis  Increased age.

Indications for stem cell transplantation          Multiple myeloma Leukemia Lymphoma Sever combined immunodeficiency or congenital neutropenia with defective stem cell. A plastic anemia Sickle cell disease Ewing’s sarcoma Neuroblastoma Myelodysplastic syndrome .

sister. The cells may be treated to kill lymphoma cells that may be present. Doctors use blood tests to be sure the donor's cells match your cells. The stem cells are frozen and stored.  Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient's healthy identical twin.  Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. After you receive high-dose treatment. Or the stem cells may come from an unrelated donor. Your brother. Your stem cells are removed before high-dose treatment.Types of stem cell transplantation  Autologous stem cell transplantation: This type of transplant uses your own stem cells. the stored stem cells are thawed and returned to you. . or parent may be the donor.

source of stem cell transplantation  Bone marrow  Peripheral blood stem cell  Umbilical cord blood .

Complications of stem cell transplantation  Infection  Veno-occlusive disease  Mucositis  Graft-versus-host disease (GVHD) GVHD is an inflammatory disease that is unique to allogeneic transplantation .

stage. .General prognosis of stem cell transplantation  widely dependent upon disease type. stem cell source.

go  WWW.COM . www.cancer.UpToDate.2009 .Referances  National cancer institute.

Thank you .

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