Yes

1. Dr. PILIP . GEVAO
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2. Outlines
 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
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3. Introduction of lymphoma
 The lymphomas are
malignant tumors of
lymphoid tissue
,characterized by the
abnormal proliferation B or
T cells in lymphoid tissue .
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4. Classification of lymphoma
lymphoma
Hodgkin’s
lymphoma
Non
hodgkin’s
lymphoma
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5. Hodgkin’s lymphoma
 Introduction:
- 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 . Late in the course of the disease,
vascular invasion leads to widespread hematogenous
dissemination.
-Hodgkin lymphoma has a bimodal age distribution with
one peak in the 20s and 30s, and a second peak over the age
of 50. 5

6. 6

7. Pathological classification of
hodgkin’s lymphoma
Lymphocyte predominant
Nodular sclerosing
Mixed cellularity (neutrophils,
eosinophils, plasma cell)-common
Lymphocyte depleted
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8. Symptoms of hodgkin’s lymphoma:
 General symptoms:
I. Fever
II.Weight loss
III.Loss of appetite
IV.Night sweats
V.Pruritus
VI.lethargy
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9.  Local symptoms:
I.Enlarged, painless, non-tender, superficial
lymph nodes
II.Alcohol-induced pain ‫ــــ‬Rarely, 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. The mechanism is unknown.
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10.  Symptoms related to mass:
1. Mediastinal mass:
retrosternal chest pain, cough, or shortness
of breath.
2. Retroperitoneal lymphadenopathy
discomfort and pain in the paravertebral or
loin regions, particularly in the supine
position.
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11.  Signs of HL:
1. Lymph node enlargement
2. Cachexia
3. Anemia
4. Splenomegaly
5. Hepatomegaly
6. Jundice. rarely
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12. Diagnosis
BLOOD:
(FBC, Film, ESR, LFT, LDH, Urate , Ca.)
Lymph node excision biopsy , image
guided needle biopsy.
Chest X-ray, CT of thorax, abdominal,
pelvis
and bone marrow biopsy‫ـــــــ‬staging of
HL 12

13. lymphomas
 Defines extent of disease; determines therapy and prognosis
 Based on physical, radiologic examination, bone marrow biopsy and
aspiration
 Ann Arbor Staging system
 B symptoms- fever, weight loss > 10% body weight, night sweats
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14. staging
I. Confined to single lymph node region
II. Involvement of two or more nodal areas on
the same side of the diaphragm
III. Involvement of nodes on both sides of
diaphragm.
IV. Spread beyond the lymph nodes e.g. liver
or bone marrow.
each stage is subdivided into A and B
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15. Management
 I-A and II-A :
Radiotherapy & short course of
chemotherapy ( ABVD: Adriamycin,
Bleomycin, 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 15

16. Complications of treatment
 Due to radiotherapy:
Second malignancies-solid tumors ,
Hypothyroidism and lung fibrosis
 Due to chemotherapy:
Myelosupperssion, nausea, infection,
alopecia and AML
 Due to both of them :
NHL & infertility
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17. Prognosis of HL
Depends on stage :
>95% in I-A of HL ‫ــــــــ‬5-year survival
<40% with IV-B of HL ‫ــــــــ‬ 5-year
survival
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18. Systemic involved
Skin lesions — A variety of skin lesions
have been associated with Hodgkin
lymphoma.
 These include ichthyosis, acrokeratosis ,
urticaria, erythema multiforme, erythema
nodosum, necrotizing lesions,
hyperpigmentation, and skin infiltration
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19. ichthyosis
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20. acrokeratosis
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21. urticaria
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22. Erythema nodosum
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23. Hyperpigmentation of skin
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24. necrotizing lesion
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25.  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. The usual pathologic pattern is that of
minimal change disease but focal
glomerulosclerosis, which represent a more
severe manifestation of the same pathologic
process, also can occur 25

26. Hodgkin’s lymphoma
 splenic involvement
Risk factors for splenic involvement
 B symptoms
 Mixed cellularity or lymphocytic depletion
histology,
 Age greater than or equal to 40 years
 Two or more supradiaphragmatic sites
 Male sex
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27. Hodgkin’s lymphoma
 Neurology system :
These include paraneoplastic
cerebellar degeneration, chorea,
neuromyotonia, limbic encephalitis,
subacute sensory neuronopathy, , and
subacute lower motor neuronopathy.
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28. Non-hodgkin’s lymphoma
 This is lymphoma without of Reed-
Sternberg cell.
 B lymphocyte more than T lymphocyte.
 The extranodal involvement is
common,more than HL.
 Causes of it’s congential and acquired
immunodeficiency e.g drugs , HIV
infection, H.pylori infection, HTLV-1
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29.  Lymphomas may be grouped by how quickly they
are likely to grow:
 Indolent (also called low-grade) lymphomas grow
slowly. They tend to cause few symptoms.
 Aggressive (also called intermediate-grade and high-
grade) lymphomas grow and spread more quickly.
They tend to cause severe symptoms. Over time,
many indolent lymphomas become aggressive
lymphomas.
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30. 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
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31.  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
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32. Clinical manifestations : as HL
Diagnosis :
 Blood
 Lymph node excision biopsy , image guided needle
biopsy.
 Chest X-ray, CT of thorax, abdominal, pelvis
and bone marrow biopsy‫ـــــــ‬staging of NHL
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33. 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 II: The lymphoma cells are in at least two lymph
node groups on the same side of the. Diaphragm Or, the
lymphoma cells are in one part of an organ and the lymph
nodes near that organ (on the same side of the diaphragm).
 Stage III: The lymphoma is in lymph nodes above and
below the diaphragm. It also may be found in one part of a
tissue or an organ near these lymph node groups.
 Stage IV: Lymphoma cells are found in several parts of one
or more organs or tissues (in addition to the lymph nodes).
Or, it is in the liver, blood, or bone marrow
each stage is subdivided into A and B 33

34. Treatment grade
Low grade
Without
symptoms
Watchful
waiting
With
symptoms
localizes
Radiotherapy
diffuse
Radiotherapy
chemotherapy &
biological therapy
High grade
Chemotherapy
(CHOP)
,biological
therapy
&Radiotherapy
Relapse
disease
High dose of
chemotherapy &stem
cell transplanted
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35. prognosis
Increased age, advanced stage,
concomitant disease, raised LDH and T
cell lymphoma are poor prognostic
signs
5-years survival for treated patients
> 50% for low grade
30% for high grade
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36. 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
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37. Types of stem cell transplantation
 Autologous stem cell transplantation: This type
of transplant uses your own stem cells. Your stem cells are
removed before high-dose treatment. The cells may be treated to
kill lymphoma cells that may be present. The stem cells are
frozen and stored. After you receive high-dose treatment, the
stored stem cells are thawed and returned to you.
 Allogeneic stem cell transplantation: Sometimes
healthy stem cells from a donor are available. Your brother, sister,
or parent may be the donor. Or the stem cells may come from an
unrelated donor. Doctors use blood tests to be sure the donor's
cells match your cells.
 Syngeneic stem cell transplantation: This type of
transplant uses stem cells from a patient's healthy identical twin.
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38. source of stem cell transplantation
 Bone marrow
 Peripheral blood stem cell
 Umbilical cord blood
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39. 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
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40. General prognosis of stem cell
transplantation
 widely dependent upon disease type, stage, stem cell
source.
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41. Thank you
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