Framing lymphomas for clinical reasoning: a Herculean task given long list of diseases in our world of molecular biology.
Here's my first attempt at a summary:
1/11
Here's my first attempt at a summary:
1/11
Word on Classification:
🔬 Previously, a lymphoid neoplasm of the marrow/blood = leukemia, solid lymph node (LN) neoplasm = lymphoma
🔬 However, any "lymphoma" can evolve into a "leukemia," & vice-versa
🔬 Now, the WHO classifies lymphoid neoplasms based on cell of origin!
2/11
🔬 Previously, a lymphoid neoplasm of the marrow/blood = leukemia, solid lymph node (LN) neoplasm = lymphoma
🔬 However, any "lymphoma" can evolve into a "leukemia," & vice-versa
🔬 Now, the WHO classifies lymphoid neoplasms based on cell of origin!
2/11
Hodgkin Lymphoma:
What?
🦉 Reed-Sternberg B-cells
🦉 Contiguous LN spread
🦉 Excellent prognosis
Presentation?
🦉 Common: LAD, mediastinal mass, B-symptoms (<20% if stage I/II, ~50% if stage III/IV)
🦉 Uncommon: diffuse pruritis (10-15%), ETOH-associated bone pain (<10%)
3/11
What?
🦉 Reed-Sternberg B-cells
🦉 Contiguous LN spread
🦉 Excellent prognosis
Presentation?
🦉 Common: LAD, mediastinal mass, B-symptoms (<20% if stage I/II, ~50% if stage III/IV)
🦉 Uncommon: diffuse pruritis (10-15%), ETOH-associated bone pain (<10%)
3/11
Labs may show:
🦉 Eosinophilia (IL-5 secretion)
🦉 Hypercalcemia (calcitriol production vs. bone involvement)
🦉 Anemia (marrow infiltration vs. hypersplenism vs. Coombs (+) hemolysis +/- ITP)
4/11
🦉 Eosinophilia (IL-5 secretion)
🦉 Hypercalcemia (calcitriol production vs. bone involvement)
🦉 Anemia (marrow infiltration vs. hypersplenism vs. Coombs (+) hemolysis +/- ITP)
4/11
Non-Hodgkin Lymphomas:
What?
🟢 Diverse group of Non-Hodgkin lymphoid neoplasma, including progenitors of B/T-cells, & mature B/T/NK-cells
🟢 Non-contiguous spread
5/11
What?
🟢 Diverse group of Non-Hodgkin lymphoid neoplasma, including progenitors of B/T-cells, & mature B/T/NK-cells
🟢 Non-contiguous spread
5/11
Presentation?
🟢 Peripheral LNs: LAD, B-symptoms
🟢 Chest: pleural/pericardial effusions, mediastinal mass c/b SVC syndrome, lung parenchymal infiltrates
🟢 Abd & Pelvis: RP/mesenteric/pelvic LAD c/b chylous ascites, obstructions (ureteral/bowel)
6/11
🟢 Peripheral LNs: LAD, B-symptoms
🟢 Chest: pleural/pericardial effusions, mediastinal mass c/b SVC syndrome, lung parenchymal infiltrates
🟢 Abd & Pelvis: RP/mesenteric/pelvic LAD c/b chylous ascites, obstructions (ureteral/bowel)
6/11
🟢 Extranodal: GI tract (inflammation, perforation) > liver/spleen (diffuse HSM) > skin (rash), testis (mass), bone (pain/swelling, fracture) > CNS (epidural SCC, nerve infiltration, primary CNS lymphoma)
🟢 Intravascular: extremely rare, rapid progressive neuro deficits
7/11
🟢 Intravascular: extremely rare, rapid progressive neuro deficits
7/11
🟢 Presentation therefore depends on site of involvement, which also varies based on subtype of Non-Hodgkin lymphoma
Note: DLBCL is most common subtype to cause Extranodal disease
8/11
Note: DLBCL is most common subtype to cause Extranodal disease
8/11
Epi?
🟢 B-cell subtypes = more common (~25% DLBCL, ~20% follicular, ~10% marginal)
🟢 T-cell subtypes = less common (<15% peripheral T cell, which is a diverse group of generally aggressive neoplasms)
🟢 Many more specific subtypes out there!
9/11
🟢 B-cell subtypes = more common (~25% DLBCL, ~20% follicular, ~10% marginal)
🟢 T-cell subtypes = less common (<15% peripheral T cell, which is a diverse group of generally aggressive neoplasms)
🟢 Many more specific subtypes out there!
9/11
Let me know how to make this framework better! Numerous approaches to this very complicated topic...
10/11
10/11
Ref:
1) #H2" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
2) #H8" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
3) ncbi.nlm.nih.gov
11/11
1) #H2" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
2) #H8" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
3) ncbi.nlm.nih.gov
11/11
@MatthewHoMD, really hoping you'll help me out with this one 😂
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