The sencond xiangya hospital,central south university Lymphoma The sencond xiangya hospital,central south university Pei minfei

Definition Neoplasm of the immune system(B-or T-cell), Neoplasm of the lymphoid tissue,usually arising in lymph nodes Hodgkin’s disease(HD)----Reed-Stemberg cell no Hodgkin lymphomas(NHL)---B-or T-cell at different stages of maturation (highly heterogeneous)

Epidemiology 1.The incidence of lymphoma,especially NHL,has been increasing steadily 2.More common in men than women(1.39 vs 0.84 per 100,000, in China),age distribution:20-40 years 3.NHL is more often than HD 4.The incidence of T-cell lymphoma is higher

Etiology 1.Infectious agents:Epstein-barr vinus(EBV); HTLV-1; Helicobacter pylori(Hp)(MALT- lymphoma); Hepatitis C virus(HCV) 2.Chemicals: pesticides,benzene,hair dyes 3.Immunosuppression: AIDS; rheumatoid disease 4.Genetic susceptibility 5.Radiation

Pathobiology and Classification 1.Basic pathobiologic features Proliferation and infiltration of the malignant monoclonal lymphoil cell (2)The normal constructure of the lymph nodes or lymphoid tissue is destroied completely or partially 2.Four subgroups of HD lymphocyte predominant; mixed cellularity; nodular sclerosing; lymphocyte depleted

Clinical manifestations 3.Classification of NHL (1)Working formulation(low、intermediate、high grade) (2)REAL classification(B-cell,T-cell and NK cell neoplasms,HD; indolent,aggressive,very aggressive) Clinical manifestations 1.Painless,progressive lymph node enlargement regions:cervical,supraclavicular,axillary,inguinal, epitrochlear nature:nontender, firm, rubbery, bulky rare phenomena: wax and wane,lymph node pain after ingestion of alcoholic beverages

2.Obstruction and/or infiltration symptoms(extra- nodal involvement) 3.Systemic symtoms: fever,night sweats,weight loss(B symptoms); fatigue,pruritus,cytopenia 4.Difference between HD and NHL The main difference is that of the pathobiology. The other difference appears in age,primary regions,spread methods,extranodal involvement, prognosis et al.

Laboratory examination 1.Complete blood counts 2.Blood chemistries:ESR,LDH,-MG,AKP,Ig, EBV-Ab,Coombs’test 3.Bone marrow aspiration and biopsy 4.Imaging studies:X-ray,ultrasonography,CT,MRI 5.Biopsy of the enlarged lymph node and/or suspected tissue 6.Others:lumbar pucture,abdominocentesis, thoracocentesis,endoscope,laprotomy

Dignosis and Diffrential Dignosis 1.Dignosis is established on the pathomorphology and immunopathology 2.Diffrential Dignosis (1)lymph node enlargment (2)fever of unknown origion (3)benign or malignant diseases of organs or tissue

Staging—Ann Arbor Staging Classification Ⅰ and Ⅱ:on the same side of the diaphragm Ⅲ: on the both sides of the diaphragm Ⅳ: diffuse or disseminated involvement group A group B Ⅰ

Treatment 1.Radiotherapy: (1)Radiotherapy fields: mantle—cervical,supraclavicular, infraclavicular,axillary,mediastinal,hilar nodes; inverted Y— paraaortic plus pelvic; subtotal nodal irradiation(SNI)= mantle plus paraaortic; total nodal irradiation(TNI)= mantle plus inverted Y; limited field irradiation (2)Indication: the patients of HD at ⅠA-ⅡA stages; some patients with low-grade NHL; limited field radiation for some patients with lymphomas

2.Chemotherapy (1)Indication: the patients who are not suitable to radiotherapy (2)Regiems: HD—ABVD,MOPP; NHL—CHOP 3.Immunotherapy a-Interferon; Anti-idiotype antibodies(such as Rituximab); radioimmunotherapy; immunotoxin 4.Surgery 5.HSCT autologous bone marrow transplantation allogenic blood stem cell

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