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

2. 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)

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

13. 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

14. Thanks!