Malignant lymphomas, including Hodgkin’s disease: Diagnosis, management, and special problems

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Additionally, your doctor uses the letters A and B to indicate whether you're experiencing symptoms of non-Hodgkin's lymphoma:.

Hodgkin’s lymphoma - Hodgkin’s Disease - Reed-Sternberg Cell

Many types of non-Hodgkin's lymphoma exist, including rare forms that are difficult for inexperienced pathologists to identify. Accurate diagnosis and staging are key to developing a treatment plan. Research shows that review of biopsy tests by pathologists who aren't experienced with lymphoma results in a significant proportion of misdiagnoses.

Get a second opinion from a specialist if needed.

Lymphoma - Hodgkin: Diagnosis |

Which non-Hodgkin's lymphoma treatments are right for you depends on the type and stage of your disease, your overall health, and your preferences. If your lymphoma appears to be slow growing indolent , a wait-and-see approach may be an option. Indolent lymphomas that don't cause signs and symptoms may not require treatment for years. Delaying treatment doesn't mean you'll be on your own. Your doctor will likely schedule regular checkups every few months to monitor your condition and ensure that your cancer isn't advancing.

If your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:. Chemotherapy is a drug treatment — given orally or by injection — that kills cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or combined with other treatments. Side effects of chemotherapy depend on the drugs you're given. Common side effects are nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine directs radiation at precise points on your body. Radiation therapy can be used alone or in combination with other cancer treatments.

During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body.

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Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease. A typical treatment plan might have you going to the hospital or clinic five days a week for several weeks, where you undergo a minute radiation treatment at each visit. Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility, and other cancers, such as breast or lung cancer.

Bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow.

Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow. For example, one biological therapy called rituximab Rituxan is a type of monoclonal antibody that attaches to B cells and makes them more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.

Also, a drug called ibrutinib Imbruvica has been approved by the Food and Drug Administration FDA for some people undergoing treatment for non-Hodgkin's lymphoma. Radioimmunotherapy drugs are made of monoclonal antibodies that carry radioactive isotopes. This allows the antibody to attach to cancer cells and deliver radiation directly to the cells. An example of a radioimmunotherapy drug used to treat non-Hodgkin's lymphoma is ibritumomab tiuxetan Zevalin.

Clinical research studies clinical trials may be an option for people whose disease has not been controlled by other treatment options. Ask your doctor about possible clinical trials for your type of non-Hodgkin's lymphoma.

Primary non-Hodgkin's lymphoma of the mandible presenting following tooth extraction

However, this diagnostic technique is now used less frequently than in the past, since it has been largely replaced by CT scanning of the pelvic and abdominal regions. A procedure known as a bone marrow biopsy may also be recommended to help determine whether the malignancy involves the bone marrow. During this procedure, a sample of bone marrow is obtained, usually from the hipbone iliac crest.

Skin and tissue over the bone is first numbed with local anesthetic, and a needle is inserted into the bone through which a bone marrow sample is withdrawn. The sample is then examined under a microscope by a pathologist. Because a bone marrow biopsy may be painful, a mild, calming sedative medication may be offered before the procedure is conducted. In such cases, analysis of cerebrospinal fluid CSF may reveal certain abnormalities of chemical content as well as the presence of cancerous cells.

CSF is a watery fluid that flows through and protects the cavities ventricles of the brain; the space i. CSF is obtained for analysis by a procedure known as a lumbar puncture. During the procedure, skin and overlying tissue at the base of the spine is numbed with local anesthetic; a needle is then inserted between certain bones in the lower back and a sample of CSF is removed. In some cases, physicians may recommend other testing procedures to help assess the extent of disease and to follow treatment.

In addition, tests may be required to help evaluate the health and functioning of certain organs that may potentially be adversely affected due to certain treatments e. For example, such tests may include certain procedures to evaluate functioning of the heart and lungs. As mentioned above, the diagnosis of different forms of NHL requires the removal biopsy and microscopic histologic examination of tissue cells from lymph nodes or other tissues suspected of being cancerous.

Such evaluation is necessary to help differentiate MCL from other malignancies, including different forms of NHL and Hodgkin's disease, as well as other diseases that may affect the lymph nodes. For further information, please see the "Related Disorders" section of this report above.

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For individuals with MCL, microscopic evaluation of biopsy samples may reveal abnormalities of the normal structure architecture of the lymph nodes, such as expansion of the region of the lymph node known as the mantle zone. The outer region or cortex includes groups of lymphocytes known as follicles; regions known as germinal centers are at the center of the follicles. Germinal cells are primarily B-lymphocytes. Microscopic analysis also enables pathologists to determine additional histologic features that may be important in the malignancy's classification, such as size of malignant lymphocytes, appearance of the nucleus within a lymphoma cell, distribution or pattern of the abnormal cells, etc.

In addition, specialized studies are conducted to help determine the malignancy's specific cell type of origin. For example, MCL cells—and the normal cells from which the malignancy develops—produce distinctive proteins antigens that may promote an antibody response e. They also may express certain antibodies on their outer surfaces e.

Thus, testing to identify such markers assists in determining the normal cells from which the malignancy derived, helping to distinguish MCL from other B-cell lymphomas and aiding in diagnosis and disease management decisions. Additional specialized tests may also be conducted on biopsy samples to assist in a diagnosis of MCL. These may include studies to detect the presence of the chromosome 11;14 translocation in malignant lymphocytes and the cyclin D1 protein.

For further information, please see the "Causes" section of this report above. As discussed above, non-Hodgkin's lymphomas NHLs may be broadly classified into B-cell and T-cell lymphomas based upon the cell type of origin. Several systems of identification have been proposed based upon certain or all of these elements. For example, NHLs may be divided into two major categories based upon growth pattern of a malignancy within a lymph node. In so-called follicular or "nodular" lymphomas, cells appear clustered together within the lymph node into distinctive nodules or follicles.

In diffuse lymphomas, there is widespread infiltration of the malignancy throughout the lymph node in an unorganized pattern. NHLs may also be categorized based upon malignant cell size as well as the appearance of a malignant cell's nucleus. The nucleus is the round, membrane-bound structure of the center of the cell containing the chromosomes..

For example, in some lymphomas, there may an abnormal indentation in a malignant cell's nucleus; such cells are called "cleaved cells. Thus, according to certain classifications, certain follicular or diffuse lymphomas may be further characterized as small or large cleaved or "noncleaved" lymphomas. In addition, NHL is commonly classified according to a "grading" system e. It is based upon how quickly the malignancy may tend to grow and spread as determined by certain characteristics of the malignancy upon microscopic examination and natural history of the specific disease.

The grading of NHLs is important in determining potential disease course and appropriate treatment approaches. Generally, malignancies comprised of small cells are classified as low grade slow growing. Those consisting of larger cells are generally categorized as intermediate grade or high grade i. Low-grade lymphomas are often called "indolent" lymphomas, since they typically grow relatively slowly and may have few apparent symptoms.

Such lymphomas may tend to be widespread at diagnosis. In addition, in some instances, indolent lymphomas may gradually transform into a combination of indolent and aggressive lymphoma, requiring more aggressive treatment approaches. Evidence indicates that, although indolent lymphomas are rarely completely "cured," affected individuals may have the disease over long periods with a relatively good quality of life.

Intermediate- or high-grade lymphomas are generally categorized as "aggressive lymphomas" since they typically grow quickly and require prompt treatment.

Key Points

With immediate, aggressive treatment, such as intensive combination chemotherapy and other therapies e. In this context, remission indicates the complete or partial disappearance of symptoms and physical signs of cancer or the period during which this occurs. Remissions may be temporary or permanent. Relapse indicates the return of the disease following apparent recovery.

Primary non-Hodgkin's lymphoma of the mandible presenting following tooth extraction

Mantle cell lymphoma MCL has been called by various terms according to different classifications, including diffuse small-cleaved cell lymphoma, centrocytic lymphoma, and lymphocytic lymphoma of intermediate differentiation. However, in , an international consensus conference of experts proposed the name mantle cell lymphoma to help distinguish it more appropriately from other NHLs.

What causes Hodgkin lymphoma in a child?

In individuals with MCL, microscopic evaluation of biopsy samples usually reveals small- to medium-sized lymphocytes that may have slightly irregular or irregular i. Such analysis may also reveal different patterns of malignant cell distribution. Thus, MCL may be further subdivided based upon these distinct growth patterns or "histologic subtypes" , including a so-called mantle-zone pattern, in which malignant cells grow in expanding nodules around germinal centers; a relatively nodular pattern or diffuse pattern of growth throughout the node characterized by small malignant cells with somewhat irregular or "cleaved" nuclei; or a distinctive variant i.

It has been suggested that the mantle-zone subtype may tend to have features of a low-grade indolent lymphoma, whereas the other subtypes may be more aggressive and are appropriately classified as intermediate-grade lymphomas. In addition, evidence suggests that the blastic variant may be most resistant to treatment.