Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and cause the characteristic clinical features of lymphadenopathy.
Occasionally, they may spill over into blood (‘leukaemic phase’) or infiltrate organs outside the lymphoid tissue.
The major subdivision of lymphomas is into Hodgkin lymphoma and non -Hodgkin lymphoma and this is based on the histological presence of Reed – Sternberg (RS) cells in Hodgkin lymphoma.
The disease can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. The following symptoms are common.
The diagnosis is made by histological examination of an excised lymph node. Th e distinctive multinucleate polyploid RS cell is central to the diagnosis of the four classic types and mononuclear Hodgkin cells are also part of the malignant clone. Th ese cells stain with CD30 and CD15 but are usually negative for B – cell antigen expression. Inflammatory components consist of lymphocytes, neutrophils, eosinophils, plasma cells and variable fi brosis. CD68 detects infi ltrating macrophages and, if strongly positive, is an unfavourable feature.
Histological classification is into four classic types and nodular lymphocyte predominant disease, each of which implies a different prognosis. Nodular sclerosis and mixed cellularity are most frequent. Patients with lymphocyte rich histology have the most favourable prognosis of classic Hodgkin lymphoma. Nodular lymphocyte predominant does not show RS cells and has many features of non – Hodgkin lymphoma and may be treated as
Treatment is with radiotherapy, chemotherapy or a combination of both. The choice depends primarily on the stage although histological grading is an additional factor. Semen storage, if appropriate, should be carried out before therapy is begun.
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