Updated: 1/28/2019

Non-Hodgkin Lymphoma

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Introduction
  • A neoplasia of lymphoid cells
  • Subtypes of NHL include (from large to small cell)
    • diffuse B-cell lymphoma
    • Burkitt lymphoma
    • follicular lymphoma
    • marginal zone lymphoma
    • mantle cell lymphoma
  • Prognosis
    • small cell NHLs typically have a better prognosis than large cell because a cell becomes small with differentiation
Diffuse Large B-cell Lymphoma
  • Introduction
    • large-size B cell proliferation
      • CD20 +
      • may be mature T cell in origin
    • most common subtype of NHL
    • arises de novo or progression from a small B cell NHL subtype
    • generally seen in the adult population, but can be seen in children
  • Presentation
    • rapidly enlarging lymph node
  • Prognosis, Prevention, and Complications
    • very aggressive with poor prognosis
Burkitt Lymphoma
  • Burkitt'sIntroduction
    • intermediate-size B cell proliferation
      • CD20 +
    • caused by 8;14 translocation
      • approximates the Ig heavy chain locus (14) with c-myc (8)
      • increased levels of c-myc drives cell growth
    • associated conditions
      • EBV infection
    • generally seen in pediatric/adolescent population
  • Presentation
    • extranodal mass 
      • jaw (African-type)
      • abdomen (sporadic-type)
  • Evaluation
    • biopsy
      • "starry-sky" appearance
Follicular Lymphoma
  • Introduction
    • small-size B cell proliferation in the follicles
      • CD20 +
    • caused by 14;18 translocation
      • approximates the Ig heavy chain locus (14) with BCL2 (18)
      • increased levels of Bcl2 inhibits apoptosis  
    • generally seen in the adult population
  • Presentation
    • painless lymphadenopathy
  • Evaluation
  • Treatment
    • rituximab (anti-CD 20)
      • only used for symptomatic patients
  • Prognosis, Prevention, and Complications
    • can progress to large B cell lympthoma
      • presents with a rapidly enlarging lymph node
Marginal Zone Lymphoma
  • Marginal ZoneIntroduction
    • small B cell proliferation in margin
      • CD20 +
    • associated conditions
      • chronic inflammatory states (Sjogren syndrome, Hashimoto's thyroiditis)
      • H. pylori infections
        • note that gastric MALTomas are a type of marginal zone lymphoma
Mantle Cell Lymphoma
  • Introduction
    • small B cell proliferation of the area surrounding the follicular zone (the mantle)
      • CD20+, CD5 +
    • caused by 11;14 translocation
      • approximates the Ig heavy chain locus (14) with Cyclin D (11)
      • increased levels of Cyclin D drives cell into S phase
    • generally seen in older adult population
  • Presentation
    • painless lymphadenopathy
 

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