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Key Features

Essentials of Diagnosis

  • Often presents with painless lymphadenopathy

  • Diagnosis is made by tissue biopsy, rather than fine needle aspirate

General Considerations

  • Heterogeneous group of cancers of lymphocytes usually presenting as enlarged lymph nodes

  • Clinical presentation and course vary from indolent to aggressive

  • Indolent lymphomas are often disseminated at diagnosis, and bone marrow involvement is frequent

  • In Burkitt lymphoma, a protooncogene c-myc is translocated from chromosome 8 to heavy chain locus on chromosome 14, where c-myc overexpression is likely related to malignant transformation

  • In follicular lymphomas, the t(14,18) translocation is characteristic and results in overexpression of bcl-2, resulting in protection against apoptosis, the usual mechanism of cell death

  • Classification of lymphomas still evolving

  • Table 13–16 outlines the World Health Organization's proposed classification based on clinical and pathologic features

Table 13–16.World Health Organization classification of B-cell neoplasms (most common).

Clinical Findings

Symptoms and Signs

  • Lymphadenopathy, isolated or diffuse (retroperitoneal, mesenteric, and pelvic)

  • Constitutional symptoms, eg, fever, drenching night sweats, or weight loss of > 10% of prior body weight

  • Extranodal sites of disease (skin, gastrointestinal tract, liver, bone marrow) sometimes found on examination

  • Abdominal pain or abdominal fullness in Burkitt lymphoma because of predilection for abdomen

Differential Diagnosis

  • Hodgkin disease

  • Metastatic cancer

  • Infectious mononucleosis

  • Cat-scratch disease

  • Sarcoidosis

  • Drug-induced pseudolymphoma (eg, phenytoin)

Diagnosis

Laboratory Tests

  • Peripheral blood is usually normal, but some lymphomas may present in leukemic phase

  • Cerebrospinal fluid cytology shows malignant cells in some high-grade lymphomas with meningeal involvement

  • Serum lactate dehydrogenase (LD) is a useful prognostic marker and is incorporated in risk stratification of treatment

Diagnostic Procedures

  • Needle aspiration biopsy may yield evidence of non-Hodgkin lymphoma, but lymph node biopsy (or biopsy of involved extranodal tissue) is required for diagnosis and ...

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