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Lymphoma - Coggle Diagram
Lymphoma
Investigations for lymphoma
and biopsy
Routine laboratory studies
Peripheral blood smear
CBC
Serum chemistries
Serology for infectious diseases
chest X-ray
Immunohistochemistry
Flow cytometry
Immunophenotype
CT scanning
Bone marrow aspiration and biopsy
LDH and β2-microglobulin
Lymphoma biopsy
to be able to diagnose and grade the lymphoma
Types of biopsy
Endoscopic biopsy
Bone marrow biopsy
Needle biopsy
Skin biopsy
Surgical biopsy
Biopsy when suspecting lymphoma
Core biopsy
Open biopsy
Fine needle aspiration
Analysis of biopsy material
Histology
Immunophenotype
Flow cytometry
Immunohistochemistry
cytogenetic testing
Molecular analysis
Mnagements for lymphoma
and have better prognosis
Hodgkin lymphoma
early stage
Favorable disease
Stage IA or IIA with no risk factors
2 cycles of ABVD followed by involved-site radiation therapy (ISRT)
or
2 – 4 cycles of Stanford V
unfavorable disease
Stage IA or IIA with risk factors
Stage IB or IIB
4 cycles of ABVD + involved - field radiation
If radiation is omitted
6 cycles of ABVD are recommended
Advanced stage
Favorable disease
Stage III or IV
6-8 cycles of ABVD
+
radiation to residual disease sites
Unfavorable prognosis
Stage III or IV with 4 or more poor prognostic factors
6-8 cycles of escalated – dose BEACOPP
+
radiation to residual disease sites
Non-Hodgkin lymphoma
Indolent lymphoma
Follicular lymphoma
Advanced
conservative therapy
Localized
Radiation therapy
Aggressive lymphoma
Diffuse large B-cell lymphoma
rituximab-based chemotherapy then by radiation
pathology of lymphoma
thus its important to perform physical examination
Hodgkin lymphoma
Classical
Mixed cellularity classical Hodgkin lymphoma
Lymphocyte-rich classical Hodgkin lymphoma
Lymphocyte-depleted classical Hodgkin lymphoma
Nodular sclerosis classical Hodgkin lymphoma
Nodular lymphocyte predominance
Non-Hodgkin lymphoma
Aggressive
Diffuse large B-cell lymphoma
Mantle cell lymphoma
Peripheral T-cell lymphoma
Highly aggressive
Anaplastic large-cell lymphoma
Burkitt lymphoma
Indolent
Follicular lymphoma
Cutaneous T-cell lymphoma
Lymphoplasmacytic lymphoma
Marginal zone B-cell lymphoma
MALT lymphoma
Small-cell lymphocytic lymphoma
Mycosis fungoides /Sézary syndrome
Lymph nodes physical examination
and further investigations
Inspection
Palpation
prognosis of lymphoma
and be cured
Hodgkin lymphoma is one of the most curable forms of cancer
overall cure rate 87%
localized have higher survival rate than regional and distant Hodgkin lymphoma
many factors determines the survival rate and quality of life
Non-Hodgkin lymphoma
international prognostic index
clinical tool used to predict the prognosis and outcome of patients with aggressive NHL
lower survival rate and quality of life compared to hodgkin lymphoma
Risk factors and causes of Lymphoma
leading to immunological consequences
Risk factors
Non-modifiable
Age
Gender
Race / ethnicity
Family history
Modifiable
Exposure to radiation
infections
Exposure to certain chemicals and drugs
weak immune system
Causes
Immune suppression
increasing age
congenital
Organ transplant
AIDS
DNA repair defects
ataxia-telangiectasia
Xeroderma pigmentosum
Chromosomal aberrations
Mantle cell lymphoma
t (11;14)
Follicular lymphoma
t (14;18)
Burkitt lymphoma
t (8;14)
t (2;8)
t (8;22)
Latrogenic factors
Radiotherapy
Chemotherapy
Chronic inflammation and antigenic stimulation
Helicobacter pylori inflammation and gastric marginal zone lymphoma
Chlamydia psittaci inflammation and ocular adnexal tissues lymphomas
Gluten-sensitive enteropathy and intestinal T cell lymphoma
Sjogren's syndrome and Hashimoto's thyroiditis
Viral causes
EBV
KSHV
HTLV-1
HHV-8
Anatomy and histology of lymphatic system
abnormalities might happen
Lymphatic system
Lymphoid tissues and organs
Lymph nodes
Cortex
B cells
follicles
Margin
Mantle
Germinal centers
Medulla
Plasma cells
Paracortex
T cells
medullary cord
Kidney shaped
medullary sinus
macrophages
Afferent lymphatic vessels
more than efferent
subscapular sinus
Trabecular sinus
medullary sinus
Efferent lymphatic vessels
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cortical sinus
inguinal and femoral lymph nodes
Cervical lymph nodes
Axillary lymph nodes
Mesenteric lymph nodes
supraclavicular lymph node
popliteal lymph node
hilar lymph nodes
mediastinal lymph nodes
iliac lymph nodes
Epitrochlear and brachial lymph nodes
pectoral lymph nodes
Thymus
Spleen
tonsils
peyer's patches
appendix
Lymphatic vessels
Lymphatics
Lymphadenopathy
lymphoma
enlargement of lymph nodes
Localized lymphadenopathy
painful
Skin infection
pharyngitis
oral/genital herpes
cat scratch disease
lymphogranuloma venereum
Chancroid
Kawasaki disease
Mononucleosis
Rubella
painless
Tuberculosis
sarcoidosis
SLE
Metastases
Residual lymph nodes after overcoming an infection
Generalized lymphadenopathy
painful
Viral infection
CMV
HIV
Mumps, Measels, Rubella
Varicella
Bacterial infection
Listeriosis
Brucellosus
Syphilis
Parasitic infections
Malaria
Schistosomiasis
Visceral leishmaniasis
Toxoplasmosis
painless
Malignancy
Malignant lymphoma
Leukemia
Autoimmune
Circulating immune complexes
Sjoegren syndrome
Others
Lysosomal storage disease
Hyperthyroidism
Amyloidosis
Sarcoidosis
Tuberculosis
staging and grading of lymphoma
to give the proper treatment
clinical stages of Hodgkin and Non-Hodgkin lymphomas
Ann Arbor classification
Stage 2
Involvement of 2 or more lymph node regions on same side of diaphragm
Stage 3
Involvement of lymph node regions on both sides of the diaphragm, may include spleen or localized extralymphatic
Stage 1
involvement of single lymph node region or single extralymphatic site
Stage 4
Diffuse extralymphatic disease (e.g liver, bone marrow, lung, skin)
All stages are further divided into
A
refers to the absence of B-symptoms
B symptoms
Night sweats
Weight loss
Fever
B
refers to the presence of B-symptoms
immunity in lymphoma
and pathological