Clinical Manifestations And Classifications Of Non-Hodgkin’s Lymphoma (NHL)
Detecting Non Hodgkin's Lymphoma
A General Overview
A vast majority of these are B cell neoplasms, though T cell NHL occurs rarely. Unlike Hodgkin’s lymphoma, the clinical involvement is more common, so also involvement of the blood and bone marrow. The disease often starts muticentrically.
Classification of Non Hodgkin’s Lymphoma
1. Nodular Type
Lymphocytic well- differentiated, Lymphocytic poorly differentiated, Lymphocytic and histiocytic (mixed)
These were known as lymphosarcomas
Reticulum cell sarcoma
2. Diffuse Type
- Lymphocytic well differentiated
- Lymphocytic poorly differentiated
- Lymphocytic and histiocytic
- Undifferentiated (Stem cell types)
Other classifications have been proposed based on the morphology and immunological characters of the cells.
Symptomatology Of Non Hodgkins Lymphoma
Immunological classification (Luke and Collins)
B cell disease: Small lymphocytic lymphoma (CLL), plasmacytoid lymphocytic disease, follicular center cell (FCC) lymphomas, small cleaved cell lymphomas, large cleaved cell lymphoma, small transformed cell lymphoma (non cleaved), Burkitt’s lymphomas, Immunoblastic sarcoma of B cells and B cell acute lymphatic leukemia.
T cell disease: T cell variants of CLL- mycosis fungoides and Sezary syndrome. More examples of such are convoluted lymphocytic lymphomas, T cell acute lymphatic leukemia, Immunoblastic sarcoma of T cells.
Undefined cell disease: Examples are: Hodgkin’s disease (HD), Leukemic reticuloendotheliosis etc.
Non- Hodgkin’s lymphomas occur all over the world. Certain types show geographic difference, eg, Burkitt’s lymphoma is seen in Africa. Kaposi’s sarcoma is a lymphoma-like disease of unknown etiology, more prevalent in Africa, but in western countries, it is seen more among homosexuals and those with acquired immunodeficiency states.
Hematology: Moderate normocytic normochromic anemia may occur in the advanced stages. The leukocyte picture is generally unremarkable but in a few cases, lymphosarcoma cells are detectable in the circulation. These cells resemble large lymphocytes with lobed or folded nuclei and may show nucleoli. The condition is termed lumphosarcoma leukemia.
Biochemistry: Paraproteins of IgM or IfG class may be detectable in a few cases. Serum uric acid is moderately elevated in the advanced stages. Hepatic involvement is characterized by rise in alkaline phosphatase and transaminases. Obstructive jaundice results from pressure of lymph nodes at the porta hepatitis.
Staging procedures are the same as for HL. Since NHL is generally advanced even on first presentation, exploratory laparatomy and splenectomy are not done except in some rare cases with strictly localized lesions.
In the majority of cases death occurs within 2- 3years of diagnosis despite therapy. Well-differentiated nodular lymphocytic lymphomas have the best prognosis and many may survive 5 years. Diffuse undifferentiated lesions have poorer prognosis. Extensive disease and advancing age are unfavourable prognostic factors. Females have a better prognosis than males. Prolonged survival and cure have been achieved in a few cases with intensive chemotherapy.
Leukemic transformation may occur in a few cases and these behave like acute lymphoblastic leukemia. Death is due to progressive disease, infections, liver failure, profound anemia, bone marrow failure or drug toxicity.
© 2014 Funom Theophilus Makama