0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
Lymphomas 933
Infectious agents (EBV, HTLV-1, HHV-8, hepatitis C virus, Heli-
cobacter pylori, HIV, Camphylobacter)
Environmental exposures (herbicides, hair dyes, organic sol-
vents [weak evidence])
Signs & Symptoms
■Lymph node enlargement
■Fevers, night sweats, unexplained weight loss (B symptoms)
■Splenomegaly
■Symptoms referable to specific disease sites – i.e., chest pain, short-
ness of breath (mediastinal mass), abdominal discomfort (mesen-
teric/retroperitoneal lymphadenopathy, infiltration GI tract), bone
pain
■Pruritus, alcohol intolerance (HD)
➣Most indolent lymphomas are asymptomatic.
CNS disease is associated with aggressive NHL; patients with
bone marrow, testicular, paranasal sinus, multiple extranodal
sites of disease
tests
Laboratory
■CBC with differential
■Screening chemistries (renal and hepatic function), calcium, lactate
dehydrogenase
■b2 microglobulin (mostly indolent NHL subtypes)
Biopsies
■Lymph node (preferred, nodal architecture necessary to diagnose
subtypes of both HD and NHL), excisional biopsy preferred. Fine
needle aspirate very limited yield.
■Other disease site if no involved/accessible lymph node
■Unilateral bone marrow (aspirate and biopsy)
■Accurate diagnosis requires review by experienced hematopatholo-
gist
■Immunophenotypic analysis via immunohistochemistry and, in cer-
tain cases, flow cytometry
■Analysis of antigen receptor gene rearrangement and, in certain
cases, disease-specific cytogenetic abnormalities – for example,
t(14:18) – follicular lymphoma; t(8;14)– Burkitt’s lymphoma
Imaging Studies
■Chest radiograph
■Chest, abdomen, pelvic CT scans