Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

934 Lymphomas

■MRI in selected cases, only useful in identifying bone or CNS involve-

ment

■FDG PET scan

➣provides functional rather than purely anatomic information

➣most useful in monitoring HD and aggressive NHL

Other

■Lumbar puncture (mandatory with certain NHL subtypes, such as

Burkitt’s, recommended with referable symptoms, or in patients with

high risk of CNS disease [see above])

differential diagnosis

■Benign etiologies of lymphadenopathy – infections, autoimmune

diseases (rheumatoid arthritis, systemic lupus erythematosus), sar-

coid, medications (phenytoin)

■Metastatic carcinomas

■Lymph node biopsy used to differentiate lymphoma from carcinoma

or benign lymphadenopathies

management

■Therapeutic approaches to HD and NHL based on specific subtype,

stage of disease, prognosis and physiologic status of the patient

■HD and NHL subtypes identified according to updated WHO patho-

logic classification

➣HD – classic HD (nodular sclerosis and mixed cellularity) and

nodular lymphocyte predominance HD

➣NHL – most common entities include

Chronic lymphocytic leukemia (CLL)/small lymphocytic lym-

phoma (SLL), plasma cell myeloma, follicular lymphoma (FL) –

indolent lymphomas with natural histories measured in years

Mantle cell lymphoma (MCL), diffuse large B-cell lym-

phoma (DLBCL), Burkitt’s lymphoma, peripheral T-cell lym-

phomas (PTCL) – aggressive/highly aggressive lymphomas

with untreated natural histories measured in months or weeks

Stage (Ann Arbor)

■I – single lymph node

■II–2ormorelymphnodes, same side of diaphragm

■III – lymph node involvement on both sides of the diaphragm

■IV – disseminated involvement of extranodal sites with or without

lymph node involvement

■A – absence of B symptoms (fever, night sweats, or weight loss)