Non-Hodgkin's lymphoma
FLes non-Hodgkin lymphomas are neoplasia developed from lymphoid tissues.
Lymphoma is a cancer of the lymphatic system at the expense of lymphocytes.
The lymphatic system includes bone marrow, spleen, thymus, lymph nodes and lymphatic vessels; It ensures the defense of the organism against microbes, pests, toxins, foreign bodies, etc.
Lymphoma Form and classifications
"ganglion" and "extra-ganglion" malignant lymphomas are distinguished
Histology
Aggressive malignant lymphomas (ganglion or extra-ganglion lymphomas with aggressive presentation) phenotype B
Large cell lymphoma:
Centroblastic lymphoma
Immunoblastic lymphoma
T-Cell-rich B-cell lymphoma
Histiocytes-rich B cell lymphoma
Large cell lymphoma B anaplastic
Burkitt-like lymphoma
Granulomatosis Papulosis
Lymphoma associated with a Pyothorax
Primitive mediastinum B lymphoma (thymic type)
Intravascular lymphoma
Serous lymphoma
Burkitt's lymphoma
Mantle lymphoma
Classic shape
With round cells
Blast form
With large cells
T phenotype
Anaplastic large cell lymphoma
Peripheral T lymphoma
Angio-Immunoblastic
T-zone lymphoma without precision
Non-Hodgkin indolent lymphomas (ganglion or extra-ganglion lymphomas having indolent presentation)
Cell lymphomas in the marginal zone
Lymphomas of lymphoid tissue associated with mucous membranes
Splenic (spleen) lymphomas with or without city lymphocytes
ganglion lymphomas with or without monocytoïdes B cells
Scattered forms
Follicular lymphomas
Grade 1 (< 50% of centroblasts) Grade 2 (> 50% of centroblasts)
Skin
DigestiveLymphoplasmocytoïdes lymphomas (or Immunocytomes)
Ann Arbor Classification
Stage I: Attainment of a single ganglionic group or a single organ.
Stage II: Reaching more than one ganglion area on the same side of the diaphragm. (Lower or upper part of the body)
Stage III: Multiple adenopathies on both sides of the diaphragm. (lower part and upper part of the body)
Stage IV: Diffuse impairment of one or more viscera and bone marrow.
To be added:
(E) in stages I, II or III: If the presence of a contiguous visceral attack
A: If no sign of B
B:-Unexplained slimming of more than 10% of body weight in less than 6 months (or 5% in 1 month) or unexplained fever > 38 °c For more than 8 days or profuse nocturnal sweats.
Classification of the general condition of the patient (WHO)
0: There is no achievement of the general health condition, the patient leads a normal life.
1: There is fatigue, but the patient can go about his daily chores and work.
2: Heavy fatigue forces the patient to lie down during the day, but less than half the day. He can no longer work but is still able to take care of himself.
3: The patient stays bedridden or sits more than half the day. The patient is dependent on certain acts of daily life: household, errands, etc.
4: The patient can no longer stand up and cannot take care of himself. need of assistance for all acts of daily life.
Classification according to their degree of malignancy
Lymphomas Non Hodgkin indolent (low malignancy)
Follicular lymphoma
Lymphocytic lymphoma (LL) (lymph node localization of chronic lymphocytic leukemia LLC)
Lymphoma of the marginal area (and lymphoma of MALT)
Waldenstrom of Macroglobulinemia (also called Lymphoplasmocytaire lymphoma or lymphoplasmocytoid)
Cutaneous T-lymphoma
Aggressive non-Hodgkin lymphomas (high malignancy)
Diffuse large-cell lymphoma B the most common lymphoma (it accounts for 30 to 40% of non-Hodgkin lymphomas). The average age of patients is 55 to 60 years but it can affect children. These aggressive lymphomas may arise in the lymph nodes or in extra-ganglion places such as the gastrointestinal tract, testicles, thyroid, skin, breast, central nervous system or bones.
B cell lymphomas, mantle cell lymphomas represent 5-10% of non-Hodgkin lymphomas and most often affect men over 50 years of age and the disease is often at an advanced stage when DIAG Nostic. Patients with multiple ganglion are generally affected. One or more organs (especially the digestive tract) and bone marrow may also be affected. This lymphoma is often aggressive. New therapies have, however, shown an efficacy on the disease.
Burkitt lymphoma, "Burkitt type" lymphoma (small non-cleaved cells) B cell lymphoma of high malignancy, it concerns adults and children. This is one of the lymphomas diagnosed in HIV-infected patients. All forms of Burkitt lymphoma are more likely to affect men, they behave the same way and are all spontaneously very aggressive. However, the prognosis after treatment is generally favorable.
Peripheral T-Lymphomas They account for 10 to 15% of non-Hodgkin lymphomas in adults. The term peripheral T-lymphoma is based on the fact that they are tumors composed of T cells (not B) and that these cells are mature. Most peripheral T lymphomas have a high malignancy with the exception of Mycosis Fungoides.
Other lymphomas
Lymphomas associated with HIV it is estimated that almost 10% of seropositive patients will develop lymphoma. It is usually of high malignancy.
Primitive lymphoma of the central nervous system Cancer that affects only the brain and the spinal cord. Apart from HIV infection, it mainly affects people over the age of 60.
The lymphomas of the child represent about 5% of the non-Hodgkin lymphomas.
Etiology
Generally indeterminate
Risk Factors:
Hiv
Epstein-Barr Virus and Burkitt lymphoma
HTLV-1 (Caribbean and Japan)
Auto-Immune disease
Immunosuppression
Viral chronic hepatitis C1
A FRANÇAISE2 study showed, at the molecular level, a relationship between occupational exposure to pesticides and the acquisition of a chromosomal anomaly known to be one of the initial stages of development of non- Hodgkin. Irradiation or exposure to radioactivity is one of the triggering factors.
Symptomatology
In addition to an alteration of the general condition, there is a low grade fever (38 °c), a slimming, night sweats (+ +), etc.
ganglion shapes
Presence of palpable and deep superficial adenopathies visible in imaging.
Extra-ganglion shapes
There are no specific symptoms but the expression of the invasion of the target organ: the stomach, the thyroid, the brain, the testicle, the parotid, the eye, the bone marrow.
Prognostic indexes
International prognostic Index of large cell lymphomas (IPI)
According to the ANN Arbor classification
According to the histology of malignant lymphoma
According to the levels of LDH (lactate dehydrogenase)
Depending on the age of the patient (more or less than 60 years)
According to its general condition (0, 1, 2, 3, 4)
Depending on the number of extra-ganglion locations (0 or 1 versus > 1)
International prognostic Index of follicular lymphoma (FLIPI)
According to the ANN Arbor classification
According to the histology of malignant lymphoma
According to the rates of lactate dehydrogenase
Depending on the age of the patient (more or less than 60 years)
Depending on the hemoglobin level
Diagnosis
Biological blood tests
Bone marrow biopsy
lymph node biopsy
CT scan of the thorax and abdomen
Positron emission tomography
Sometimes associated with:
Lumbar puncture
Gastric or colic fibroscopy
Bone scan
Immunophenotyping of lymphocytes
Treatment
Radiotherapy
Chemotherapy
Immunotherapy:
A method of treatment intended to modify the body's natural defences, either by injection of serum or immunoglobulin which brings the specific antibodies (passive immunotherapy), or by vaccine therapy which elicits the production of these Antibodies (active immunotherapy).
Monoclonal antibodies: Rituximab (MabThera)
Interferon
Gene therapy
Anti-angiogenic Therapy
Radio-Immunotherapy
Vaccines
Proteasome inhibitors
Antisense molecules
Surgery
Splenectomy
Allograft
Autograft
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