PRESENTATION, STAGING AND DIAGNOSIS OF LYMPHOMA: A CLINICAL PERSPECTIVE
Abstract
Background: Due to lack of awareness among health professionals, lymphoma is often misdiagnosed.This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma.
Methods: Sixty diagnosed cases of lymphoma were selected (aged 12-65 years) from medical units of
Civil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basic
laboratory investigations including imaging procedures were done in all the patients. The diagnosis of
lymphoma was based on histology, following the International Working Formulation classification
system. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The Ann
Arbor Staging Classification was used to classify the extent of disease. Results: Out of 60 cases of
lymphoma, 81.6% (49 cases) were diagnosed as non-Hodgkin's lymphoma and 18.3% (11 cases) as
Hodgkin's disease, with an overall male predominance. Both categories exhibited a bimodal age
distribution. Lymphadenopathy was the commonest presenting features in both the types of
lymphomas; however, patients with Hodgkin's disease had a prominence of '˜B' symptoms, whereas
abdominal signs and symptoms were more common in non-Hodgkin's lymphoma. On histopathology,
majority of non-Hodgkin's lymphomas (91.8%) showed a diffuse pattern, while mixed cellularity was
the commonest type seen in Hodgkin's disease (81.8%). Conclusion: Non-Hodgkin's lymphoma was 4
times more common than Hodgkin's disease. The vast clinical spectrum of lymphoma sometimes
delays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hence
required among the health professionals regarding its varied clinical presentations.
Keywords: Non-Hodgkin's lymphoma, Hodgkin's disease, Lymphadenopathy, Hepatomegaly,
Splenomegaly
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