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 ofCivil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basiclaboratory investigations including imaging procedures were done in all the patients. The diagnosis oflymphoma was based on histology, following the International Working Formulation classificationsystem. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The AnnArbor Staging Classification was used to classify the extent of disease. Results: Out of 60 cases oflymphoma, 81.6% (49 cases) were diagnosed as non-Hodgkin’s lymphoma and 18.3% (11 cases) asHodgkin’s disease, with an overall male predominance. Both categories exhibited a bimodal agedistribution. Lymphadenopathy was the commonest presenting features in both the types oflymphomas; however, patients with Hodgkin’s disease had a prominence of ‘B’ symptoms, whereasabdominal 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 wasthe commonest type seen in Hodgkin’s disease (81.8%). Conclusion: Non-Hodgkin’s lymphoma was 4times more common than Hodgkin’s disease. The vast clinical spectrum of lymphoma sometimesdelays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hencerequired among the health professionals regarding its varied clinical presentations.Keywords: Non-Hodgkin’s lymphoma, Hodgkin’s disease, Lymphadenopathy, Hepatomegaly,SplenomegalyReferences
Jose BO, Koerner P, Spanos WJ Jr, Paris KJ, Silverman CL,
Yashar C, et al. Hodgkin’s lymphoma in adults – clinical
features. J Ky Med Assoc 2005;103:15–7.
Al-Mobeireek AF, Arafah M, Siddiqui N. An African male
with cough, hemoptysis, weight loss and hypercalcemia: TB or
not TB? Eru Respir J 2002;20:1060–3.
Phelan E, Lang E, Gormley P, Lang J. Kikuchi-Fujimoto
disease: a report of 3 cases. Ear Nose Throat J 2007;86:412–3.
Young, Iland. Clinical perspectives in lymphoma. Internal
Medicine Journal 2007;37:478–84.
The Non-Hodgkin’s Lymphoma Pathologic Classification
Project. National Cancer Institute sponsored study of
classifications of non-Hodgkin’s lymphomas: summary and
description of a working formulation for clinical usage. Cancer
;49:2112–35.
Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML
et al. A revised European–American classification of lymphoid
neoplasms: a proposal from the International Lymphoma Study
Group. Blood 1994;84:1361–92.
Jaffe ES, Harris NL, Stein H, Vardiman JW (eds). Pathology and
Genetics of Tumours of Haematopoietic and Lymphoid Tissues.
World Health Organization Classification of Tumours. Lyon,
France: IARC Press, 2001.
Pongpruttipan T, Sitthinamsuwan P, Rungkaew P, Ruangchiraurai R, Vongjirad A, Sukpanichnant S. Pitfalls in classifying
lymphomas. J Med Assoc Thai 2007;90:1129–36.
Armitage JO. Staging non-Hodgkin lymphoma. CA Cancer J
Clin 2005;55:368–76.
Franco V, Tripodo C, Rizzo A, Stella M, Florena AM. Bone
marrow biopsy in Hodgkin’s lymphoma. Eur J Haematol
;73:149–55.
Peh SC, Kim LH, Thanaletchimy N, Chai SP, Poppema S.
Spectrum of malignant lymphomas in Klang Hospital, a public
hospital in Malaysia. Malays J Pathol 2000;22:13–20.
Haddadin WJ. Malignant lymphoma in Jordan: a retrospective
analysis of 347 cases according to the World Health Organization
classification. Ann Saudi Med 2005;25:398–403.
Shome DK, George SM, Al-Hilli F, Satir AA. Spectrum of
malignant lymphomas in Bahrain. Leitmotif of a regional pattern.
Saudi Med J 2004;25:164–7.
Groves FD, Linet MS, Travis LB, Devesa SS. Cancer
surveillance series: Non-Hodgkin’s lymphoma incidence by
histologic subtype in the United States from 1978 through 1995. J
Natl Cancer Inst 2000;92:1240–51.
Landgren O, Caporaso NE. New aspects in descriptive, etiologic,
and molecular epidemiology of Hodgkin’s lymphoma. Hematol
Oncol Clin North Am 2007;21:825–40.
Dinand V, Dawar R, Arya LS, Unni R, Mohanty B, Singh R.
Hodgkin’s lymphoma in Indian children: prevalence and
significance of Epstein-Barr virus detection in Hodgkin’s and
Reed-Sternberg cells. Eur J Cancer 2007;43:161–8.
Flavell KJ, Murray PG. Hodgkin’s disease and the Epstein-Barr
virus. Mol Pathol 2000;53:262–9.
Gutensohn NM. Social class and age at diagnosis of Hodgkin's
disease; new epidemiologic evidence on the “two-disease”
hypothesis. Cancer Treat Rep 1982;66:689–95.
Mayall F, Darlington A, Harrison B. Fine needle aspiration
cytology in the diagnosis of uncommon types of lymphoma. J
Clin Pathol 2003;56:821–5.
Olu-Eddo AN, Ohanaka CE. Peripheral lymphadenopathy in
Nigerian adults. J Pak Med Assoc 2006;56:405–8.
Song JY, Cheong HJ, Kee SY, Lee J, Sohn JW, Kim MJ, et al.
Disease spectrum of cervical lymphadenitis: analysis based on
ultrasound-guided core-needle gun biopsy. J Infect
;55:310–6.
Biagi JJ, Seymour JF. Insights into the molecular pathogenesis of
follicular lymphoma arising from analysis of geographic
variation. Blood 2002;99:4265–75.
Sahni CS, Desai SB. Distribution and clinicopathologic
characteristics of non-Hodgkin’s lymphoma in India: a study of
cases using WHO classification of lymphoid neoplasms
(2000). Leuk Lymphoma 2007;48:122–33.
Aziz Z, Rehman A, Akram M, Saeed A. Non-Hodgkin’s
lymphoma in Pakistan: a clinicopathological profile of 175
patients. J Pak Med Assoc 1999;49:11–5.
Siddiqui N, Ayub B, Badar F, Zaidi A. Hodgkin’s lymphoma in
Pakistan: a clinico-epidemiological study of 658 cases at a cancer
center in Lahore. Asian Pac J Cancer Prev 2006;7:651–5.
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