Lymphoma

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Non-Hodgkin’s lymphoma (NHL): Mature B-cell neoplasms and Mature NK-cell/T-cell neoplasms

As shown in figure 1 the current classification for NHL is into either Mature B-cell neoplasms or Mature NK-cell/T-cell neoplasms. The term Non-Hodgkin’s lymphoma (NHL) is no longer part of the classification system, however it is still used commonly to identify lymphomas that are not HL. In this group it is possible to have lymphoma with changes in the mature lymphocytes, in the immature lymphocytes, in the macrophages, in the dendritic cells, or in a combination of these cells.

Mature B-cell neoplasms

Some neoplasms in this group are categorised as chronic leukaemias such as chronic lymphocytic leukaemia; B-cell prolymphocytic leukaemia; hairy cell leukaemia and are discussed briefly in the leukaemia section.  Their distinction is that the abnormal cells are present predominantly in the peripheral blood and bone marrow in leukaemia rather than mostly in the lymph nodes as in lymphoma, although both occur.

There are over 20 additional types of Mature-B cell neoplasms for example, follicular lymphoma, Burkitt lymphoma, mantle cell lymphoma and diffuse large B cell lymphoma. The diagnosis of each is made through a study of the type of abnormal cell by identifying surface antigens and their location throughout the body or how the abnormal cells distribute within a lymph node. Some neoplasms have specific genetic abnormalities such as Mantle Cell lymphoma which has a translocation between chromosome 11 and 14, t(11;14).

Once a diagnosis of lymphoma has been confirmed the stage of the disease must be made using either computed tomography (CT) or Positron emission tomography (PET) scans. A bone marrow biopsy is also done to check if the lymphoma has spread to the bone marrow.  This is more common in some of the mature B-cell neoplasms then in others.

There are a range of treatments available for the mature B-cell neoplasms and are targeted to specific diagnoses.  Ensuring the correct diagnosis is made can sometimes be difficult but is very important for selecting treatment options. 

Mature T-cell and NK-cell neoplasms

Some neoplasms in this group are categorised as chronic leukaemias such as T-cell prolymphocytic leukaemia and are discussed briefly in the leukaemia section.  Their distinction is that the abnormal cells are present predominantly in the peripheral blood and bone marrow rather than mostly in the lymph nodes, although both occur.

There are over 20 additional types of Mature-T cell and NK-cell and diagnosis is achieved in the same way as the mature B-cell neoplasms.  

Once a diagnosis of lymphoma has been confirmed the stage of the disease must be made using either computed tomography (CT) or Positron emission tomography (PET) scans. Patients are scanned from the neck to the pelvis to show all the places in the body that the lymphoma has spread to. A bone marrow biopsy is also done to check if the lymphoma has spread to the bone marrow. 

There are a range of treatments available for the mature T-cell and NK-cell neoplasms and are targeted to specific diagnoses. Ensuring the correct diagnosis is made can sometimes be difficult but is very important for selecting treatment options just as it is with other types of leukaemia.

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