Clinical Review

ABC of clinical haematology: Malignant lymphomas and chronic lymphocytic leukaemia

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7087.1103 (Published 12 April 1997) Cite this as: BMJ 1997;314:1103
  1. G M Mead

    Introduction

    The malignant lymphomas (non-Hodgkin's lymphoma and Hodgkin's disease) are a clinically and pathologically diverse group of cancers of largely unknown cause that are rapidly increasing in incidence. They are highly treatable and sometimes curable. Chronic lymphocytic leukaemia, the commonest adult leukaemia, shares many features with these cancers. The whole group constitutes about 5% of malignant diseases.

    Management of the malignant lymphomas is complex and is best carried out in specialised treatment centres

    Pathology and staging

    The non-Hodgkin's lymphomas arise from malignant transformation of lymphocytes, deriving from B cells in about 85% of cases and T cells in most of the rest. Chronic lymphocytic leukaemia is largely a B cell malignancy, but the cell of origin of the Reed Sternberg cell, which characterises Hodgkin's disease, remains uncertain.

    Ann Arbor staging system for lymphoma

    Site

    • Stage I–Single lymphoid area or extranodal site (stage IE)

    • Stage II–Two lymphoid areas or extranodal sites on the same side of the diaphragm

    • Stage III–Lymphoid areas (including the spleen) on both sides of the diaphragm

    • Stage IV–Diffuse involvement of an extranodal organ(s) (liver, bone marrow)

    Symptoms

    • A–No symptoms

    • B– >10% Weight loss, drenching night sweats, or unexplained fevers ≥38°C

    Histopathologically, lymphomas comprise an admixture of identical (monoclonal) malignant cells with variable amounts of reactive lymphoid cells and stroma. The lymphomas are variably subcategorised by pathologists into about 20 different types on the basis of conventional cytological staining and special stains to determine subtype and lineage.

    A diagnosis of lymphoma (or even B or T cell lymphoma) gives no clue to the natural course of the disease in an individual patient. Clinicians treating these patients take account of the histopathology and the history provided by the patient, as well as many other factors (for example, stage and age), before recommending treatment or advising about prognosis. The complexity of non-Hodgkin's lymphomas requires a simplified management approach, on the …

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