Diagnosis

Signs and symptoms

Lymphoma presents with certain non-specific symptoms. If symptoms are persistent, lymphoma needs to be excluded medically.

· Lymphadenopathy or swelling of lymph nodes – It is the primary presentation in lymphoma.

· B symptoms (systemic symptoms) – can be associated with both HL and NHL. They consist of:

- Fever

- Night sweats

- Weight loss

· Other Symptoms :

- Loss of appetite or anorexia

- Fatigue

- Respiratory distress or dyspnoea

- Itching

Lymphoma is definitively diagnosed by a lymph node biopsy, meaning a partial or total excision of a lymph node that is then examined under the microscope. This examination reveals histopathological features that may indicate lymphoma. After lymphoma is diagnosed, a variety of tests may be carried out to look for specific features characteristic of different types of lymphoma. These include:

· Immunophenotyping (this is a technique used to study the protein expressed by cells)

· Flow cytometry (this is a laser-based, biophysical technology employed in cell counting, cell sorting, biomarker detection and protein engineering, by suspending cells in a stream of fluid and passing them by an electronic detection apparatus)

· FISH testing (Fluorescent in situ hybridization (FISH) is a cytogenetic technique that is used to detect and localize the presence or absence of specific DNA sequences on chromosomes. FISH uses fluorescent probes that bind to only those parts of the chromosome with which they show a high degree of sequence complementarity).

Hodgkin's Lymphoma (or Hodgkin's disease)

HL is a malignant disease of the lymphatic system characterized by the presence of Reed-Sternberg cells in the lymphomatous tissue (Image 9.22). The Reed-Sternberg cell is a large cell which is either multinucleated or has a multilobulated nucleus. In most cases it arises from B-cells of the germinal center.

Unlike many other cancers, the adult and pediatric forms have similar biology and natural history. Pediatric HL accounts for 12% of all HL cases.

HL accounts for 6% of all pediatric malignancies, with an incidence of about 6 cases per 1 million, with a bimodal distribution with peaks in adolescence (15 to 19 years) and after age 55 years. HL is exceedingly rare in children less than 5 years of age.

In younger children it is more common in boys, but during adolescence the sex ratio is equalized.

Cure rates for pediatric HL are excellent, approaching 90% to 95%. Despite these excellent rates of cure, treatment can result in significant short-term and long-term morbidity.

Image 9.22 Hodgkin Lymphoma: Nodular Sclerosis. Classic Reed-Sternberg cell is 20 to 50 microns in size, with acidophilic or amphophilic cytoplasm, large bilobed or multilobed nucleus with vesicular or coarse chromatin. A large, round, eosinophilic central nucleolus is always present.