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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The majority of women with lymphoma are asymptomatic. On physical examination, 80% will have superficial lymphadenopathy. Those with Hodgkin’s disease are more likely to have localized lymphadenopathy, most often involving cervical, submaxillary, or axillary nodes. A small percentage of patients have fever, night sweats, weight loss, or pruritus, which are associated with poor prognosis. Biopsy is the “gold standard” of diagnosis. The histology of Hodgkin’s lymphoma often shows multinucleated Reed–Sternberg cells with a pattern that is most commonly nodular sclerosing or lymphocytic. Histology is no longer thought to contribute to overall prognosis, as recent evidence demonstrates that the two most important prognostic factors are stage of disease and patient’s age (244). Hodgkin’s lymphoma is staged by the Ann Arbor staging system.
Haematology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
TREATMENT According to stage (Ann Arbor staging) and histological type: Localised NLPHD with radiotherapy only.Localised classical HD with chemotherapy and radiotherapy.Advanced disease with chemotherapy alone.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Hodgkin’s lymphoma most commonly affects the cervical and supraclavicular glands, although mediastinal involvement may be seen in two-thirds of children with the disease. An increased risk is seen in children from higher socio-economic groups. Diagnosis is made by taking a biopsy from the affected node, which may feel firm or rubbery. The cell that is affected in Hodgkin’s disease is the Reed–Sternberg cell. Although a diagnosis of Hodgkin’s lymphoma cannot be made in the absence of Reed–Sternberg cells, they are not pathognomonic for the disease, as they may also be present in some non-Hodgkin’s lymphomas and Epstein–Barr virus infection. The Ann Arbor staging system is used to help stage the disease. Stage I denotes involvement of a single lymph node region whereas stage IV represents diffuse involvement of extralymphatic organs or tissues. The staging may be suffixed with A or B. The suffix ‘B’ denotes presence of B symptoms: fever, night sweats or greater than 10% weight loss in the preceding 6 months and is associated with a worse prognosis. The suffix ‘A’ is designated in the absence of these symptoms. Chemotherapy forms the mainstay of treatment although radiotherapy is also needed at times.
Mucosa-associated lymphoid tissue lymphoma in thymus: a SEER analysis
Published in Expert Review of Anticancer Therapy, 2022
Meng-Xin Zhou, Ye-Ye Chen, Lei Liu, Gui-Ge Wang, Jia-Qi Zhang, Ke Zhao, Shan-Qing Li
The Ann Arbor staging system was first used to classify Hodgkin’s lymphoma and later non-Hodgkin’s lymphoma [25]. Most patients were at stage I or II in the current study, indicating that the tumor was indolent and metastasis was scarce. However, the value of the Ann Arbor stage for thymic MALT lymphoma remains questionable due to the following reasons: 1) it could not predict the prognosis of patients according to the regression and survival analysis in our study, 2) involvement of other extra lymphoid sites (stage IV) may be not a result of metastasis but concurrent MALT lymphoma (in previous studies, 10 cases [2,7,26–31] were reported as stage IV, but only 2 of them were considered as metastasis), and 3) the choice of treatment does not entirely depend on the stage. Another staging system, such as TNM, might be superior to Ann Arbor because it considers tumor size and regional lymph nodes for generating guidance for therapy, especially surgery [2,7,26–33]. However, this classification could not be validated in the present study.
A 10-year cohort study of 175 primary gastrointestinal lymphoma cases in Thailand: clinical features and outcomes in the immunochemotherapy era
Published in Hematology, 2021
Weerapat Owattanapanich, Theera Ruchutrakool, Tawatchai Pongpruttipan, Monthira Maneerattanaporn
The 175 PGIL patients enrolled had a median age was 60 years (range, 20–98) and a male predominance (60%). The PS of the patients, which were based on the Eastern Cooperative Oncology Group (ECOG) classification system, were ECOG-PS 0, 0.6%; 1, 47.4%; 2, 41.1%; 3, 9.7%; and 4, 0.6%. Most of the patients (82.8%) had abdominal pain as a presenting symptom. Other common initial manifestations were palpable abdominal mass (29.3%), upper GI bleeding (20.1%), lower GI bleeding (12.1%), gut obstruction (10.9%), hollow viscus organ perforation (10.4%), chronic diarrhea (10.4%), superficial lymphadenopathy (8%), and dysphagia (7%). Over half of the patients presented with B symptoms, of which 50.6% were significant weight loss, 12.6% were fever, and 2.9% were night sweats (Table 1). Because there were various lymphoma subtypes, we re-evaluated the staging of all cases based on the Ann Arbor staging system. The staging 0, 1, 2, 3, 4 were 30.9%, 20.0%, 10.3% and 29.7%, respectively.
Adjuvant radiotherapy and chemotherapy in early-stage diffuse large B cell lymphoma of head and neck with extranodal involvement
Published in Hematology, 2019
Cuiying Peng, Joshua Ho, Harrison X. Bai, Yuqian Huang, Raymond Y. Huang, Li Yang
The final study cohort consisted of 1,929 stage I or II HN-DLBCL patients who received multi-agent CT and/or RT as the primary treatment modality. Baseline patient, tumor, and treatment characteristics for the included patients are summarized in Table 1. Comparison of demographic factors among included and excluded patients is shown in supplementary Table 5. Significant statistical differences were found in insurance status and B symptoms between the two groups. In terms of Ann Arbor staging, 56.7% of the patients were stage I and 43.3% stage II. The median age at diagnosis was 64.5 years (range:2–90 years); 65.4% were older than 60 years; the male to female ratio was 1.3:1. Among all patients, 52.4% (n = 1,011) patients received multi-agent CT alone, and 47.6% (n = 918) patients received multi-agent CT plus RT.