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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.
Medicine
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Daniel, a 21-year-old man, presents to you complaining of feeling an enlarged lump in his neck for the past 6 weeks. You examine it and find it to be 3 cm by 2 cm, painless on palpation and with a ‘rubbery’ feel to it. You suspect lymphoma. List three symptoms he may also complain of. (3)Name two signs you will look for on examination. (2)The biopsy shows the presence of a binucleated cell. The haematologist states it is Hodgkin’s lymphoma.What is the name of this cell that suggests Hodgkin’s lymphoma? (1)State two staging investigations. (2)What staging system is classically used for Hodgkin’s lymphoma? (1)Whilst being investigated, Daniel presents to A&E with dyspnoea, swelling of the face and congested veins in his neck and chest.What has happened? (1)
Second cancers after radiotherapy
Published in Michael C. Joiner, Albert J. van der Kogel, Basic Clinical Radiobiology, 2018
Klaus Rüdiger Trott, Wolfgang Dörr
Wolden et al. (41) described the incidence of second cancers in 697 patients who were less than 21 years old at the time of treatment in Stanford, some followed up for more than 35 years. Eighty patients (11%) developed 85 new malignant tumours. Twenty-five (31%) were non-melanoma skin cancers. The second most frequent second cancer was breast cancer (16 patients), followed by sarcoma (13 patients). Eight second leukaemias occurred, all but one within 10 years and all eight patients had received chemotherapy with alkylating agents. The actuarial risk of second cancer at 20 years after treatment for Hodgkin lymphoma, at a mean attained age of 36 years, was 9.7% for males and 16.8% for females with more than half of their risk being due to breast cancer (9.2%). The most remarkable finding of this important single institution study was that among the 48 solid second cancers, 43 (90%) occurred within the high-dose radiotherapy treatment field or in the penumbra region, and 40 (83%) developed in volumes that had received at least 35 Gy. The authors stress that treatment policies for Hodgkin lymphoma have changed dramatically over the past 30 years, putting more emphasis on multi-agent chemotherapy and reduced radiation doses and treatment volumes to involved sites. Thus, the second malignancy rates seen after long follow-up in this study do not represent the risk for patients treated in the modern era. It should be noted that death of the patients from their primary Hodgkin lymphoma was more than twice as likely as from a second cancer (11% versus 4%).
Clinical prognostic risk analysis and progression factor exploration of primary breast lymphoma
Published in Hematology, 2022
Jili Deng, Lan Mi, Xiaopei Wang, Jun Zhu, Chen Zhang, Yuqin Song
Blood test reports were comprehensively collected to explore better this small group of patients’ adverse prognostic factors. Elevated ESR has previously been suggested as a poor prognostic factor for Hodgkin's lymphoma[24]. In our cohort, other general prognostic risk factors, such as ESR, LDH level, B symptoms, and IPI scores, were equally applicable in PB-DLBCL, showing poor prognostic factors for both OS and PFS (P < 0.05). The stage-adjusted IPI can also identify patients with a survival benefit, even if the disease is confined to an early stage. Although B symptoms in patients with non-Hodgkin lymphoma are frequently neither recorded nor accurate, as mentioned in the Lugano classification[25], they are still crucialin lymphoma patients, especially those with weight loss.
A review of the risks of long-term consequences associated with components of the CHOP chemotherapy regimen
Published in Journal of Drug Assessment, 2022
Crystal Watson, Hemanth Gadikota, Arie Barlev, Rachel Beckerman
Higher doses were associated with increased risk with patients exposed to high-dose doxorubicin (450 mg/m2), cyclophosphamide (17.6 g/m2), and ifosfamide (140 g/m2) at a much greater risk (up to 16 (95% CI: 3.84– 65.82)-fold increase) compared with doxorubicin (375 mg/m2) and cyclophosphamide (20.4 g/m2)52; the high-dose category (≥10 g/m2) of the alkylating agents was also associated with a 6.2 (95% CI: 2.4–16.1)-fold increased secondary leukemia risk compared with no exposure51 (Table 3). Risks were also increased in patients with a primary cancer diagnosis of Hodgkin’s lymphoma (2 (95% CI: 0.6– 6.6) to 6.4 (95% CI: 1.6–24)-fold greater risk)51,56 (Table 3).
Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision
Published in Acta Oncologica, 2021
Rasmus Krarup Sigaard, Kasper Wennervaldt, Lars Munksgaard, Lise Mette Rahbek Gjerdrum, Preben Homøe
Lymphoma is in the top ten of the most commonly diagnosed cancers in Denmark. With an incidence of approximately 1400 cases per year, it is responsible for 3.4% of all cancers in Denmark, and the age-standardized incidence rate has been increasing over the last six decades [1]. Lymphomas are traditionally divided into Hodgkin lymphoma, which accounts for approximately 10% of the cases, and non-Hodgkin lymphoma, including the remaining 90% [2]. Standard treatment for Hodgkin lymphoma includes chemo- and radiotherapy and the 5-year survival rate is higher than 85% [1]. Non-Hodgkin lymphomas entail more than 30 different subtypes [2,3]. Various treatment combinations are available and most often include chemo-immunotherapy. Survival rates are very much dependent on the lymphoma subtype, but the overall 5-year survival is approximately 70% [1].