Lymphomas

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The management of lymphoma has developed into a specialized area of clinical practice.
It is essential that the oncologist, surgeon,radiologist and pathologist discuss cases
at all stages in the diagnostic process.

Histological evaluation of biopsy tissue is central to diagnosis and subsequent management.
It is greatly helped by immunohistochemical detection of markers for B-cells and T-cells
In some circumstances, establishing that a lesion is malignant depends on showing that a cell proliferation is monoclonal by demonstrating clonal immunoglobulin gene re-arrangement (B-lymphocytes) and clonal T-cell receptor gene re-arrangement (T-lymphocytes).

Cytogenetic investigation may demonstrate the presence of a specific chromosomal marker, e.g. the translocations seen in follicular lymphomas and Burkitt's lymphomas.

In cases of suspected lymphoma, tissue removed for biopsy is now received fresh in the
laboratory and carefully divided to allow a detailed morphological and molecular analysis.
Staining of lymphomas with markers of T-cells or B-cells is routine practice in the evaluation
of these tumours. Here, a lymphoma presenting as lumps in the skin shows positivity for
a B-cell marker (brown reaction) indicating a B-cell lymphoma.

SURVIVAL AND PROGNOSIS IN LYMPHOMA

Survival for all types of treated non-Hodgkin's lymphoma evens out after ten years because low-grade disease is hard to cure
The survival for patients with non-Hodgkin's lymphoma varies according to the grade of disease and its extent. Paradoxically, patients with high-grade disease may be cured, whereas many patients with low-grade disease suffer late relapses.
Patients who have high-grade disease are often encountered at an early stage and may be cured by aggressive chemotherapy.
Patients with low-grade disease often have extensive dissemination at diagnosis and, although disease may be controlled by therapy, cure is seldom achieved.
Although there is a 70% five-year survival for low-grade non-Hodgkin's lymphoma, with a 40%
five-year survival for high-grade disease, survival at ten years is still about 40% for
both types, reflecting continued deaths in patients with low-grade disease.
Patients who tend to die early with non-Hodgkin's lymphoma include the elderly, those who have extensive dissemination with haematological abnormalities, and those with systemic symptoms or weight loss and fever.
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