Clinical Spectrum of non-Hodgkin lymphoma: A Hospital based study of 410 cases.
Keywords:
lymph node, hepatomegaly, splenomegaly, non-Hodgkin lymphoma
Abstract
Background: Lymphoma can be misdiagnosed due to lack of awareness of various clinical features. There is a rising incidence of lymphomas over the past few years. Several non Hodgkin lymphoma can present with different ‘B’ symptoms, different clinical signs and different sites of involvement. This study was done to evaluate the different clinical features and lymph node involvement at presentation in non Hodgkin lymphoma.Methods: 410 diagnosed and treated cases of non-Hodgkin lymphoma were selected from Kasturba Medical College, Manipal between Jan 2009 and December 2012. Clinical history, ‘B’ symptoms, laboratory investigations, including imaging procedures were noted in all the cases. The diagnosis of lymphoma was based on histology, IHC and WHO-2008 classification.Results: Out of 410 cases of non Hodgkin lymphoma, Nodal lymphomas comprised of 57.34% of total cases while extranodal lymphomas accounted for 42.6% of cases. B cell lymphoma accounted for 80.3% and T cell lymphoma were 19.6%. Most of the patients with NHL were in the age group of 50-60 yrs. 69% of cases were males while 31% of cases were females. Anemia was the commonest presenting feature among ‘B’ symptoms and cervical lymph node was most commonly involved lymph node.Conclusion: The clinical spectrum of lymphoma sometimes delays its diagnosis, leading to its eventual presentation in late stages. Awareness is required among the health professionals regarding its varied clinical presentations to diagnose at the earliest.References
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25. Blay JY, Negrier S, Combaret V, Attali S, Goillot E, Merrouche Y, et al.
Serum level of interleukin 6 as a prognosis factor in metastatic renal cell carcinoma. Cancer Research 1992;52(12):3317–3322.
26. Tran TT, Liu Y, Zurita A, Lin Y, Baker-Neblett KL, et al. Prognostic or predictive plasma cytokines and angiogenic factors for patients treated with pazopanib for metastatic renal-cell cancer: a retrospective analysis of phase 2 and phase 3 trials. Lancet Oncology 2012;13(8):827–837.
27. Preti HA, Cabanillas F, Talpaz M, Tucker SL, Seymour JF, Kurzrock R. Prognostic value of serum interleukin-6 in diffuse large-cell lymphoma. Annals of Internal Medicine 1997;127(3):186–194.
28. Denz H, Orth B, Weiss G, Hermann R, Huber P, Wachter H et al. Weight loss in patients with hematological neoplasias is associated with immune system stimulation. Clinical Investigator 1993;71: 37-41.
29. Lymphoma Association. Symptoms of Hodgkin lymphoma.1-6.
30. Olu-Eddo AN, Ohanaka CE. Peripheral lymphadenopathy in Nigerian adults. J PakMed Assoc 2006;56:405–8.
31. Hahn JS, Seok K, Young S, Chong et al. Eight- Year experience of malignant Lymphoma-survival and prognostic factors, Yonsei Medical Journal 1997; 38;5:270-284.
32. Song JY, Cheong HJ, Kee SY, Lee J, Sohn JW, Kim MJ, et al. Disease spectrum of cervical lymphadenitis: analysis based on ultrasound-guided core-needle gun biopsy. J Infect 2007;55:310–6.
2. Jose BO, Koerner P, Spanos WJ Jr, Paris KJ, Silverman CL, Yashar C, et al. Hodgkin’s lymphoma in adults – clinical features. J Ky Med Assoc 2005;103:15–7.
3. Al-Mobeireek AF, Arafah M, Siddiqui N. An African male with cough, hemoptysis, weight loss and hypercalcemia: TB or not TB? Eru Respir J 2002;20:1060–3.
4. Erum Naz, Talat Mirza, Sina Aziz. Frequency and clinicopathologic correlation of different types of Non Hodgkin’s lymphoma according to WHO classification. J Pak Med Assoc 2011; 61: 260-63.
5. Hingorjo MR, Sadiqa S. Presentation, staging and diagnosis of lymphoma: a clinical perspective. J Ayub Med Coll Abbottabad 2008; 20(4).
6. Hassan K, Ikram N, Bukhari KP, SH Shah. The pattern of Bone Marrow Infiltration in Non-Hodgkins Lymphomas. Journal of Pakistan Medical Association 1995; 45:173.
7. Cunlan MG, Armitage JO, Bast BSM, Weisenburger DD et al. Clinical significance of hematologic parameters in non-Hodgkins lymphoma at diagnosis. Cancer 1991; 67: 1389 -95.
8. Ghosh J, Singh RKB, Saxena R, Gupta R, Vivekanandan S, Sreenivas V et al. Prevalence and aetiology of anaemia in lymphoid malignancies. TNMJI 2013; 26: 2.
9. Idris M, Shah SH, Fareed J, Gul N. An experience with sixty cases of haematological malignancies; a clinicohaematological correlation. J Ayub Med Coll Abbottabad 2004; 16: 51-4.
10. Hohaus S, Massini G, Giachelia M, Vannata B, Bozzoli V, Cuccaro A, et al. Anemia in Hodgkin’s lymphoma: The role of interleukin-6 and hepcidin. J Clin Oncol 2010; 28:2538–43.
11. Ludwig H, Strasser K. Symptomatology of anemia. Semin Oncol 2001;28 (2-8):7–14.
12. Cella D. Factors influencing quality of life in cancer patients: Anemia and fatigue. Semin Oncol 1998;25 (3-7):43–6.
13. Moullet I, Salles G, Ketterer N, Dumontet C, Bouafia F, Neidhart-Berard EM, et al. Frequency and significance of anemia in non-Hodgkin’s lymphoma patients. Ann Oncol 1998; 9:1109–15.
14. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s Disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998;339:1506–14.
15. Murakami J, Shimizu Y. Hepatic Manifestations in Hematological Disorders. International Journal of Hepatology 2013;1-13.
16. Biemer JJ. Hepatic manifestations of lymphomas. Ann Clin Lab Sci 1984; 14(4):252-60.
17. Salo J, Nomdedeu B, Bruguera M et al. “Acute liver failure due to non-Hodgkin’s lymphoma,” The American Journal of Gastroenterology 1993;
88;5:774–776, 1993.
18. Nair S, Shukla J, Chandy M. Non-Hodgkin's lymphoma presenting with
prominent splenomegaly-clinicopathologic diversity in relationship to immunophenotype. Acta Oncol 1997;36(7):725-7.
19. Sra N, Verma SK, Singh D & Bal MS. Incidence of lymphoma in head and
neck region. Indian J Otolaryngol Head Neck Surg 2003; 55(4): 303–305.
20. Kurzrock R. The role of cytokines in cancer-related fatigue. Cancer
2001;92(6 Suppl):1684–1688.
21. Beaupre DM, Talpaz M, Marini FC, Cristiano RJ, Roth JA, Estrov Z, et al.
Autocrine Interleukin-1? Production in Leukemia Evidence for the Involvement of Mutated RAS6. Cancer Research 1999;59(12):2971–2980.
22. Seymour JF, Talpaz M, Cabanillas F, Wetzler M, Kurzrock R. Serum
interleukin-6 levels correlate with prognosis in diffuse large-cell lymphoma. Journal of Clinical Oncology1995;13(3):575–582.
23. Seymour JF, Talpaz M, Hagemeister FB, Cabanillas F, Kurzrock R. Clinical correlates of elevated serum levels of interleukin-6 in patients with untreated Hodgkin’s disease. The American Journal of Medicine 1997;102(1):21–28.
24. Fayad L, Keating MJ, Reuben JM, O’Brien S, Lee BN, Lemer S, Kuzrock R. Interleukin-6 and interleukin-10 levels in chronic lymphocytic leukemia: correlation with phenotypic characteristics and outcome. Blood 2001;97(1):256–263.
25. Blay JY, Negrier S, Combaret V, Attali S, Goillot E, Merrouche Y, et al.
Serum level of interleukin 6 as a prognosis factor in metastatic renal cell carcinoma. Cancer Research 1992;52(12):3317–3322.
26. Tran TT, Liu Y, Zurita A, Lin Y, Baker-Neblett KL, et al. Prognostic or predictive plasma cytokines and angiogenic factors for patients treated with pazopanib for metastatic renal-cell cancer: a retrospective analysis of phase 2 and phase 3 trials. Lancet Oncology 2012;13(8):827–837.
27. Preti HA, Cabanillas F, Talpaz M, Tucker SL, Seymour JF, Kurzrock R. Prognostic value of serum interleukin-6 in diffuse large-cell lymphoma. Annals of Internal Medicine 1997;127(3):186–194.
28. Denz H, Orth B, Weiss G, Hermann R, Huber P, Wachter H et al. Weight loss in patients with hematological neoplasias is associated with immune system stimulation. Clinical Investigator 1993;71: 37-41.
29. Lymphoma Association. Symptoms of Hodgkin lymphoma.1-6.
30. Olu-Eddo AN, Ohanaka CE. Peripheral lymphadenopathy in Nigerian adults. J PakMed Assoc 2006;56:405–8.
31. Hahn JS, Seok K, Young S, Chong et al. Eight- Year experience of malignant Lymphoma-survival and prognostic factors, Yonsei Medical Journal 1997; 38;5:270-284.
32. Song JY, Cheong HJ, Kee SY, Lee J, Sohn JW, Kim MJ, et al. Disease spectrum of cervical lymphadenitis: analysis based on ultrasound-guided core-needle gun biopsy. J Infect 2007;55:310–6.
Published
2016-02-29
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