Transcription
It's Medicos. It's perfection; else, once again. And today, let's talk about non-Hodgkin's lymphoma, the most common type of lymphoma. As you know, hematological malignancies are leukemias, lymphomas, and myeloma—a solid tumor of the immune system—not only in the lymph node but also spleen, MALT (mucosa-associated lymphoid tissue), bone marrow, thymus, etc. Lymphoma is divided into Hodgkin's and non-Hodgkin's, which is more common. Hodgkin's is local nodal; this is nodal and extranodal in non-Hodgkin's. You also get constitutional symptoms, also known as B symptoms or B-cell symptoms, as well as hepatosplenomegaly, because again, non-Hodgkin's is extranodal. Non-Hodgkin's is subdivided into B-cell (70% of cases, the most common) and T-cell (the least common, 30% of cases only). It has aggressive and indolent subtypes.
Non-Hodgkin's lymphoma: nodal involvement, extranodal, and constitutional symptoms. External—like what? Liver, spleen, GI tract, thyroid, testes, skin, brain, and sometimes bone. Constitutional symptoms are fever, weight loss, night sweats, and some sources will add itching. Non-Hodgkin's lymphoma is associated with Epstein-Barr virus, human herpes virus 8, and human T-cell lymphoma virus 1. And we have talked about this before when you have talked about human T-cell leukemia. Some lymphomas will cause compression syndromes; they will press on the local structures leading to airway obstruction, severe vena cava syndrome if they are up in the mediastinum; if they are lower, they can cause gut obstruction, ascites, maybe spinal cord compression. Some lymphomas will secrete IgM, leading to hyperviscosity syndrome, because this is the largest immunoglobulin, as well as autoimmune cytopenias, such as autoimmune hemolytic anemia. Others will lead to, on the opposite, hypogammaglobulinemia—low gamma globulin—leading to infections.
Non-Hodgkin's lymphoma is a late manifestation of HIV/AIDS. It's the second most common cancer in AIDS patients. Do you know what's the number one cancer in AIDS patients? Please let me know below in the comments. Non-Hodgkin's lymphoma can take place after organ transplant and in immunosuppressed patients, as well as in congenital immunodeficiency. What's common in this? Decreased immunity. Because when your immunity is bad, bad things happen to you, including lymphoma. The median age of presentation in non-Hodgkin's is 50 years of age. The older you get, the higher the risk of developing non-Hodgkin's lymphoma.
Risk factors for non-Hodgkin's lymphoma: viruses such as human herpes virus 8, human T-cell lymphoma virus, sometimes HIV, and sometimes even hepatitis C virus; immunological problems could be immunodeficiency or autoimmune problems; radiation exposures; such as H. pylori; when we talk about MALT (mucosa-associated lymphoid tissue) lymphoma.
How to diagnose non-Hodgkin's lymphoma? Excisional biopsy, not fine needle aspiration. We need excisional to help the pathologist determine the architecture of the node, as well as cell appearance. Immunohistochemical stains and flow cytometry; immunoglobulin measurements because some of them have IgG, others have IgM; uric acid levels, especially in high-grade non-Hodgkin's lymphoma; they can have very high uric acid levels; plus HIV testing because non-Hodgkin's lymphoma may be common in AIDS patients.
Staging: How to stage? We need a physical exam and a CT scan. It's a physical exam, CT scan of the neck, chest, abdomen, or pelvis. PET scans can help diagnose and follow-up, and it will talk about this later. If you have cytopenias such as pancytopenia, we need a bone marrow biopsy to determine the cause of this cytopenia.
Treatment of non-Hodgkin's lymphoma: radiation, chemo, transplant. Pretty straightforward. So that's it for today. In the next video, we'll talk about aggressive versus indolent non-Hodgkin's lymphoma. Thank you so much for watching. If you have any questions, let me know below in the comments. And until next time, be safe, stay happy, and study hard. When it goes as perfect as nails.