What Is an Indolent Lymphoma?

Lymphoma is a malignant tumor that originates in the lymphoid hematopoietic system. It is mainly manifested as painless lymphadenopathy, hepatosplenomegaly, all tissues and organs in the body can be affected, with systemic symptoms such as fever, night sweats, weight loss, and itching.

Basic Information

English name: lymphoma
Visiting department: Oncology
Common locations: lymph

Common causes: Unclear etiology
Common symptoms: Chronic progressive painless lymphadenopathy with fever, night sweats, etc.
Contagious: no

Lymphoma etiology

The cause is unclear. It is generally believed that it may be related to genetic mutations, as well as viral and other pathogen infections, radiation, chemical drugs, and combined autoimmune diseases.

Clinical manifestations of lymphoma

Malignant lymphoma is a large heterogeneous tumor. Although it occurs in lymph nodes, due to the distribution of the lymphatic system, lymphoma is a systemic disease that can invade almost any tissue and organ in the body. Therefore, the clinical manifestations of malignant lymphoma not only have certain common characteristics, but also have great differences according to different pathological types, affected sites and areas.

Local manifestations include superficial and deep lymphadenopathy, most of which are painless, smooth, and active, and the texture of the palate is tenacious, full, and even. Early activity, isolated or scattered in the neck, armpit, groin, etc., and late Mutual fusion, adhesion to the skin, inactivity, or formation of ulcers; Pharyngeal lymphatic ring lesions Oropharyngeal, tongue base, tonsils and nasopharyngeal mucosa and submucosa are rich in lymphatic tissue, which constitutes the pharynx lymphatic ring, also known as Wechsler ring It is a common site of malignant lymphoma. Most of the primary nasal lymphomas are NHL. The main pathological types include nasal NK / T-cell lymphoma and diffuse large B-cell lymphoma. Thoracic mediastinal lymph nodes are malignant lymphomas. The most common sites of tumor are diffuse large B-cell lymphoma and precursor T-cell lymphoma of the primary mediastinum in HL and NHL. There are round or quasi-round or lobular shadows on the chest X-ray. The progression of the disease can compress the bronchus and cause atelectasis, and sometimes the central tumor necrosis forms a cavity. Some lung lesions appear as diffuse interstitial changes. At this time, clinical symptoms are obvious. Cough, sputum, shortness of breath, dyspnea are often present, and secondary infections may have fever. Malignant lymphomas can invade the heart muscle and pericardium. Pericardial effusion, lymphoma invasion of the myocardium is manifested as myocardial lesions, which may have arrhythmia, abnormal electrocardiogram and other manifestations; the abdominal manifestation of the spleen is the most common sublingual invasion site of HL. The gastrointestinal tract is the most common site of extranodal disease in the NHL. Mesenteric, retroperitoneal, and popliteal lymph nodes are also common sites of lymphoma invasion; skin manifestations of malignant lymphoma can be primary or secondary skin invasions, which are more common in NHL; bone marrow invasion of bone marrow lymphoma manifests as bone marrow invasion or with leukemia Most of them are one of the late manifestations of the disease, most of which are NHL; Nervous system manifestations: such as progressive multifocal leukoencephalopathy, subacute necrotizing myelopathy, sensory or motor peripheral neuropathy, and polymyopathy, etc. which performed. Malignant lymphoma can also be primary or secondary to the brain, extradural, testis, ovary, vagina, cervix, breast, thyroid, adrenal glands, posterior orbital tissue, larynx, bone, and muscle soft tissue. The clinical manifestations are complex and diverse. Attention should be paid to identification.

Full body manifestations include

Systemic symptoms

Malignant lymphoma may develop systemic symptoms such as fever, itching, night sweats, and weight loss before or at the same time as lymphadenopathy.

2. Immune and blood system performance

10% to 20% of patients with malignant lymphoma may have anemia. Some patients may have white blood cell counts, thrombocytosis, and increased erythrocyte sedimentation. Individual patients may have leukemia-like reactions and neutrophils are significantly increased. Increased lactate dehydrogenase is associated with tumor burden. Some patients, especially advanced patients, show abnormal immune function. In B-cell NHL, the number of monoclonal immunoglobulins can be detected in the serum of some patients.

3 Skin lesions

Patients with malignant lymphoma may have a series of non-specific skin manifestations, skin lesions are polymorphic, erythema, blisters, erosion, etc. Patients with advanced malignant lymphoma have low immune status, skin infections often rupture and exudate, forming systemic scattered Skin thickening and desquamation.

Lymphoma examination

1. Blood routine and blood smear

The blood routine is generally normal, which can be combined with anemia of chronic diseases; HL can appear with increased PLT, WBC, and eosinophils; invasive NHL invasion of bone marrow can cause anemia, reduced WBC and PLT, and lymphoma cells in peripheral blood.

2. Bone marrow smear and biopsy

HL rare bone marrow involvement. NHL invades the bone marrow. Lymphoma cells can be seen in the bone marrow smear. The cells are large in size, rich in chromatin, gray-blue, and obviously abnormal in shape, showing "tailing". Lymphoma cells 20% are lymphoma leukemia; bone marrow biopsy can be seen Lymphoma cells aggregate and infiltrate. In some patients, bone marrow smears show increased hemophagocytosis and hemophagocytosis, which are more common in T-cell NHL.

3. blood biochemistry

Increased LDH is related to tumor burden and is an indicator of poor prognosis. HL may have faster ESR and higher ALP.

4. Cerebrospinal fluid examination

Patients with moderate to highly aggressive NHL clinical stage III / IV may have central nervous system involvement, or those with central nervous system symptoms, need to undergo cerebrospinal fluid examination, which is manifested by increased cerebrospinal fluid pressure, increased biochemical protein, increased number of conventional cells, and single nucleus. Primary, pathological or flow cytometry can detect lymphoma cells.

5. Histopathological examination

The basic pathological morphological change of HL is to see diagnostic RS cells and their variant cells in a mixed proliferation background with multiple inflammatory cells. Immunohistochemical characteristics: classic CD15 ⁺ , CD30 ⁺ , CD25 ⁺ ; nodular lymphocytes predominantly CD19 ⁺ , CD20 ⁺ , EMA ⁺ , CD15-, CD30-. NHL lymph nodes or histopathology showed normal lymph nodes or tissue structure destruction, tumor cells were scattered or diffusely infiltrated, and had their own unique pathological manifestations and immune phenotypes according to different pathological types.

6. TCR or IgH gene rearrangement

Can be positive.

Lymphoma diagnosis

Lymphoma has various clinical manifestations. Although it can be chronic, progressive, and painless lymphadenopathy, it can also be manifested as other system involvement or systemic symptoms. When clinically suspected of lymphoma, a pathological biopsy (biopsy) of the lymph nodes or other affected tissues or organs can be performed to confirm the diagnosis.

Lymphoma treatment

Lymphomas are highly heterogeneous, and treatment effects vary widely. Lymphomas of different pathological types and stages differ greatly in terms of treatment intensity and prognosis. Lymphoma treatment methods mainly include the following, but specific patients should also be analyzed according to the actual situation of the patient.

Radiation therapy

Certain types of lymphoma can be treated with radiotherapy alone at an early stage. Radiotherapy can also be used for consolidation therapy after chemotherapy and adjuvant therapy during transplantation.

2. Chemotherapy

Lymphoma chemotherapy often uses combined chemotherapy, which can be combined with targeted therapeutic drugs and biological agents. In recent years, chemotherapy for lymphoma has been greatly improved, and the survival of many types of lymphoma has been greatly improved.

3. Bone marrow transplant

For patients under 60 years of age who can tolerate high-dose chemotherapy, autologous hematopoietic stem cell transplantation may be considered. Allogeneic hematopoietic stem cell transplantation may also be considered in young patients with partial recurrence or bone marrow invasion.

4. Surgery

Only limited to biopsy or complications management; combined with hypersplenism and no contraindications, those who have indications for spleen cutting can cut the spleen to improve blood image and create favorable conditions for future chemotherapy.

Lymphoma prognosis

The prognosis of Hodgkin's lymphoma is closely related to the tissue type and clinical stage. The prognosis of the lymphocyte predominant type is the best, with a 5-year survival rate of 94.3%. The lymphocyte depleted type is the worst, with a 5-year survival rate of only 27.4%. Node sclerosis and mixed cell types are in between. Hodgkin's lymphoma is clinically staged, with a 5-year survival rate of 92.5% for stage I, 86.3% for stage II, 69.5% for stage III, and 31.9% for stage IV; systemic symptoms are worse than those without systemic symptoms. The prognosis of children and the elderly is generally worse than that of the young and middle-aged; women are better than men after treatment.

The prognosis of non-Hodgkin's lymphoma is equally important in its pathological type and stage. The 6-year survival rate of patients with diffuse lymphocyte differentiation is 61%; the 6-year survival rate of patients with diffuse lymphocyte differentiation is 42%; the 4-year survival rate of lymphoblastic lymphoma is only 30%. The presence or absence of systemic symptoms has a smaller effect on prognosis than HL. The course of non-Hodgkin's lymphoma in the low malignant group is relatively mild, but there is no effective cure, so it is a chronic process with multiple recurrences, and it also causes death due to conversion to other types and resistance to chemotherapy. However, if the low-grade malignant group is found earlier, after reasonable treatment, it can have a survival period of 5-10 years or even longer. Some highly malignant lymphomas are sensitive to radiotherapy and chemotherapy, and after reasonable treatment, the survival time can be significantly prolonged.