Lymphoma: Wikis


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Classification and external resources

Gastric MALT lymphoma
ICD-10 C81.-C96.
ICD-O: 9590-9999
MeSH D008223

Lymphoma is a cancer that begins in the lymphocytes of the immune system and presents as a solid tumor of lymphoid cells. It is treatable with chemotherapy, and in some cases radiotherapy and/or bone marrow transplantation, and can be curable, depending on the histology, type, and stage of the disease.[1] These malignant cells often originate in lymph nodes, presenting as an enlargement of the node (a tumor). Lymphomas are closely related to lymphoid leukemias, which also originate in lymphocytes but typically involve only circulating blood and the bone marrow (where blood cells are generated in a process termed haematopoesis) and do not usually form static tumors.[1] There are many types of lymphomas, and in turn, lymphomas are a part of the broad group of diseases called hematological neoplasms.

Thomas Hodgkin published the first description of lymphoma in 1832, specifically of the form named after him, Hodgkin's lymphoma.[2] Since then, many other forms of lymphoma have been described, grouped under several proposed classifications. The 1982 Working formulation classification became very popular. It introduced the category non-Hodgkin lymphoma (NHL), divided into 16 different diseases. However, because these different lymphomas have little in common with each other, the NHL label is of limited usefulness for doctors or patients and is slowly being abandoned. The latest classification by the WHO (2001) lists 43 different forms of lymphoma divided in four broad groups.

Some forms of lymphoma are categorized as indolent (e.g. small lymphocytic lymphoma), compatible with a long life even without treatment, whereas other forms are aggressive (e.g. Burkitt's lymphoma), causing rapid deterioration and death. However, most of the aggressive lymphomas respond well to treatment and are curable. The prognosis therefore depends on the correct classification of the disease, established by a pathologist after examination of a biopsy.[3]

Although older classifications referred to histiocytic lymphomas, these are recognized in newer classifications as of B, T or NK cell lineage. True histiocytic malignancies are rare and are classified as sarcomas.[4]



A number of different classification systems exist for lymphoma. As an alternative to the American Lukes-Butler classification, in the early 1970s, Karl Lennert of Kiel, Germany, proposed a new system of classifying lymphomas based on cellular morphology and their relationship to cells of the normal peripheral lymphoid system.[5]



In the mid 1990s, the Revised European-American Lymphoma (REAL) Classification attempted to apply immunophenotypic and genetic features in identifying distinct clinicopathologic entities among all the lymphomas except Hodgkin's lymphoma.[6] REAL has been superseded by the WHO classification.


The WHO Classification, published in 2001 and updated in 2008,[4] is the latest classification of lymphoma and is based upon the foundations laid within the "Revised European-American Lymphoma classification" (REAL). This system attempts to group lymphomas by cell type (i.e. the normal cell type that most resembles the tumor) and defining phenotypic, molecular or cytogenetic characteristics. There are three large groups: the B cell, T cell, and natural killer cell tumors. Other less common groups, are also recognized. Hodgkin's lymphoma, although considered separately within the WHO (and preceding) classifications, is now recognized as being a tumor of, albeit markedly abnormal, lymphocytes of mature B cell lineage.

Mature B cell neoplasms

DNA-microarray analysis of Burkitt's lymphoma and diffuse large B-cell lymphoma (DLBCL) showing differences in gene expression patterns. Colors indicate levels of expression; green indicates genes that are underexpressed in lymphoma cells (as compared to normal cells), whereas red indicates genes that are overexpressed in lymphoma cells.

Mature T cell and natural killer (NK) cell neoplasms

Hodgkin lymphoma

Immunodeficiency-associated lymphoproliferative disorders

Working Formulation and Non-Hodgkin lymphoma

The 1982 Working Formulation is a classification of non-Hodgkin lymphoma. It excluded the Hodgkin's lymphomas and divided the remaining lymphomas (currently numbering 39 distinct diseases) into four grades (Low, Intermediate, High, and Miscellaneous) related to prognosis, with some further subdivisions based on the size and shape of affected cells. Because the most sophisticated technology used in diagnostic work at the time was the simple light microscope, it included no information about cell surface markers, or genetics, and it made no distinction between T-cell lymphomas or B-cell lymphomas.

The Working Forumulation was superseded by REAL, which in turn has since been replaced by the WHO in 2001 (updated in September 2008), but it is still used by cancer agencies for compilation of lymphoma statistics and historical comparisons. The Working Formulation is obsolete,[7] as is the term non-Hodgkin lymphoma.

Other classification systems


Diagnosis, etiology, staging, prognosis, and treatment

Depends on the specific form of lymphoma. For low-grade lymphoma, watchful waiting is often the initial course of action. If a low-grade lymphoma is becoming symptomatic, radiotherapy or chemotherapy are the treatments of choice, as while they do not cure the lymphoma, they can palliate symptoms, particulary painful lymphadenopathy. Patients with low-grade lymphoma can live near-normal lifespans, but the disease is incurable. Treatment of high-grade lymphoma can result in a cure in the majority of cases, however, the prognosis for patients with a poor response to therapy is worse. Treatment for high-grade lymphoma typically consists of aggressive chemotherapy, including the CHOP regimen. Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localized. Advanced Hodgkins disease requires systemic chemotherapy, sometimes combined with radiotherapy. See the article on the corresponding form of lymphoma for further information.


Age-standardized death from lymphomas and multiple myeloma per 100,000 inhabitants in 2004.[9]
     no data      less than 1.8      1.8-3.6      3.6-5.4      5.4-7.2      7.2-9      9-10.8      10.8-12.6      12.6-14.4      14.4-16.2      16.2-18      18-19.8      more than 19.8

Lymphoma is the most common form of hematological malignancy, or "blood cancer", in the developed world.

Taken together, lymphomas represent 5.3% of all cancers (excluding simple basal cell and squamous cell skin cancers) in the United States, and 55.6% of all blood cancers.[10]

According to the U.S. National Institutes of Health, lymphomas account for about five percent of all cases of cancer in the United States, and Hodgkin's lymphoma in particular accounts for less than one percent of all cases of cancer in the United States.

Because the whole system is part of the body's immune system, patients with a weakened immune system, such as from HIV infection or from certain drugs or medication, also have a higher incidence of lymphoma.

See also


  1. ^ a b Parham, Peter (2005). The immune system. New York: Garland Science. p. 414. ISBN 0-8153-4093-1. 
  2. ^ Hellman, Samuel; Mauch, P.M. Ed. (1999). Hodgkin's Disease. Chapter 1: Lippincott Williams & Wilkins. p. 5. ISBN 0-7817-1502-4. 
  3. ^ Wagman LD. "Principles of Surgical Oncology" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
  4. ^ a b ed. by Elaine S. Jaffe .... (2001). Pathology and Genetics of Haemo (World Health Organization Classification of tumors S.). Oxford Univ Pr. ISBN 92-832-2411-6. 
  5. ^ Lennert, Karl; Feller, Alfred C.; Jacques Diebold; M. Paulli; A. Le Tourneau (2002). Histopathology of Non-Hodgkin's Lymphomas (Based on the Updated Kiel Classification). Berlin: Springer. pp. 2. ISBN 3-540-63801-6. 
  6. ^ on Lymphoma, Non-Hodgkin
  7. ^ Clarke CA, Glaser SL, Dorfman RF, Bracci PM, Eberle E, Holly EA (January 2004). "Expert review of non-Hodgkin's lymphomas in a population-based cancer registry: reliability of diagnosis and subtype classifications". Cancer Epidemiol. Biomarkers Prev. 13 (1): 138–43. PMID 14744745. 
  8. ^
  9. ^ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov. 11, 2009. 
  10. ^ Horner MJ, Ries LAG, Krapcho M, Neyman N, et al. (eds).. "SEER Cancer Statistics Review, 1975–2006". Surveillance Epidemiology and End Results (SEER). Bethesda, MD: National Cancer Institute. Retrieved 03 November 2009. "Table 1.4: Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival Rates By Primary Cancer Site, Sex and Time Period" 

External links

Simple English

Lymphoma is a cancer of the lymphatic system. There are many types of lymphoma, including Hodgkin's lymphoma, the primary central nervous system lymphoma, the B-cell lymphoma, and the hepatosplenic lymphoma.



Chemotherapy is often used for both Hodgkin lymphoma and Non-Hodgkin Lymphomas.[2][3] Radiotherapy may also be used.[4]



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