Lymphoma non-hodgkinien
The Lymphome S non-hodgkiniens are Néoplasie S developed starting from lymphoid fabrics.
A lymphoma is a cancer of the lymphatic system. The lymphatic system includes/understands osseous marrow, the lymphatic spleen, thymus, ganglia and the blood-vessels and ensures the defense of the organization.
Form lymphoma and classification
One distinguishes the ganglionic and extra-ganglionic malignant lymphomas
Histology
*Lymphomes malignant aggressive (ganglionic or extra-ganglionic lymphomas having an aggressive presentation)- Phenotype B
- lymphoma with large cells:
- lymphoma centroblastic
- lymphoma immunoblastic
- lymphoma with cells B rich in cells T
- lymphoma with cells B rich in histiocytes
- lymphoma with large anaplasic cells B
- lymphoma Burkitt-like
- granulomatose lymphomatoïde
- lymphoma associated with a pyothorax
- lymphoma with the médiastin
- intravascular lymphoma
- lymphoma with séreuses the
- lymphoma with Burkitt
- Phenotype T
- lymphoma with large anaplasic cells
- lymphoma T peripheral
- angio-immunoblastic
- lymphoma with the zones T without precision
*Lymphomes not hodgkiniens indolent (ganglionic or extra-ganglionic lymphomas having a indolente presentation)
- Lymphomas with cells of the marginal zone
- lymphomas of the M.A.L.T. (Mucosa Associated Lymphoid Tissue: lymphomas of lymphoid fabric associated with the mucous membranes)
- splenic lymphomas (of spleen) with or without villous lymphocytes
- ganglionic lymphomas with or without cells B monocytoïdes
- disseminated forms
- follicular Lymphomas
- grade 1 (< 50% of centroblastes)
- rank 2 (> 50% of centroblastes)
- cutaneous
- digestive
- Lymphomas with cells of the coat
- traditional form
- with round cells
- blastic form
- with large cells
- Lymphomas lymphoplasmocytoïdes (or immunocytomes)
Classification of Ass Arbor
- Stage I: Attack of only one ganglionic group or only one body.
- Stage II: Attack of more than one ganglionic surface on the same side of the diaphragm. (lower part or upper part of the body)
- Stage III: Multiple adenopathies on the two sides of the diaphragm. (lower part and upper part of the body)
- Stage IV: Attack diffuses one or more internal organs and osseous marrow.
to Which one adds:
- E at the stages I II III: if presence of a contiguous visceral attack
- a: if no sign of B
- b: - unexplained Slimming of more than 10% of the weight of the body in less than 6 months or unexplained Fever >38°C of more than 8 night days or Sweats profuses.
Classification of the general state of the patient
- 0: There is no attack of the general state of health, the patient carries out a normal life.
- 1: There exists a tiredness, but the patient can be occupied with his daily occupations.
- 2: A strong tiredness obliges the patient to lie down in the course of the day.
- 3: The patient remains confined to bed more half of the day.
- 4: The patient cannot rise any more.
Etiologies
- Generally unspecified
- HIV
- Virus of Epstein-Barr and the Lymphoma of auto-immune Burkitt
- Disease
- Immunosuppression
Symptomatology
In addition to a deterioration of the general state, one finds a fébricule (38°C), a slimming, night sweats (++)…
Ganglionic forms
Presence of Adenopathy S surface palpable and deep visible in imageries.
Extra-ganglionic forms
There is no specific symptom but the expression of the invasion of the target body: the Stomach, the Thyroid , the Brain, the Testicle, the Parotid , the eye, the osseous Marrow
Prognostic indices
international prognostic Index of the lymphomas with large cells (IPI)- According to the Classification of Ass Arbor
- According to the Histology of the malignant lymphoma
- According to the rates of LDH (Lactate déshydrogénase)
- According to the age of the patient (about 60 years)
- Depending on his general state (0,1, 2,3,4)
international prognostic Index of the follicular lymphomas (FLIPI)
- According to the Classification of Ass Arbor
- According to the Histology of the malignant lymphoma
- According to the rates of LDH (Lactate déshydrogénase)
- According to the age of the patient (about 60 years)
- According to the rate of Hemoglobin
Diagnosis
- biological Examinations of blood
- Biopsy of osseous marrow
- Tomodensitométrie (Scanner) of the thorax and the abdomen
with Which are sometimes associated:
- lumbar Puncture
- gastric Fibroscopie
- Fart-Scan (Tomography with emission of positon)
Treatment
Method of treatment intended to modify the natural means of defense of the organization, is by injection of serum or of immunoglobulin which brings the specific antibodies (immunothérapie passivates), are by vaccinotherapy which causes the production of these antibodies (immunothérapie active).- monoclonal Antibodies: Rituximab (MabThera)
- Interféron
- genic Therapy
- therapy anti-angiogénique
- radio-immunothérapie
- inhibiting Vaccines
- of protéasome
- Molecules antisens
- Surgery
- Splénectomie
- Allogreffe
- Autograft
External bonds
- France Lymphoma Hope: The association of patients of the lymphoma
- FROZE: Group study of the lymphomas of the adult
- Fondation lymphoma Canada
- old teaching Moulage (of wax), presenting a lymphoma. (Museum of the mouldings of the Saint-Louis hospital)
See too
- Lymphoma
- Mitoxantrone