64. Lymphoma



Hodgkin’s disease, 201.9


Lymphoma, 202.8


Non-Hodgkin’s lymphoma, 202.8







I. Ann Arbor Staging Classification is the anatomic staging system that parallels non-Hodgkin’s and Hodgkin’s disease.


A. Stage I: single lymph node or single extralymphatic origin


B. Stage II: two or more lymph node regions or extralymphatic sites on the same side of the diaphragm


C. Stage III: involvement of lymph node regions or extralymphatic sites on both sides of the diaphragm


D. Stage IV: diffuse or disseminated involvement of more than one extralymphatic organ with or without associated lymph node involvement. Bone marrow involvement confers stage IV designation.


E. Cotswold modifications


1. Massive mediastinal disease (thoracic ratio of maximum transverse mass diameter) 33% or more of the internal transverse thoracic diameter (measured at the T5-6 intervertebral disk level on chest radiography)


2. Number of anatomic regions involved should be indicated by a subscript (e.g., II3).


3. Stage III may be subdivided into


a. III1, with or without plenic, hilar, celiac, or portal nodes


b. III2, with para-aortic, iliac, or mesenteric nodes


4. Staging should be identified as clinical stage (CS) or pathologic stage (PS).


5. New category of response to therapy, unconfirmed/uncertain complete remission (CR), can be designated following persistent radiologic abnormalities of uncertain significance.



III. Revised European-American Lymphoma Classification (REAL)


A. B-cell neoplasms


1. Precursor B-cell neoplasms; precursor B-lymphoblastic leukemia/lymphoma


2. Peripheral B-cell neoplasms


a. B-cell chronic lymphocytic leukemia/prolymphocytic leukemia/small lymphocytic lymphoma


b. Lymphoplasmacytoid lymphoma/immunocytoma


c. Mantle cell lymphoma


d. Follicle center lymphoma, follicular lymphoma


i. Provisional cytologic grades


(a) Grade I: small cell


(b) Grade II: mixed small and large cell


(c) Grade III: large cell


ii. Provisional subtype: diffuse, predominantly small cell type


e. Marginal zone B-cell lymphoma


i. Extranodal (mucosa-associated lymphoid tissue type ± monocytoid B cells)


ii. Provisional subtype: nodal (±monocytoid B cells)


f. Provisional entity: splenic marginal zone lymphoma (± villous lymphocytes)


g. Hairy cell leukemia


h. Plasmacytoma/plasma cell myeloma


i. Diffuse large B-cell lymphoma. Subtype: primary mediastinal (thymic) B-cell lymphoma


j. Burkitt’s lymphoma


k. Provisional entity: High-grade B-cell lymphoma, Burkitt’s-like



C. Hodgkin’s disease


1. Lymphocyte predominance


2. Nodular sclerosis


3. Mixed cellularity


4. Lymphocyte depletion


5. Provisional entity: lymphocyte-rich classic Hodgkin’s disease


IV. World Health Organization (WHO) Classification of Lymphoid Neoplasm (modified from REAL: Gold Standard)



B. T-cell and NK cell neoplasms


1. Precursor T-cell neoplasm


a. Precursor T-lymphoblastic lymphoma/leukemia (precursor T-cell acute lymphoblastic leukemia)


2. Mature (peripheral) T/NK cell neoplasm


a. T-cell prolymphocytic leukemia


b. T-cell granular lymphocytic leukemia


c. Aggressive NK cell leukemia


d. Adult T-cell lymphoma/leukemia (human T-lymphotropic virus [HTLV]-1+)


e. Extranodal NK/T-cell lymphoma, nasal type


f. Enteropathy-type T-cell lymphoma


g. Hepatosplenic gamma delta T-cell lymphoma


h. Subcutaneous panniculitis-like T-cell lymphoma


i. Mycosis fungoides/Sézary syndrome


j. Anaplastic large cell lymphoma, T/null cell, primary cutaneous type


k. Peripheral T-cell lymphoma, not otherwise characterized


l. Angioimmunoblastic T-cell lymphoma


m. Anaplastic large cell lymphoma, T/null, primary systemic type

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Mar 3, 2017 | Posted by in NURSING | Comments Off on 64. Lymphoma

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