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Lymphoma for the Internist

When To Suspect Lymphoma. 1. Patients with impaired immune systems HIV, Transplant, Auto immune diseases 2. Patients with unexplained fever, night sweats, weight loss 3. Patients with lymphadenopathy. Lymphadenopathy. Medicine 79:338 47, 2000 Biopsy or not Ne

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Lymphoma for the Internist

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    1. Lymphoma for the Internist Lee Berkowitz, MD Oct 2, 2007

    2. When To Suspect Lymphoma 1. Patients with impaired immune systems HIV, Transplant, Auto immune diseases 2. Patients with unexplained fever, night sweats, weight loss 3. Patients with lymphadenopathy

    3. Lymphadenopathy Medicine 79:338 – 47, 2000 Biopsy or not Neg Positive Tenderness Generalized Pruritus Size < 1cm Supraclavicular Hard

    4. Non-Hodgkins

    5. Hodgkins

    6. How to make the Diagnosis FNA Biopsy

    7. Hodgkins Lymphocyte Predominant Nodular Sclerosing Mixed Cellularity Lymphocyte Depleted

    8. Non-Hodgkins The indolent lymphomas B-cell neoplasms Small lymphocytic lymphoma/B-cell chronic lymphocytic leukemia Lymphoplasmacytic lymphoma (ą Waldenstrom's macroglobulinemia) Plasma cell myeloma/plasmacytoma Hairy cell leukemia Follicular lymphoma (grade I and II) Marginal zone B-cell lymphoma Mantle cell lymphoma T-cell neoplasms T-cell large granular lymphocyte leukemia Mycosis fungoides T-cell prolymphocytic leukemia Natural killer cell neoplasms Natural killer cell large granular lymphocyte leukemia The aggressive lymphomas B-cell neoplasms Follicular lymphoma (grade III) Diffuse large B-cell lymphoma Mantle cell lymphoma T-cell neoplasms Peripheral T-cell lymphoma Anaplastic large cell lymphoma, T/null cell The highly aggressive lymphomas B-cell neoplasms Burkitt's lymphoma Precursor B lymphoblastic leukemia/lymphoma T-cell neoplasms Adult T-cell lymphoma/leukemia Precursor T lymphoblastic

    9. Staging I. 1 nodal group II. 2 nodal groups on the same side of the diaphragm III. Disease above and below the diaphragm IV. Disease in other organs

    10. Staging Physical examination CT scans Bone marrow biopsies

    11. Staging Hodgkins I. 15% II. 35% III.35% IV.15%

    12. Staging Non-Hodgkins Low –Grade I-II III- IV

    13. Staging Non-Hodgkins Low-Grade I-II 5% III-IV 95%

    14. Staging Non-Hodgkins Intermediate Grade I-II 30% III-IV 70%

    15. Treatment Hodgkins Stage I – Cure with radiation therapy Stage II, III, IV – Cure with chemotherapy

    16. Treatment Non-Hodgkins Intermediate and High-grade – Cure with chemotherapy

    17. Treatment Non-Hodgkins Low – Grade

    18. Treatment Low-grade 1. These cells over express bcl 2 2. The median survival for these patients untreated is 8 years

    19. Treatment Non-Hodgkins Low-grade 1. Observation 2. Standard chemo 3. Monoclonal antibodies – rituximab 4. Stem-cell transplants

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