Lymphoma is considered to be a malignant tumor of lymphoid tissue that develops outside the bone marrow. Most people associate the term with a serious cancer disease, the essence of which is difficult to understand, as well as to understand the types of this tumor. Enlarged lymph nodes are considered an invariable sign of lymphoma., while general symptoms of malignant lesions may be absent for a long time with a relatively favorable course or rapidly progress with aggressive, poorly differentiated tumors.

Lymphoma occurs in people of all ages, but specific types are more often diagnosed at certain periods of life. Among the patients there are more men, but there is no explanation for this gender difference yet. The disease is more common in the white population, and for certain forms of the tumor a clear connection has been established with the geographical area, for most forms - with genetic abnormalities and viral infection.

Lymphomas are extremely diverse in their characteristics, ranging from the morphological features of tumor cells to clinical manifestations.

Thus, the same type of tumor in patients of different sexes and ages may manifest itself differently, determining a different prognosis and overall life expectancy. In addition, individual characteristics such as the nature of genetic abnormalities, the presence or absence of a viral infection, and the location of the lesion play a significant role.

To date, scientists have not been able to develop a clear and comprehensive classification of lymphomas; questions still remain, and modern diagnostic methods help identify new types of tumors. In this article we will try to understand the terminology and main types of lymphomas, the features of their course, without delving into the complex mechanisms of tumor development and the numerous forms that oncologists encounter.

Causes and types of lymphoid tissue tumors

large nodes of the human body affected by lymphoma

During our life, our body constantly encounters many harmful factors and influences, foreign agents and microorganisms, protection from which is provided by lymphoid tissue. A gigantic network of lymph nodes is scattered throughout the body, connected by thin vessels and acting as a kind of filters that capture everything foreign and dangerous from the lymph. Also lymph nodes also retain tumor cells in cancer of various localizations, then they talk about.

To perform barrier functions and participate in immune defense lymph nodes are equipped with a whole complex of mature and maturing cells of the lymphoid series, which themselves can become a source of a malignant tumor. Under unfavorable conditions or the presence of mutations, the process of differentiation (maturation) of lymphocytes is disrupted, the immature forms of which constitute the neoplasm.

Lymphoma always grows outside the bone marrow, affecting lymph nodes or internal organs– spleen, stomach and intestines, lungs, liver. As the tumor develops, its cells can move beyond the primary location, metastasizing like cancer and entering other organs and the bone marrow (leukemia lymphoma).

picture: stage 4 lymphoma, target organs are affected by metastases, leukemia of lymphoma is shown

The causes of lymphomas and lymphosarcoma are:

• Viral infection (infection with Epstein-Barr virus, T-lymphotropic virus, HIV, hepatitis C virus, etc.).
• Immunodeficiencies – congenital or acquired due to HIV infection, after radiation therapy or the use of cytostatics.
• Autoimmune diseases – systemic lupus erythematosus, rheumatoid arthritis.
• Genetic abnormalities - translocations, when genes move from one chromosome to another, breaks in DNA sequences, etc., as a result of which cell division and maturation of lymphocytes are disrupted.
• External carcinogenic factors - polyvinyl chlorides, dioxin, some herbicides.

Some terminology

To understand the variety of tumors of lymphoid tissue, you need to know what terms are used to call their varieties.

The term " lymphoma» is usually used for all tumors of the lymph nodes and lymphoid tissue, but it means mostly neoplasia from mature lymphocytes or prolymphocytes, that is, such a tumor is mature, and along the way it can be quite benign, without making itself felt for many years other than an enlarged lymph node. Transition of lymphoma into a malignant analogue ( lymphosarcoma or ) occurs quite rarely and many years and even decades after its occurrence.

For absolutely benign neoplasms from mature lymphocytes, the term “ lymphocytoma", but often it is replaced by the usual "lymphoma".

All malignant neoplasias from lymphoblasts that develop in the lymph nodes or lymphatic tissue of internal organs are usually called lymphosarcoma. This term very well reflects the malignancy of such tumors, because it is known that they always consist of immature cells and are accompanied by all the signs of an oncological process. Lymphosarcoma is manifested not only by enlarged lymph nodes, but also by general symptoms such as fever, weight loss, metastasis and bone marrow damage.

The use of the word “cancer” is not correct in relation to tumors of the lymphatic system, but is often used by people far from medicine, for whom this definition indicates the undoubted malignancy of the process. “Lymph node cancer” is nothing more than a high-grade lymphoma or lymphosarcoma. Such terminological subtleties are accessible only to doctors, so the average person can be forgiven for not knowing them.

It is necessary to distinguish from true lymphomas cancer metastases in the lymph nodes, when tumor cells enter there with the lymph flow from the focus of neoplasia growth. As a rule, such lesions are detected first near the organ in which the cancerous tumor is growing. For example, if the lymph nodes around the trachea and bronchi are enlarged, a histological examination will clearly show the presence of tumor complexes of an epithelial structure in them, and not a pathological proliferation of lymphocytes, as in the case of lymphoma.

Video: medical animation of lymphoma using the example of non-Hodgkin's lymphoma

Classification Features

There are a great many types of lymphomas, and understanding them is not so easy. Until recently, the division into non-Hodgkin's lymphoma (NHL) and Hodgkin's disease was generally accepted., but such a contrast between one disease and all other tumors is not entirely successful and does not reflect the characteristics of different types of lymphomas, much less help in determining the prognosis or treatment tactics.

In 1982, it was proposed to divide non-Hodgkin's lymphomas into low-grade and high-grade neoplasms, and within each group, identify types depending on the morphological characteristics of tumor cells. This classification was convenient for clinical use by oncologists and hematologists, but today it is outdated, since it implies only 16 subtypes of non-Hodgkin lymphomas.

The most modern is the WHO classification, developed in 2008 on the basis of the European-American classification, proposed and refined at the end of the last century. More than 80 types of non-Hodgkin lymphomas are divided into groups according to the degree of maturity of tumor cells and their origin (T-cell, B-cell, large cell, etc.).

Hodgkin's lymphoma (lymphogranulomatosis), although called lymphoma, is, in fact, not one, since the neoplasm consists of cells of macrophage and monocyte origin, and not lymphocytes and their precursors, therefore the disease is usually considered separately from other lymphomas, previously called non-Hodgkin's, but within the framework of malignant neoplasms of the lymphoid tissue in which it develops. Lymphogranulomatosis is accompanied by the formation of peculiar nodules (granulomas) from specific tumor cells, so this name more accurately defines the essence of the disease, but still the well-established “Hodgkin lymphoma” is more familiar and widely used to this day.

According to the prevalence of the tumor, they are divided into:

• Nodular lymphoma (similar lymphoid follicles are found in the cortex and medulla of the lymph node).
• Diffuse tumor (diffuse tumor damage to many lymph nodes and internal organs).

According to the origin and source of growth, lymphomas are:

1. Primary.
2. Secondary.
3. T cell.
4. B-cell.

The degree of differentiation of tumor cells implies the identification of neoplasms:

• Low degree of malignancy.
• High degree of malignancy.

Learn more about the types of non-Hodgkin's lymphomas

Non-Hodgkin lymphoma is a fairly broad concept, so suspicion of such a tumor always requires clarification of the degree of its malignancy and the source of formation.

There are two groups of lymphocytes in lymphoid tissue: T lymphocytes and B lymphocytes. The former are necessary for the implementation of cellular immunity, that is, they themselves are directly involved in the capture and inactivation of foreign particles, B-lymphocytes are capable of forming antibodies - specific proteins that bind to a foreign agent (virus, bacteria, fungus) and neutralize it. In lymphoid tissue, these cells are grouped into follicles (nodules), where the center is predominantly B-lymphocyte, and the periphery is T-cell. Under appropriate conditions, inadequate proliferation of cells in a particular zone occurs, which is reflected in determining the type of neoplasm.

Depending on the maturity of the tumor cells, lymphomas can be low or high grade. The first group includes neoplasms that develop from small or large lymphocytes, cells with split nuclei, and the second group includes immunoblastic, lymphoblastic sarcomas, Burkitt lymphoma, etc., the source of which is immature cells of the lymphoid series.

If lymphosarcoma grows from an existing benign lymphoma, it will be called secondary. In cases where the root cause of the tumor cannot be established, that is, a previous mature lymphoid tumor is not detected, we speak of primary lymphoma.

Mature cell lymphomas (lymphocytomas)

Relatively benign lymphomas arise from mature lymphocytes, therefore, many years can be practically asymptomatic, and the only sign of the disease will be enlarged lymph nodes. Since this is not accompanied by any painful sensations, and lymphadenopathy or lymphadenitis in various infections is a fairly common phenomenon, it does not cause proper attention from the patient. With the further development of the disease, signs of tumor intoxication, weakness appear, and the patient begins to lose weight, which forces him to go to the doctor.

About a quarter of all mature cell lymphomas will eventually transform into lymphosarcoma, which will respond well to treatment. A local change in lymphoid tissue or damage to any one organ, an increase in the number of lymphocytes in a blood test, as well as the presence of rapidly multiplying mature lymphocytes in the affected lymph node should be the reason for timely treatment of a still benign tumor.

B-cell non-Hodgkin lymphomas

The most common variant of non-Hodgkin B-cell lymphoma is considered neoplasia from the cells of the center of the lymphoid follicle, which makes up approximately half of all NHL.

This tumor of the lymph nodes is diagnosed more often in older people and does not always have the same manifestations. The maturity of tumor cells determines either a non-progressive course for a long time, when patients for 4-6 years feel relatively well and have practically no complaints, or the tumor behaves aggressively from the very beginning and quickly spreads to various groups of lymph nodes.

Lymphocytoma of the spleen also mainly affects older people. Being relatively benign, for a long time it is manifested only by an increase in certain groups of lymph nodes (cervical, axillary) and the spleen. A feature of this type of lymphoma is the stabilization of the patient’s condition and long-term remission after removal of the spleen.

In some cases, tumor lesions are found in the mucous membranes gastrointestinal tract, respiratory system, skin, thyroid gland. Such lymphomas are called MALT-omas and are considered low-grade neoplasms. Symptoms of this type of lymphoma, localized in the gastrointestinal tract, may resemble a gastric or duodenal ulcer, and they can be detected even by chance during an endoscopic examination for gastritis or ulcers. Gastric lymphoma is associated with carriage of Helicobacter pylori infection, which causes a response from the mucous membrane in the form of enlargement and formation of new lymphoid follicles, when the likelihood of a tumor due to the proliferation of lymphocytes increases.

"Cancer of the lymph nodes in the neck" patients may call it a tumor of the cells of the mantle zone of the lymphoid follicle, in which a typical symptom will be enlarged lymph nodes in the neck and under the lower jaw. The tonsils may also be involved in the pathological process. The disease occurs with symptoms of intoxication, fever, headaches, signs of damage to the liver, spleen and gastrointestinal tract.

T cell lymphomas

T-cell lymphomas often affect the skin and are represented by mycosis fungoides and Sézary syndrome. Like most similar tumors, they are more common in men over 55 years of age.

Mycosis fungoides is a T-cell lymphoma of the skin, accompanied by redness, bluishness, severe itching, peeling and blistering, which lead to thickening, the appearance of fungi-like growths that tend to ulcerate and cause pain. Enlargement of peripheral lymph nodes is typical, and as the tumor progresses, areas of it can be found in the internal organs. In the advanced stage of the disease, symptoms of tumor intoxication are clearly expressed.

manifestations of various forms of lymphoma

Sezary's disease manifests itself as diffuse damage to the skin, which becomes bright red, peels, itches, hair loss occurs and the structure of the nails is damaged. Due to their characteristic appearance, these manifestations are sometimes called the “red man” symptom. Today, many scientists tend to consider Sézary's disease as one of the stages of mycosis fungoides, when tumor cells reach the bone marrow due to tumor progression (leukemia lymphoma).

It is worth noting that cutaneous forms have a more favorable prognosis in the absence of lymph node involvement, and the most dangerous option is considered to be the one that is accompanied by damage to internal organs - liver, lungs, spleen. Patients with this form of cutaneous T-cell lymphoma live on average for about a year. In addition to the tumor itself, the cause of death of patients is often infectious complications, the conditions for which are created on the skin affected by the tumor.

T- and B-cell lymphosarcoma

Lymphosarcoma, that is, malignant tumors of immature lymphocytes, is accompanied by damage to many lymph nodes, including the mediastinum and abdominal cavity, spleen, skin, and tumor intoxication. Such neoplasms metastasize quite quickly, grow into the surrounding tissue and disrupt the outflow of lymph, which leads to severe swelling. Like mature lymphomas, they can be B-cell or T-cell.

DiffuseLarge B cell lymphosarcoma lymph nodes account for about a third of all cases of non-Hodgkin lymphoma, it is more often diagnosed in people over 60 years of age, it grows quickly and rapidly, but about half of the patients can be cured completely.

The disease begins with an enlargement of the supraclavicular and subclavian, cervical lymph nodes, which become denser, form conglomerates and grow into the surrounding tissue, so it is no longer possible to determine their boundaries at this stage. Compression of veins and lymphatic vessels leads to swelling, and involvement of nerves causes severe pain.

Follicular lymphoma, unlike the previous form, grows slowly, develops from the cells of the central part of the lymphoid follicle, but over time it can become a diffuse form with rapid progression of the disease.

In addition to the lymph nodes, B-cell lymphosarcoma can affect the mediastinum (more often in young women), thymus, stomach, lungs, small intestine, myocardium, and even the brain. Symptoms of the tumor will be determined by its location: cough, chest pain in the pulmonary form, abdominal pain and stool disturbances in the case of damage to the intestines and stomach, difficulty swallowing and breathing due to compression of the mediastinal organs, headaches with nausea and vomiting, focal neurological symptoms in lymphosarcoma brain, etc.

A peculiar type of undifferentiated malignant tumors of lymphoid tissue is Burkitt lymphoma, which is most common among residents of Central Africa, especially children and young men. The disease is caused by the Epstein-Barr virus, which can be found in approximately 95% of patients. Interest in this lymphoma is due to the fact that new cases began to be registered with the spread of HIV infection and then, in addition to residents of the African continent, Europeans and Americans began to appear among patients.

atypical lymphocytes affected by Epstein-Barr virus

A characteristic feature of Burkitt's lymphoma is considered to be primarily damage to the facial skeleton, which leads to tumor growths in the upper jaw, orbit, severe swelling and deformation of facial tissues ( shown in the photo above). Often tumor nodes are found in the abdominal cavity, ovaries, mammary glands and meninges.

The progressive course of the tumor leads to rapid exhaustion, patients experience fever, weakness, severe sweating, and possible pain.

With HIV infection in the AIDS stage (final stage), severe immunodeficiency contributes not only to the introduction of tumor-causing viruses into the body, but also to a significant weakening of the natural antitumor defense, so lymphomas are often a marker of the terminal phase of the disease.

T-lymphoblastic lymphoma is much less common Compared to B-cell tumors, their symptoms are very similar, but neoplasia originating from T cells progresses faster and is accompanied by a more severe course.

To summarize, we can outline the main features and symptoms of lymphoma:

• Mature tumors are characterized by a long-term benign course, while malignant lymphosarcoma, originating from poorly or undifferentiated cells, is characterized by rapid progression, damage to many organs, involvement of surrounding tissues and metastasis.
• Lymphomas often transform into lymphosarcoma, but at the same time retain high sensitivity to therapy and the likelihood of long-term remission or complete cure.
• Symptoms of lymphomas and lymphosarcoma consist of:
  1. mandatory damage to the lymph nodes or lymphoid tissue of internal organs - one or many groups, both peripheral and located inside the body (in the abdominal cavity, mediastinum);
  2. signs of intoxication and oncological process - weight loss, weakness, fever, sweating, loss of appetite;
  3. swelling of tissues due to disruption of lymph flow through tumor-affected lymph nodes;
  4. symptoms of damage to internal organs and skin with the corresponding localization of the tumor or its metastases (shortness of breath, cough, nausea, vomiting, gastric or intestinal bleeding, signs of damage to the nervous system, etc.);
  5. anemia, thrombocytopenia with bleeding, impaired immune defense when tumor cells colonize the bone marrow and the transition of lymphoma to leukemia.

As tumor cells spread throughout the body, they may be introduced into the bone marrow (leukemia of lymphoma), then the manifestations and response to treatment will correspond to leukemia. The likelihood of such a development of events is greater with aggressive immature types of lymphosarcoma, which are prone to metastasis and damage to many internal organs.

Hodgkin's disease (lymphogranulomatosis)

Hodgkin's lymphoma was first described at the beginning of the 19th century by Thomas Hodgkin, but the development of medical science at that time involved the observation of symptoms and clinical features of the disease, while laboratory “reinforcement” of the diagnosis was not yet available. Today it is possible not only to make a diagnosis based on a microscopic examination of lymph nodes, but also to carry out immunophenotyping in order to identify specific surface proteins of tumor cells, and the result of a detailed study of tumor tissue will be the determination of the stage and variant of the disease, which will affect both treatment tactics and prognosis.

As noted above, until recently, Hodgkin's disease was opposed to all other types of lymphoma, and this made some sense. The fact is that with lymphogranulomatosis, a specific tumor process is observed in the lymphoid organs with the appearance of peculiar cells not found in any other type of lymphoma. In addition, a feature that distinguishes lymphogranulomatosis from other lymphomas is the monocyte-macrophage origin of the parent tumor cell, and in lymphomas the tumor always grows from lymphocytes, be they undifferentiated, young or mature forms.

Causes and forms of lymphogranulomatosis

The debate about the causes of lymphogranulomatosis (HLG) continues to this day. Most scientists are inclined to believe that the disease is viral, but the influence of radiation, immune suppression, and genetic predisposition are also discussed.

In more than half of patients, Epstein-Barr virus DNA can be detected in tumor tissues, which indirectly indicates the role of infection in the occurrence of neoplasia. Among the patients, men are more common, especially of the Caucasian race. The peak incidence occurs at a young age (20-30 years) and after 55 years.

The main change that reliably indicates Hodgkin's disease is the detection in the affected lymph nodes of large Reed-Berezovsky-Sternberg cells and small Hodgkin cells, which are the precursors of the former.

Depending on the cellular composition of the lymph nodes, they are divided into:

• Lymphohistiocytic variant of LGM, when mature forms of lymphocytes predominate in the lymph nodes. This type of disease is considered the most favorable, is most often detected at an early stage and allows the patient to live for 10-15 years or more.
• The nodular sclerotic form of LGM, which makes up about half of all cases of the disease, is more common in young women and is characterized by hardening of the lymph nodes due to sclerosis (overgrowth of connective tissue). The prognosis is usually good.
• The mixed-cellular variant is diagnosed in childhood or old age, the lymph nodes have a diverse cellular composition (lymphocytes, plasma cells, eosinophilic leukocytes, fibroblasts), and the tumor is prone to generalization. With this form of Hodgkin's lymphoma, the prognosis is very serious - the average life expectancy after diagnosis is approximately 3-4 years, the symptoms of generalized damage quickly increase and are accompanied by the involvement of many internal organs.
• The variant of LGM with suppression of lymphoid tissue is the rarest and, at the same time, the most severe, corresponding to stage IV of the disease. In this form of Hodgkin's disease, lymphocytes are not detected in the lymph nodes at all, fibrosis is characteristic, and the five-year survival rate is only about 35%.

stage of lymphoma, depending on the degree of organ damage

Stages of Hodgkin lymphoma (I-IV) are determined by the number and location of affected lymph nodes or organs, as well as on the basis of examination of the patient, clarification of complaints and symptoms using laboratory and instrumental diagnostic methods. The presence or absence of intoxication symptoms, which affect the determination of the prognosis, must be indicated.

Manifestations of lymphogranulomatosis

LGM has quite diverse clinical signs, and even the onset of the disease can occur differently in different patients. In most cases, there is an increase in peripheral lymph nodes - cervical, supraclavicular, axillary and other groups. At first, such lymph nodes are mobile and do not cause pain or anxiety, but later they become denser, merge with each other, and the skin over them may become red. In some cases, the lymph nodes may be painful, especially after drinking alcohol. Increased body temperature and intoxication are not typical in the initial stages of the disease.

About a fifth of patients name dry cough, shortness of breath, chest pain, and swollen neck veins as the first signs of trouble. Such symptoms are caused by enlarged mediastinal lymph nodes.

Less commonly, the disease begins suddenly, in the midst of complete health, with increased body temperature, sweating, and rapid weight loss. Acute onset of LGM indicates a very poor prognosis.

As the tumor process progresses, the phase of advanced clinical manifestations begins, during which the following is observed:

1. Enlarged lymph nodes of different groups.
2. Sharp weakness.
3. Decreased performance.
4. Sweating, especially severe at night and during periods of fluctuating body temperature.
5. Bone pain.
6. Fever.
7. Itching of the skin, both in the area of ​​the affected lymph nodes and throughout the body.

In addition to these “general” symptoms, enlarged lymph nodes can cause other disorders, squeezing blood vessels, gland ducts, and internal organs. Patients can call the advanced stage of LCM “cancer of the lymphatic system,” since there is damage to the lymphoid organs, which can no longer be confused with banal lymphadenitis or lymphadenopathy, and there is a tendency to progress and the patient’s condition worsens.

Enlarged lymph nodes are found in different parts of the body; they are dense, form conglomerates, but are never connected to the skin. Almost always such changes are observed on the neck, in the armpit area. If the lymph nodes of the abdominal cavity are affected, jaundice may appear due to compression of the gallbladder duct. Sometimes the lymph nodes enlarge to such a size that they can be easily felt through the anterior abdominal wall.

Signs of a tumor process in the pelvic and inguinal lymph nodes may be severe swelling of the legs, since the outflow of lymph from the lower extremities is sharply hampered. Retroperitoneal lymph nodes can compress the spinal cord and ureters.

The spread of the tumor from the lymph nodes to the internal organs leads to the addition of more and more new symptoms. Thus, when the gastrointestinal tract is affected, patients experience pain, diarrhea, and bloating, which increases exhaustion and can lead to dehydration. Involvement of the liver is considered a bad sign and is manifested by jaundice, bitterness in the mouth, and enlarged liver. Almost half of the patients suffer from lung damage, which is manifested by cough, shortness of breath, and chest pain. The spleen almost always enlarges during the period of widespread tumor process.

Tumor cells with lymph flow can move from lymph nodes or internal organs to the bones, which is quite typical for all variants of the course of pelvic tumors. Typically, tumor damage occurs to the spine, ribs, pelvic bones and sternum. Bone pain is the main sign of metastasis of a malignant tumor to them.

Diagnosis and treatment of tumors of the lymphatic system

Diagnosis of tumors of the lymphatic system requires a thorough examination of the patient and the use of various laboratory and instrumental methods. In some cases, complex and quite expensive cyto- and molecular genetic and immunohistochemical studies may be required to establish the exact type of tumor.

Since all tumors of lymphoid tissue are accompanied by enlarged lymph nodes, the detection of such a sign should always be alarming. Of course, you shouldn’t immediately panic and think about the worst if, for example, the submandibular or inguinal lymph nodes have become enlarged, because this often happens against the background of various infections and fairly common diseases (tonsillitis, genital tract infections). Pet lovers may notice enlarged lymph nodes after a cat scratch, and those who do not take good care of their oral hygiene almost constantly feel enlarged lymph nodes under the lower jaw.

In the case of the infectious nature of lymphadenopathy, the administration of antibiotics always leads to a subside of the inflammatory process and a reduction in the size of the lymph nodes. If this does not happen, then a detailed examination becomes necessary.

First of all, the doctor will find out in detail the nature of the complaints, the time of their occurrence and duration, the presence of signs of intoxication in the form of weight loss, unexplained rises in temperature or night sweats.

Laboratory confirmation of the diagnosis involves : a general blood test, which can detect an increase in the number of lymphocytes with some leukopenia, an acceleration of ESR.

The main and most reliable method for diagnosing lymphomas is a lymph node biopsy. when its fragment is taken for microscopic examination for the presence of tumor cells. Sometimes it becomes necessary to re-take material for examination or remove the entire lymph node.

lymph node biopsy

To further clarify the diagnosis, establish its stage, prevalence and nature of changes in the internal organs, use:

• X-ray of the chest organs.
• CT, MRI (for studying the liver, spleen, brain, lungs, neck area, etc.)
• Fibroesophagogastroscopy (if primary lymphoma is suspected or the tumor process has spread from other organs).
• Radioisotope bone scan.
• Puncture with bone marrow biopsy.

diagnostic image of a patient with lymphoma, pos. B – result of 3 months of chemotherapy

The choice of examination regimen depends on the type and location of the tumor and is determined by the oncologist individually for each patient. Once the diagnosis has been made, it is necessary to decide on further treatment for lymphoma, which involves prescribing chemotherapy, radiation and even surgery.

Surgical treatment has very limited use for lymphomas and is used more often for isolated forms of tumors or to alleviate the patient’s condition in advanced stages, reduce pain or pressure from enlarged lymph nodes on internal organs. In the case of primary damage to the spleen, they resort to its removal, which gives a very good therapeutic effect and even complete cure of the tumor.

– the main and most effective way to fight tumors of the lymphatic system. The use of chemotherapy makes it possible to achieve long-term remission in many patients, even with aggressive high-grade lymphomas. Elderly and weakened patients may be prescribed one antitumor drug, while blast forms in young people require the use of programs for the treatment of acute lymphocytic leukemia.

For aggressive, low-grade tumors, simultaneous administration of 5-6 drugs works well. Of course, such treatment is associated with the risk of side effects, but correction of emerging disorders, monitoring blood counts, prescribing antiemetic drugs, antibiotics, vitamins and microelements contribute to better tolerability.

Radiation may be given in parallel with chemotherapy or before it. especially in cases of local lesions, as well as tumor spread to the bones and mediastinal organs.

A bone marrow transplant may be a promising way to combat the tumor. or individual blood cells from both the patient and the donor. If lymphoma spreads to the bone marrow, only a donor organ can be used.

As for amateur activities and folk remedies, so beloved by many, we just need to remind you once again that cancer is not a case when you can abandon official medicine in favor of alternative medicine. Such neglect of one's health can cost one's life.

In conclusion, I would like to note that Most lymphomas are still highly treatable if diagnosed and treated early. You shouldn’t waste time, wait until it “goes away on its own” or trust your health to traditional healers. In case of any problem, you should immediately contact an oncologist who is able to provide qualified assistance aimed at prolonging life and cure.

Video: lymphoma in the program “Live Healthy!”

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

Lymphoma is a type of cancer involving immune system cells called lymphocytes. Lymphoma is found in many different types of cancer (about 35). But all diseases of this type are divided into two categories:

1. Non-Hodgkin's lymphomas.

The first type affects only about 12% of people and is currently a treatable disease.

Non-Hodgkin's cancer attacks the body's lymphatic system, which is made up of vessels that carry fluid called lymph to the body. When subtypes of B or T cells begin to multiply uncontrollably, malignant transformation occurs. Abnormal cells may collect in one or more lymph nodes or other tissues such as the spleen. Through the lymphatic system, the tumor quickly spreads to distant parts of the body.

Rapidly growing lymphoma - prognosis

There is an international prognostic index that was developed to help doctors determine the outlook for people with fast-growing lymphoma.

The indicator depends on 5 factors:

1. Patient's age.
2. Stages of lymphoma.
3. The presence of disease in the organs of the external lymphatic system.
4. General condition (how well a person can perform daily activities).
5. A blood test to determine the level of lactate dehydrogenase (LDH), which comes with the amount of lymph.

Many conditions influence positive prognosis for lymphoma:

• patient's age (up to 60);
• stage (I or II);
• the absence of lymphoma outside the lymph nodes or the presence of metastases in only one area outside them;
• the patient’s body is able to function normally;
• serum LDH is normal.

If the indicators differ from those indicated, this indicates poor prognostic factors. Accordingly, on a 5-point scale, such patients have the least favorable prognosis for recovery and survival. In this regard, there are 4 risk groups:

1. Low (zero or single unfavorable circumstances).
2. Low intermediate (2 unfavorable conditions).
3. Cancers with a high intermediate level (3 low survival rates).
4. High (4 or 5 unfavorable factors).

Research developed over the past decade indicates that about 75% of people in the lowest risk group lived at least 5 years. While in the high-risk group, about 30% of patients lived for 5 years.

Over the past five years, treatment methods have changed, and new procedures have been developed for the treatment of malignant tumors, which has a positive effect on prognostic data. Global research in recent years shows that about 95% of people in the very low risk group lived for at least 4 years. While with high hazard rates (low survival rate), life expectancy is already 55%.

Follicular lymphoma - survival prognosis

For follicular lymphoma, which is characterized by slow growth, other prognostic indices have been developed.

Good prognostic factors:

• age under 60 years;
• Stage I or II;
• hemoglobin 12/g or higher;
• metastatic lesion has spread to 4 or fewer lymphatic areas;
• serum LDH is normal.

Risk groups and survival:

1. Low risk (1 unfavorable factor): 5-year survival rate becomes 91%, 10-year survival rate becomes 71%.
2. Intermediate risk (2 unfavorable factors): 5-year survival rate - 78%, 10-year survival rate - 51%.
3. High risk (3 negative factors): 5-year survival rate - 53%, 10-year survival rate - 36%.

Lymphoma survival

The survival rate directly depends on the stage of the cancer. Also, it should be borne in mind that modern clinical trials (for example, such as stem cell transplantation) can reduce the risk of an unfavorable outcome.

Survival also varies significantly depending on the subtype of Non-Hodgkin's lymphoma. Follicular lymphoma has a better prognosis (96%) than diffuse B-cell lymphoma (65%). characterized by readings that reach 71%. For the marginal zone of the disease - 92%.

Lymphatic cancer with a survival prognosis by stage is presented as follows:

1. In patients with stage 1 lymphoma, five-year prognostic indicators are quite high - 82%.
2. Patients with stage 2 disease have an 88% five-year survival rate.
3. The five-year prognosis from the initial diagnosis of the disease for patients of the third stage includes 63%.
4. The fourth stage of cancer is represented by rates of 49% within 5 years of the disease from the first diagnosis.

Five-year survival rates for young men and women are highest and decrease with increasing age:

• in men, the five-year prognosis for lymphoma ranges from 83% (for 15-39 year olds) to 36% (for 80-99 year olds);
• In women, the five-year survival rate for lymphoma ranges from 86% to 40% in the same age groups.

Compared to the 1990s, in 2014–2015, cancer of the lymphatic system in most cases can have a favorable outcome. Thus, the five-year standardized survival rate for men increased by 30%, and for women by 39 points, which represents a positive trend.

Lymphoma is a collective term for malignant and benign neoplasms of lymphoid tissue. Benign lymphomas are caused by harmless causes - infectious diseases. Malignant ones arise due to a genetic mutation of one cell, which begins to divide uncontrollably. The diagnosis is confirmed by histological examination of the removed lymphatic tissue. Treatment methods depend on the type of lymphoma and the patient's condition.

Every cell in the body can degenerate due to certain changes in the genetic material. Some gene mutations can cause cells to grow uncontrollably. Lymphomas are neoplasms that originate from lymphatic organs - lymph nodes, spleen or cells.

Lymphoma is a neoplasm of lymphoid tissue that can have both benign and malignant forms.

Over time, malignant lymphocytes replace normal lymphoid tissues. As a result, secondary immunodeficiency may occur. Because lymph tissue is found in many areas of the human body, malignant lymphoma can also affect other areas and organs such as the skin, stomach, intestines or brain.

Malignant lymphomas are rare compared to breast, colon, or lung cancers. Together they make up about 5% of cancer cases in Russia. About 2-4 out of every 100,000 Russians develop Hodgkin lymphoma every year. Most patients are between 25 and 30 years of age. The number of malignant non-Hodgkin's lymphomas has been steadily increasing for several years. Each year, 8 to 10 people per 100,000 are diagnosed with non-Hodgkin lymphoma, which equates to almost 10,000 new cases per year. Most cancer patients over 60 years of age have non-Hodgkin lymphoma.

The distribution of the disease in the body is of great importance for determining the treatment regimen. According to the Ann Arbor classification, there are four stages (I-IV) of malignant lymphoma.

In the International Classification of Diseases, 10th revision (ICD-10), malignant neoplasms of lymphoid, hematopoietic and related tissue are designated by codes C81-C96.

Symptoms

The main symptom is painless enlargement of the lymph nodes, which mainly occurs asymmetrically. Most often they increase in the neck, groin or armpit. Some adult patients experience common symptoms of lymphoma: fatigue, loss of appetite, nausea, lymphadenitis, or heartburn.

Night sweats, unexplained fever, and weight loss (more than 10% of body weight in 6 months) are called B symptoms. The first signs occur in approximately 20% of patients with non-Hodgkin lymphoma (less common than with Hodgkin lymphoma).

Lymphoma of the bone or other organs often goes undetected for a long time. When symptoms first appear, they usually do not directly indicate lymphoma. Often, signs and symptoms are misclassified as the flu, a cold, or simple fatigue, which can delay diagnosis.

The main symptom is painless enlargement of the lymph nodes

Lymphoma in the uterine area can cause infertility in the long term. Anorgasmia is often observed in women. Sometimes severe uterine bleeding and muscle spasms occur. Lymphoma in the ovarian region can lead to ovulatory dysfunction and androgen excess.

If left untreated, the prognosis of some types can be fatal within a few months. For this reason, it is important that doctors and the public understand the signs and symptoms of lymphoma. Some patients experience pain in the lymph nodes (near the spine or neck) after drinking alcohol.

Lymphoma in the eye area is characterized by displacement of the eyeball and uveitis - inflammation of the choroid. Sometimes lymphoma near the eyes can lead to complete blindness or permanent vision impairment.

Enlarged lymph nodes can also cause other symptoms: swelling of an arm or leg, buttock spasms, back pain, and numbness or tingling in the extremities due to blocked nerve fibers. Testicular lymphoma can cause erectile dysfunction (impotence). Tonsil lymphoma can mimic the symptoms of an acute respiratory viral infectious disease.

Lymphoma in the thyroid gland increases in size in a short time, which can lead to compression of surrounding tissues. Often this pathology is accompanied by paralysis of the larynx, swelling of the tonsils and soreness of the nasopharynx. Only half of patients develop hypothyroidism.

Reasons

Why does malignant lymphoma occur? The lymphatic system is distributed throughout the body and consists of lymphatic vessels, lymph nodes, bone marrow, spleen and thymus. Lymphoid tissue is found in some organs - the small intestine, skin and tonsils. The lymphatic system plays a critical role in protecting the body from various pathogens. Lymphatic vessels, similar to blood vessels, are distributed unevenly throughout almost the entire body. They contain lymph (tissue water), which is used to nourish cells and transport lymphocytes into the bloodstream. The nodes form a network of biological filters in which the lymph is cleansed of foreign substances and infectious agents.

Lymphocytes are a group of white blood cells that are a central part of the immune system. They arise from stem cells in the bone marrow and are divided into T and B cells. B cells mature into functioning immune cells in the bone marrow, while T cell maturation occurs in the thymus. Mature T and B lymphocytes then travel to the lower or upper lymphatic organs: the spleen, lymph nodes or tonsils.

Congenital or acquired characteristics of the immune system, infections are the cause of lymphoma

The main task of lymphocytes is to remove defective self or foreign material from the body. There are cell-mediated (cellular) and antibody-mediated (humoral) immune responses. The cellular immune response is primarily the task of T lymphocytes and is directed against pathogens and tumors. The humoral immune response is essentially the task of B lymphocytes; they form certain proteins called antibodies that recognize and mark bacteria as well as foreign cells. In turn, the pathogen, loaded with antibodies, can be recognized and destroyed by T lymphocytes.

Like all other cells in the human body, lymphocytes can degenerate due to various factors. There are three risk factors that increase the likelihood of cancer: chemicals, viruses and radiation. Genetic factors also play a role in the development of about 5-10% of cancers. Different types of lymphoma can start almost anywhere in the body and occur in a single lymph node, a group of lymph nodes, or a lymph organ.

Long-term cigarette smoking is a risk factor for lymphoma, but the link has not yet been conclusively proven. According to WHO, congenital or acquired characteristics of the immune system and viral infections are also possible risk factors for the disease. Recent studies have shown that Epstein-Barr virus and primary immunodeficiency are involved in the development of Hodgkin lymphoma. Other viruses may also be involved in the development of this pathology.

Classification

Lymphomas are divided into benign and malignant. Benign is characterized by the formation of lymphatic tissue in the lymph nodes. Such tumors have a dense consistency and grow very slowly. It is most often caused by a chronic inflammatory disease.

Malignant lymphomas are divided into two main groups: Hodgkin lymphoma (known as Hodgkin disease, or lymphogranulomatosis) and non-Hodgkin lymphoma. By histological examination of the lymph nodes and lymphoid tissue, the pathologist can differentiate between these two groups of diseases.

Based on their clinical course, lymphomas are divided into aggressive (fast-growing) and indolent (slow-growing) forms.

The prognosis of lymphoma is worse in the rapidly growing form if treatment is not started in a timely manner.

Hodgkin's lymphoma

London pathologist Thomas Hodgkin first described lymphogranulomatosis in 1832. The disease arises from B lymphocytes in the lymph nodes. In the early stages, the pathology is limited to the lymph nodes and then spreads to adjacent structures. In the advanced stage, B lymphocytes spread into the bloodstream and finally the disease also affects organs outside the lymphatic system (eg, bone marrow, liver). Identification of mononuclear Hodgkin cells and polynuclear Sternberg cells is characteristic of Hodgkin lymphoma. These two types of cells are tumor cells.

Based on histological examination, classification is carried out into various subgroups and can be made according to the content of lymphocytes and tumor cells. Classic Hodgkin lymphomas are divided into 4 subtypes according to the WHO classification:

• I: lymphohistiocytic type (3%).
• II: type with nodular sclerosis (82%).
• III: mixed cell type (14%).
• IV: type with lymphoid tissue suppression (1%)

In addition, there is another independent form of the disease - Hodgkin lymphoma with lymphocytic predominance.

Lymphoma is classified into 4 types

Non-Hodgkin's lymphoma

Non-Hodgkin's primary lymphoma can arise from B cells (90%) and T cells (10%). To classify diseases, various systems have previously been used. In the Kiel classification, the terms “high and low grade” of malignancy were used. However, the WHO classification is generally accepted, which distinguishes malignant neoplasms by the shape of cells, the rate of their division and surface features (antigens).

The most common types of malignant T-cell non-Hodgkin lymphomas according to the WHO classification:

• Chronic lymphocytic leukemia.
• Oncocytoma.
• Multiple myeloma (plasmoblastic lymphoma).
• Follicular lymphoma.
• Plasmacytoma.
• Extranodal marginal zone cell lymphoma.
• Burkitt's lymphoma.
• Diffuse large B-cell lymphomas.
• Mantle cell lymphoma.

The most common types of malignant B-cell lymphomas according to the WHO classification:

• T-cell lymphoblastic lymphoma.
• Aggressive NK cell leukemia.
• Mycosis fungoides.
• Peripheral.
• Anaplastic.

Chronic lymphocytic leukemia is characterized by an increase in the number of white blood cells (leukocytes) in the blood. The term "leukemia" usually refers to the degeneration and malignant proliferation of white blood cells. In chronic lymphocytic leukemia (lymphoma), a certain type of white blood cell - lymphocytes - multiplies uncontrollably. Despite its name, chronic lymphocytic leukemia is also considered non-Hodgkin's lymphoma.

An essential criterion for choosing treatment methods for malignant lymphoma is the stage of the disease, which reflects the extent of cancer in the body. The purpose of initial examinations is to accurately determine the extent of the lymphoma. In 1971, the Ann Arbor classification system was developed and is used to determine the stage of both Hodgkin's lymphoma and non-Hodgkin's lymphoma.

The main stages of development of malignant tumors:

• Stage 1: involvement of one area of ​​lymph nodes;
• Stage 2: involvement of two or more lymph node areas on one side of the diaphragm;
• Stage 3: involvement of two or more lymph node areas on both sides of the diaphragm;
• Stage 4: at the fourth stage, involvement of other organs (bone marrow, liver) is observed.

If general symptoms such as fever, night sweats or weight loss occur, a “B” is added in addition to the stage. If there are no symptoms, the letter "A" is added. If the lymphoma has spread beyond the lymph node (in the lungs, eyes, bones, muscles), the letter "E" is added.

The extranodal form of lymphoma (maltoma) is a malignant neoplasm that is located in organs outside the lymphatic system. Lymphoma in the breast area is the most common type of maltoma. Renal lymphoma is a rarer type of maltoma that occurs in 0.3% of patients with non-Hodgkin lymphoma.

Diagnostics

First, anamnesis is collected and a physical examination is performed: blood pressure, heart rate, consistency, mobility and tenderness of the lymph nodes are measured. The anamnesis is the starting point for further research.

To identify the disease, a whole range of studies will be required

Computed tomography (CT) uses X-rays to visualize different parts of the body. Computers combine individual cross-sections into a three-dimensional image. Mediastinal lymphoma is well visualized on CT without contrast agent. CT has largely replaced a number of more invasive procedures in the X-ray diagnosis of lymphoma.

Puncture of the medullary cavity of flat bones (for example, sternum, iliac crest) is performed using a special cannula. Mostly a bone marrow sample is taken for the study. Using histological examination, metastases of lymphosarcoma can be detected.

If there is a suspicion of lymphoid sarcoma, it is necessary to completely examine the affected lymph node. For this purpose, the most accessible lymph nodes (for example, in the neck) are selected. They can be removed using local anesthesia, but depending on the location (such as the abdomen or breast), a general anesthetic is sometimes required. The isolated lymph node is examined histologically by a pathologist to confirm the diagnosis.

Using the histological sections (sections of tissue) of the removed lymph nodes, the pathologist can make a diagnosis. For this purpose, areas are stained using various methods and examined microscopically. The pathologist identifies typical features of various diseases, such as the characteristic Hodgkin and Reed-Sternberg cells of classical Hodgkin lymphoma.

Other diagnostic methods that will give the doctor more information about the extent of lymphoma:

• General blood test.
• Ultrasound examination.
• Magnetic resonance imaging.
• Skeletal scintigraphy.

Lymphoma in the thyroid gland is detected using immunohistochemical examination of the affected tissue. For lymphoma in the bone marrow, a myelogram may be required.

How is malignant lymphoma treated? There are no standard methods. Treatment for different forms of lymphoma varies greatly. It largely depends on the patient’s condition, age, concomitant diseases, type and grade of lymphoma.

Indolent forms of lymphoma progress slowly and cause little discomfort, so doctors usually wait for symptoms or complications to develop. Careful monitoring is important, so treatment should begin immediately if the disease worsens. For low-grade non-Hodgkin lymphoma, treatment is not necessary. Unlike most other types of cancer, early treatment does not improve the chances of recovery. If symptoms worsen, chemotherapy is recommended first. It is often combined with antibody therapy.

Recurrence rates are very high in low-grade non-Hodgkin's lymphoma, with many patients developing a new cancer within a few years. However, you can live well with this less aggressive lymphoma.

The treatment method depends on the form of lymphoma and the age of the patient

In the relatively new radioimmunotherapy, an antibody is “laced” with radioactive particles and then given through an IV. The radioactive substance is injected directly into the tumor, where it destroys it. For highly malignant non-Hodgkin lymphomas, chemotherapy is combined with antibody therapy. Treatment is urgent and intensive. Depending on the severity and form of the lymphoma, radiotherapy is then prescribed.

If it comes to relapse, a transplant of the patient's stem cells (autologous stem cell transplant) is usually performed. Transplantation of foreign stem cells is also possible. Hodgkin's lymphoma can also be effectively treated with chemotherapy. Depending on the stage and severity of the disease, treatment lasts from 2 to 8 months. This is followed by radiation therapy.

Chemotherapy

Chemotherapy has a high priority in the treatment of lymphomas. In late stages of the disease with a low degree of malignancy and in Hodgkin's disease, it is recommended to administer cytostatic substances through a vein. Usually in several cycles. For some forms of lymphoma, the tablets are also used to maintain the success of treatment over a longer period of time.

Combination regimens combine various cytotoxic drugs that act at different starting points of cellular metabolism. As a result, lower doses of individual cytostatic agents can be used. Reducing the dose reduces the likelihood of adverse reactions. Ancillary drugs are partially added to improve the tolerability of chemotherapy drugs.

Radiation therapy

Radiotherapy is a treatment that uses ionizing radiation to kill cancer cells. Radiotherapy can be given alone or with chemotherapy. Radiation therapy is a local treatment that treats only the affected part of the body. It is performed with equipment that directs high intensity beams to a specific area of ​​the body. Radioimmunotherapy combines immune agents (such as rituximab) with radioactive isotopes and has some benefits in treating tumors.

In some cases, patients undergo chemotherapy or radiation to destroy undetected cancer cells that may be present in the central nervous system (CNS).

Can cross the blood-brain barrier and enter the central nervous system. If this occurs, chemotherapy or other treatments that were administered at the systemic level may not reach the central nervous system. Therefore, the only way to treat is to use chemotherapy or specific radiation therapy. Sometimes the doctor injects anticancer drugs directly into the cerebrospinal fluid.

Bone marrow transplantation

Bone marrow transplantation may also be a treatment option, especially in patients whose cancer recurs (comes back). Bone marrow transplants are used to replace cells damaged or destroyed by high doses of chemotherapy. The therapy uses both the bone marrow of the donor and the patient himself before chemotherapy. Until the transplanted bone marrow begins to produce enough white blood cells, patients should avoid infectious diseases.

Immunotherapy

Biologic therapy is a form of treatment that directly or indirectly uses the body's immune system to fight cancer or reduce the side effects that some cancer treatments may cause. It uses elements created by the body or developed in the laboratory to stimulate, direct or restore the body's natural defenses against lymphoma in the breast or other parts of the body.

Side effects of therapy

In some cases, recurrence or other cancers occur approximately 15 to 20 years after therapy. Therefore, it is important to undergo regular examinations.

Side effects of chemotherapy occur because cytotoxic substances damage not only the tumor, but also healthy cells. After completion of chemotherapy, almost all patients often experience a deterioration in blood quality: the concentration of white blood cells decreases and severe anemia occurs. If there is a risk of infection, special precautions must be taken - wear a mask, refrain from eating food that has not been heat-treated, and take antibiotics. Anemia can seriously impair patients' quality of life.

Hair loss occurs with more intensive therapies (high dose chemotherapy). Inflammation of the oral mucosa mainly affects patients undergoing high-dose chemotherapy with melphalan. Side effects completely disappear within a few days after discontinuation of the drug. Long-term consequences of high-dose chemotherapy are blood disorders. In young patients, the ability to conceive or bear children may be lost.

Recently, more and more attention has been paid to a late complication of long-term therapy with amino-bisphosphonates: osteonecrosis of the jaw - death of bone substance caused by a decrease in local blood supply. At the same time, the first larger studies were published: the incidence of osteonecrosis is 1% after 12 months of therapy and increases to 13% after 4 years. Risk factors include dentures, poor oral hygiene and periodontal intervention.

You should visit your doctor regularly

The patient should be regularly examined by the attending physician. Regular examinations help to detect relapse of the disease at an early stage. For this purpose, after completion of treatment, it is necessary to regularly conduct examinations of organ systems that may be affected by the disease (bone marrow, skeleton, kidneys). History taking, physical examination, blood and urine tests, and technical examinations are performed to varying degrees. Follow-up should also be used to identify or treat complications that may have occurred during therapy.

If a patient is participating in a clinical trial, the frequency of visits to the treating physician will be based on a strict protocol. Typically, all study patients are assessed at the study center on a quarterly basis after completion of treatment. In any case, participation in the study ensures that new onset of disease can be quickly detected and treated accordingly.

How long do people live with lymphoma? Understanding the nature of cancer and what to expect can help patients and their families plan treatment and initiate lifestyle changes. Prognosis is a prediction of the future evolution of the disease and the likelihood of recovery.

Some patients use statistics to try to obtain the likelihood of a cure; however, statistics reflect the experience of a large group of patients and cannot be used to predict what will happen to an individual. The prognosis for a patient with this tumor can depend on many factors - the type of cancer, age, general health and response to treatment. The disease is curable if treatment begins at an early stage.

The prognosis for life depends on many factors

The five-year survival rate of patients with Hodgkin lymphoma is 80% when therapy is started in a timely manner. Sometimes it is possible to go into long-term remission. Hodgkin's lymphoma can be completely cured in the early stages.

The life expectancy of patients with non-Hodgkin's lymphoma can be significantly reduced if therapy is not started in a timely manner. 5-year survival rates range from 80% for anaplastic large cell lymphoma to 14% for mantle cell lymphoma (especially in the mediastinal region). With this form of lymphoma, it is necessary to consult a doctor in the early stages.

Prevention

Patients who suffer from this disease should undergo periodic check-ups after completing treatment. Aftercare is an important part of the entire treatment plan, and people should not hesitate to discuss it with their doctor. Regular and periodic monitoring can ensure that the doctor can prevent complications of the disease in a timely manner.

During follow-up visits, people who have non-Hodgkin's lymphoma should report any health problems.

anonymously

Hello Elena Sergeevna, please advise, female, 37 years old, for about a year I have been feeling some constant tiredness and drowsiness. Weight is stable, appetite is good. 2 months ago I noticed how the posterior auricular lymph nodes on both sides of the necks had enlarged, I suspect that it could be longer. Then the posterior cervical, occipital, submandibular, axillary and inguinal ones appeared. There are no supraclavicular or subclavian lymph nodes, the lymph nodes are of a dense structure, hypoechoic, with differentiation into layers, the blood flow is not increased. The maximum anterior cervical lymph nodes are 16.6*5 mm and 14.5*4mm. In total, about 30 lymph nodes were identified, mostly all larger than 1 cm. She did not suffer from acute respiratory infections. CBC and leukocyte formula: leukocytes - 4.27 10E9/l, neutrophils 1.7710E9/l, lymphocytes 2.03 10E9/l, monocytes 0.2 10E9/l, eosinophils 0.11 10E9/l, basophils 0.04 10E9 /l, atypical lymphocytes 0.13 10E9/l, hemoglobin 142 g/l, hematocrit 42.3%, 0 erythrocytes 4.23 10E12/l, average erythrocyte volume 100.10 fl, average conc.hem. in erythrocytes 335 g/l, average heme content. in an erythrocyte 33.5 ng, erythrocyte volume distribution 14.2 5, platelets 206 10 units9/l, average erythrocyte volume 7.80 fl, ESR 2 mm/h, Beta-2 microglobulin – 1.277 μg/ml (normal up to 2. 5), alphafetoprotein 1.990 IU/ml (normal up to 5) FLG - without pathologies, FSH - normal, ultrasound of the abdominal cavity, thyroid gland, without pathology, HIV, ultrasound of the mammary glands - mastopathy. The spleen is not enlarged - 28 cm2. Herpes 7 and 8 are absent. EBV - to VCA IgM - negative. 0.10 (normal 0.00-0.90), IgG – positive. , to the early antigen - all negative, to the nuclear antigen - IgG positive. 134.5 U/ml. CMV immediate early protein – IgG – positive. 1.553 (normal 0.000-0.990), IgM – negative. 0.714 (normal 0.000-0.990) Rubella IgG – positive. 151.5 IU/ml (normal 0.0-10.0) In the immunogram, phagocytosis (monocytes) is increased, total IgE is increased. The 3D image revealed 2 radicular cysts of 2.7 and 1.6 teeth. We performed a puncture of the posterior auricular lymph node, the result: cells with elements of lymph node hyperplasia, a rare cluster of honuclear cells, lymphoid cells with dystrophy, suspicious for atypia - exclude lymphoma. In another laboratory, the slides were reviewed, the result: The material is cellular, but is almost completely dominated by the solution to varying degrees, the nuclear structure of most cells is not visible, there are many bare nuclei, destroyed cells, the preparation is unevenly stained, the count was made in a few preserved places. There are lymphoid cells, single nuclear neutrophils, plasma cells, monocytes and single, rather large lymphoid cells with several nucleoli. When counted per 500 nl: Bl 0.6% Lymphoid 16.2% h/nuclear neutrophils 0.4% monocytes 0.2% plasma cells 0.2% lymphocytes 82.4%. They refuse to do a lymph node biopsy due to the fact that the lymph nodes are of normal structure, and they also refuse to repeat the puncture due to the low-quality drug. A diagnosis of reactive lymphadenopathy is made, possibly due to infection, dynamic observation. But a week ago, a low-grade fever of 37.2 rose and persists. There are no active viral infections. Please tell me whether there is a need to insist on a biopsy or at least a repeat puncture. How serious are these indicators? Thank you.

Good day. Sorry for the late reply. Your letter is very detailed, with all the circumstances. Indeed, there are a lot of reasons that can cause enlarged lymph nodes. Reactive lymphadenopathy can be caused by viral, bacterial causes, as well as helminths. Enlarged lymph nodes in the projection of the head and neck can also be associated with inflammatory, chronic processes in the head area. Also with HIV infection, a malignant disease of the lymphatic system - lymphoma. Lymph nodes are “infection traps”; the infectious agent accumulates and is destroyed. Normally, an adult may have a small number of enlarged lymph nodes. If we talk about the diagnosis of lymphoma.. All the tests that you listed are without global changes. For all blood tests, you need to consult with an immunologist or an infectious disease doctor. In the presence of lymphoma pao OBP - SPLENOMEGALY (enlarged spleen). In terms of diagnosing lymphoma, it is necessary to perform MSCT of the chest and abdominal cavity in order to identify retroperitoneal and mediastinal lymph nodes. Because with lymphoma, the primary focus is located there. Lymph nodes on the periphery are not indicative; they will never contain atypical cells. To diagnose lymphoma, it is necessary to find the very first node that has enlarged, and take only this node for a biopsy. All others are not indicative. Regarding the cervical lymph nodes, it is necessary to dynamically monitor and periodically perform ultrasound of the nodes. In intact nodes, the structure according to ultrasound is not changed, differentiation into layers is preserved. Cytological preparations are not of very good quality. It is difficult to draw a conclusion. There is no need to insist on a biopsy. Not only is the incision in the projection of the neck, but the information content is minimal. In some cases, antibiotic therapy is prescribed and the nodes are monitored using ultrasound. Also with lymphoma there is a change in red blood counts. Therefore, it is worth further examination and consultation with the listed doctors - AT the initial stage. All the best to you. Sincerely, Elena Sergeevna

Lymphoma of the intestine

This type of intestinal disease is diagnosed in approximately eighteen cases out of a hundred, among all malignant pathologies of the small intestine, and in one case out of a hundred, when it comes to the large intestine. Most often, the presence of B-cell non-Hodgkin lymphoma is determined in this part of the digestive tract.

In the photo: Sectional view of a removed intestinal lymphoma

There are such types of small intestinal lymphoma as posterior type lymphoma, as well as alpha heavy chain disease. The pathology mainly affects children under ten years of age, or men after fifty. The most common location (in eighty percent) is the small intestine. Precancerous diseases in this case are usually called celiac disease, hypogammaglobulinemia, and Crohn's disease.

This is a rather dangerous pathology, the diagnosis of which should be treated with the utmost caution. The fact is that there are no specific symptoms that can distinguish small intestinal lymphoma from other tumors. In this regard, treatment must be comprehensive, including all available methods.

Photo of removed small intestinal lymphoma

Liver lymphoma

This is the development of a tumor from lymphatic tissues in the liver. Primary liver lymphoma is identified, which occurs in no more than fifteen percent of cases and is most often a solitary formation; usually this type develops in patients with immunodeficiency syndrome or against the background of a recent transplantation of this organ.

Photo of a liver affected by lymphomas

Secondary lymphoma is also isolated, which forms as a distant metastasis from other affected organs. This is due to the good blood supply to the liver and the fact that one of the main functions of this organ is filtering and purifying the blood. In this case, diffuse small-focal lesions are more typical.

Predisposing factors are pathologies such as:

• Cirrhosis.
• Diabetes mellitus of any type.
• Alcohol abuse.
• Biliary dyskinesia.

Thyroid lymphoma

Lymphoma of the thyroid gland is an oncological disease that originates from the lymphoid inclusions of the organ. Characteristic clinical symptoms develop, which are manifested by compression of the surrounding anatomical structures, which leads to an increase in the anterior surface of the neck, lymph nodes, as well as problems with the passage of the food bolus through the esophagus and hoarseness of the voice.

In the photo: a man with thyroid lymphoma

Diagnostic measures are limited to a blood test for thyroid hormones, as well as a fine-needle biopsy. Thyroid lymphoma is treated with a course of chemotherapy for lymphoma cancer, and in the presence of limited forms of the disease, a radical ectomy of the organ is performed, followed by lymph node dissection. Thyroid lymphoma is more common in women after sixty years of age and has fairly good prognostic indicators.

Lymphoma of bone

Bone lymphoma usually develops in people over sixty years of age; this type of sarcoma can grow from absolutely any bone. In the case of secondary damage, most often the primary site is the liver, intestines or thyroid gland.

MRI image: bone lymphoma

Characteristic symptoms of the pathology are bone pain, which usually worsens at night, swelling, and the development of pathological fractures as a result of osteoporosis. Predisposing factors are considered to be congenital malformations, genetic conditions, and the presence of chronic exposure to radiation or chemical harmful factors.

Abdominal lymphoma

This is a type of blood cancer that causes abnormal lymphocytes to accumulate in the abdominal area. The characteristic clinical picture usually consists of the following symptoms:

• The presence of a palpable neoplasm in the abdomen, which leads to compression of the intestinal loops and the clinical picture of chronic intestinal obstruction.
• Frequent feeling of a full stomach as a result of eating the usual amount of food.
• Splenoid and hepatomegaly.
• Chronic abdominal pain and decreased appetite, even to the point of aversion to food.
• Accumulation of free fluid in the abdominal cavity.

An abdominopolar scan with enhanced contrast computed tomography showed a large soft tissue dense mass (white arrow) in the middle of the ascending colon and above the ileocecum. After extended scanning, heterogeneous enhancement was noted.

Diffuse lymphoma (large B-cell) is a type of pathology in which lesions develop not only in the lymph nodes, but also in other internal organs. The risk group includes people with reduced immune reactivity, the presence of the Epstein-Barr virus, as well as those with infectious mononucleosis.

Histology of diffuse lymphoma

Lymphoma of the central nervous system

There are both primary and secondary types of this tumor. Secondary CNS lymphoma develops as a result of metastasis of lymphoma cells from other organs or tissues. Primary CNS lymphomas are considered to be quite rare types of non-Hodgkin lymphomas that arise in the area of ​​the structures of the central nervous system, but do not subsequently spread beyond its boundaries.

Magnetic resonance imaging of the brain showing B-cell non-Hodgkin's lymphoma of the sella turcica, hypothalamus, and tectum (intense white areas, middle).

Diagnosis is based on the presence of focal brain symptoms and invasive instrumental methods such as tumor resection or biopsy. A frequent clinical manifestation is an unbearable headache of a bursting nature, the appearance of damage to the spinal or optic nerves.

Lymphoma of the breast

This is an oncological tumor in the mammary gland, which occurs in five-tenths of one percent of all cases of pathological neoplasms in this anatomical structure. Usually it develops secondarily. As a result of metastasis from the primary tumor.

Mammography showed a round, 1.5 cm, well-described nodule, with uniform density, tiny petal borders and no microcalcifications

Palpation reveals a round inclusion with clearly defined edges, which is combined with local thickening of the skin. Once the final diagnosis is determined by biopsy, the choice of treatment follows. Most often, it involves the use of complex therapy, which includes surgery, chemotherapy and radiotherapy.

Testicular lymphoma

Testicular lymphoma - the development of a primary tumor in this zone of lymphoid origin is considered quite rare and occurs in only two percent of cases among all lymphomas. The risk group includes men over fifty years of age. In every fifth case, bilateral damage to these organs is observed.

The photo shows a multiradiate mass with a diameter of 5.4 cm. Histology and immunohistochemical findings diagnosed diffuse testicular B-cell lymphoma.

Diagnosis in the early stages is possible due to the presence of compaction and the sensation of a foreign body in the scrotum. In this regard, the treatment regimen used is successful in eighty percent of cases.

Lymphoma in children

This is a common disease due to the fact that children are at risk. This is due to the development of the immune system and its restructuring during the period of six to seven years of age. At this point, a malfunction in the replication of the genetic code may develop, which leads to the development of the disease.

There are the following types of lymphoma in children:

• Non-classical.
• Mixed cell.
• With lymphotosis.
• With lymphopenia.
• Nodular form.

The mass of complications associated with lymphoma in children obliges specialists to devote every effort to early detection of pathology and comprehensive treatment. The most common symptoms at this age are:

• Weight loss.
• Development of low-grade fever.
• Increased sweating at night.
• Chronic weakness and accelerated fatigue.
• Itching of the skin.
• Pallor.
• Pain in the bones and joints.

Marginal zone lymphoma of the spleen

Marginal zone lymphoma of the spleen is a tumor that develops at the border of the white and red pulp of the spleen. It is this part of the organ that is called the magrinal zone; there is a large accumulation of lymphocytes. This non-Hodgkin's lymphoma mostly affects people over seventy years of age and accounts for no more than three percent of all non-Hodgkin's lymphomas.

Splenic lymphatic marginal zone. An enlarged image shows the chromatin pattern characteristic of lymphoid cells, accompanied by polar villi.

Nonspecific manifestations of the disease are the following symptoms::

• Weakness.
• Excessive sweating.
• Fatigue.
• Heaviness in the left hypochondrium, which is not associated with food intake.
• Low-grade fever.
• Weight loss.

Mantle cell lymphoma

Mantle cell lymphoma is a formation of B lymphocytes that develops as a result of a chromosomal mutation. This pathology is characterized by enlargement of the lymph nodes, spleen, liver size, as well as damage to the lymph nodes of the digestive tract. Differential diagnosis must be carried out with intestinal polyposis, this is due to a similar clinical picture.

Mantle cell lymphoma, general pathology - the mucous membrane of the colon, dotted with tumor nodules in intestinal lymphomatous polyposis.

The growth originates from the mantle zone, where pathological cells multiply. Lymphoma from the cells of the mantle zone is considered a pathology with a low degree of malignancy, since there is no proliferation in the germinal center of the lymph nodes.