curs 8 - limfoame hodgkin si non-hodgkin

7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin

http://slidepdf.com/reader/full/curs-8-limfoame-hodgkin-si-non-hodgkin 1/63

Boala Hodgkin



Defnitie

• Este o prolierare clonala a unorcelule limoide.

• Descrisa initial de Thomas Hodgkin in1832 – primul limom descris

• inia celulara a ramas mult timpsu!iect de de"!atere

• #ercetari recente demonstrea"aoriginea in centrul germinal dinoliculii limoi"i secundari



• $ai rec%enta in Europa si &'( )mairara in *aponia+.

• ,ncidenta %arstei de tip !imodal -%arul maor intre 2/ si 20 ani si%arul minor la / ani.

• Histologia cea mai rec%enta este cu'clero"a odulara )'+ in adultiitineri )456 dintre ca"uri sunt 7 /ani+



9actori de risc

• 'tatus socioeconomic ridicat in copilarie sirasa #aucasian in &'(.

• Agregare familiala rec%enta risc crescut lagemeni tineri

• egatura puternica cu inectia cu EBV : risccrescut la tinerii cu inectie do%edita cumononucleo"a inectioasa



#lassifcare );E(< =H>+1. HL cu predominenta nodulara limfocitara (NLPHL): 3–86? contine

limocite B mari atipice si histiocite )celule popcorn+2. HL clasic: celule mari mononucleate )celule Hodgkin+ sau !inucleate @

multinucleate );eedA'tern!erg+

Patru tipuri histologice:•. Scleroza nodulara8/6?.•. Celularitate mixta 146?.•. Depletie limfocitara rar•. Predominenta limfocitara.



T(B>&#,,# ,B>((

H>DC,



Ta!lou clinic

• 9rec%ent cu adenopatii supradiaragmaticenedureroase< de consistenta erma rec%entlocali"ate laterocer%ical

• Diseminarea are loc prin contiguitate pe lantulganglionar.

• ocali"ari rec%ente: supracla%icular si ailar• ;ara este aectat inelul =aldeFer.• 'plenomegalie doar in 3/6• Hepatomegalie 56.• eo!isnuit doar cu adenopatii a!dominale ara

aectare splenica.



HodgkinGslFmphoma



• De o!icei se asocia"a aectareasupradiaragmatica cu intraa!dominala si rardoar aectare regionala sau doarsu!diaragmatica

• (denopatiile %oluminoase )!ulkFI+ mediastinal siin hil pot produce simptome locale: – )e. compresie !ronsica sau de %ena ca%a

superioara@J#'+ sau etensie directa )e. plaman<pericard< pleura sau coaste+. Kleure"ie in 2/6.



• Determinarea etranodala apare rar prin Luul sanguin

)e.g. madu%a osoasa )1–6+< plaman sau fcat+.• Kre"enta !olii generali"ate este acompaniata cu

adenopatii generali"ate si aectare splenica si semnegenerale

• 2 336 au M1 simptome constitutionale ‘B’:

– Scadere ponderala >10% in ultimele luni! – fe"ra – #ranspiratii reci nocturne$

• 'e corelea"a cu !oala etensi%a si prognostic prost

• (lte simptome specifce: – Krurit generali"at – durere ganglionara indusa de consumul de alcool

• 'ensi!ilitate la inectii cu tu"erculoa! fungi!protooare si &irusuri 'germeni oportunisti(



)n&estigatii! diagnostic sistadialiare

• Documentarea semnelor NBIdin istoric.

• Eamen clinic al determinarilor ganglionare.

• #onfrma diagnosticul prin "iopsie ganglionara prin eci"iegg<

!iopsie ghidata prin #Tsau chiar laparotomie< mediastinoscopiesau mediastinotomie

• 'tadiali"area clinicP si imagistica

• 'tadiali"area patologicP necesitP o !iopsie de confrmare siconfrmarea in siteAuri anormale.

• 9rotiul de sange perieric: – anemie normocromP normocitarP< – leucocito"P reacti%P< – eo"inoflie Qi @ sau – usoara trom!ocito"a reacti%P.



• ;adiografe toracica

• #T piept< a!domen sipel%is pentru adefni determinarile oculte

• PE#*+# 'tomogra,e cuemisie de poitroni( - este

standardul



.adiolog/

#hest RAraF< #Tscan

(!dominalultrasound

KET scan+# scan *ediastinall/mphadenopath/

+hest *ra/ - enlarged

mediastinum

PE#*scan - meta"olicall/ acti&emediastinal mass



• Biopsie osteomedulara pentrua e3clude determinarea medulara lapacientii cu stadiul ))) 4 )V "olii sausimptome B 'nu sunt esen5iale 6n faade )A 4 A)) "olii(7

• B poatepreenta caracteristici reacti&e

• Scintigra,e osoasa! .8

• Biopsia in alte site*uri suspecte dee3emplu! hepatice sau osoase$



+lasi,carea Ann Ar"or

Stage ) aectarea unui singur ganglion sau grup ganglionarStage )) aectarea a cel putin 2 ganglion@grupuri ganglionare

de aceeasi parte a diaragmuluiStage ))) aectarea de am!ele parti ale diaragmului

– )))1 S splina< hil splenic< gg celiac sau portal?

– )))9 gg paraAaortici< iliaic sau mesentericiStage )V aectarea a cel putin unei locali"ari etranodale )e.g.

B$< fcat sau alte locali"ari etranodale+.• ( ara semne constitutionale• B semne B• (dditional su!scripts applica!le to anF disease stage:• R !ulkF disease )Uidening o mediastinum !F 336 or mass 1/cm+

• E in%ol%ement o a single etranodal site contiguous or proimal to knoUn nodal site.• #' clinical stage• K' pathological stage



Tratament

)nitial - e&aluarea stadiului si factorilorde prognostic nefa&ora"il

Boala localiata! stadiul )*))

Boala a&ansata! stadiul )))*)V



EV;<#)E< P.=8S#)+

#u tratament A / – 0/6 din pacienti sunt in ;#pe termen lung

actori de prognostic nefa&ora"il:

V histologie #$ si DV %arsta /

V se masculin

V simptome B

V J'H / mm@hV stadiu ,,,@,J

V !ulkF disease



Prognostic fa&ora"il:

stadiul ) sau ))

fara nici un factor de risc

Tinta: cura cu eecte secundare minime.

• Tratamentul chimioterapie< e.g. ABV? @ cicluri radioterapie determinari de "oala ,9; )3–/CF+.

• e%olutie: 0/6 ailureAree sur%i%al )99'+ si 056>' la 5 ani

(lternati%e: iradiere limoida su!totala )3–/CF+



Prognostic nefa&ora"il:sta,ul ) sau )) ; cu orice factor de risc

'cop: cura cu unelereacWii ad%erse accepta!ile.

• Esentiala este chimioterapia

com"inata< e.g. ABV? cicluri radioterapie )3–/CF+

• e%olutie: 856 D9' si0/6 >' la 5

ani.• ptiune terapeutica alternati&a:PP*ABV? cicluri radioterapiea locali"arilor aectate )3–/CF+



Boala odgCin a&ansata

Stadiul III-IV

Sunt identicati 7 factori de prognostic:

– H! 71/.5g@d. – 'e masculin. – 'tadiul ,J. – Jarsta M5. – =B# 1 1/0@. – Fmopenia 7/. 1/0@ sau 786 in ormula leucocitara. – (l!umina serica 7/g@.



+himioterapie com"inata• ,ntroduceWi pacient XntrAun studiu clinic

randomi"at< multicentric< dacP este posi!il.

• regim standard pentru pacientii cu BH a%ansat )stadiul ,,, sau,J+< care nu este Xnscris XntrAun studiu clinic.

– *D cicluri de ABV? a ost echi%alentul a 19 cicluri de PP*ABV? regim alternati% )#; 826 aWP de 836+

• ABV? are un risc mult mai mic de infertilitate de regimuride $>KK Qi nu este asociat cu un risc crescut de leucemie<dar anthraciclinele pot eacer!a complicaWiicardiace Qi pulmonare secundare iradierii mediastinale.

• De multe ori prost tolerat de pacienWi %Yrstnici dincau"a do"ei cumulati%e de dooru!icinP )insufcienta cardiaca+Qi !leomicina )f!ro"a pulmonara+.

– *D cicluri BEA+PP standard si regim escaladat

• (lternati%e: durate scurte de do"e terapeutice intensifcate< deeemplu< Stanford V do"e mici cumulati%e de alchilanti<dooru!icinP Qi !leomicina de peste 12 sPptPmYni< urmatede radioterapie in "onele cu detereminare )M 5cm+? 99' 806< risc foarte scut de leucemie.



.adioterapie adFu&anta

• ;adioterapia esteadministrata rec%ent la

– !oli mediastinale %oluminoase dupPterminarea chimioterapiei

• ;adioterapia la de!ut doar in !oalacu mase tumorale mari si compresie

importanta



#erapie de sal&are

• 5/6 dintre pacienWi recad duparadioterapie primara in stadiul incipient< desi se stie caH poate f %indecat prin chimioterapie (BJD.

• Xn general< 99K dura!ila Qi supra%ieWuirea prelungitP nu suntreali"ate de chimioterapie con%entionale pentru pacienWiicu recPderi dupP chimioterapia iniWialP.

• Do"ele mari de chimioterapie)HDT+< cu transplant autolog de sGnge periferic decelule stem 'S+#( au de&enit a"ordarea desal&are standard pentru maForitatea pacien5ilor curecderi dup chimioterapie< cu rate de raspuns

complet )de pYnP la 8/6+< remisiuni dura!ile complete

de la / A 56 Qi de mor!iditate Qi mortalitate redusP.

• ?# plus S+# autolog poate , cea mai "unaoptiune pentru pacientii cu "oala refractarala tratamentul ini5ial<deQi pacienWii cu !oalP progresi%P la terapia con%entionala a

u XncP un prognostic nea%ora!il.



LIMFOAMELE MALIGNE

NONHODGKINIENE



ORGANELE LIMFOIDE:

Centrale: - maduva hematogena

- timuul

!eri"eri#e: - ganglioni

- $lina

- teut lim"oid ataatmu#oaelor % MAL&'



=anglionullimfatic



Lim"oamele maligne - de"initie

• Gru$ heterogen de (oli neo$la)i#e #u

originea in #elulele itemului imun

- in#identa *- + , #a)uri noi an



+lasi,carile &echi ale limfoamelorsi schemele de tipiare

=rupul limfoamelor este di&ers$ ?istinctia intrediferitele tipuri de limfoame se "aeaa pecaracteristicile diferite ale celulelor tumorale$ Au

fost folosite de*a lungul anilor diferite sisteme declasi,care:• .appaport: utiliat inainte de anii 1HI0! s*a "aat

numai pe aspectul microscopic• Jiel: utiliat in special in Europa! se "aeaa pe

aspectul microscopic si imunologic 'in functie detipul de proteine produse de celula(! a fostupdatat in 1HH9$

• 8ational +ancer )nstituteKs LorCing ormulation ')L(: introdus in 1HD9! )L imparte limfoamelein loM*grade! intermediate*grade and high*



.e&ised European*American +lassi,cation of;/mphoid 8eoplasms '.EA;(: introdus in1HH@! .EA; descrie diferitele tipuri delimfoame ca entitati cu ,ecare tip clasi,cate

in functie de originea celulara! "aat peapectul – morfologic! – imunologic si – criteriile genetice

#ratamentul pacientilor cu limfom a fostafectat de lipsa uniformitatii dintre acestesisteme de clasi,care



Jechile clasifcari alelimoamelor

LorCing formulation ;oM*grade• (.small lFmphocFtic< consistent Uith

Uell chronic lFmphocFtic leukemia )'+• B.ollicular< predominantlF small clea%ed

cell )9'#+• #.ollicular< mied small clea%ed and

large cell )9$+)ntermediate*grade• D. ollicular< predominantlF large cell

)9+• E. diZuse< small clea%ed cell )D'#+• 9. diZuse mied< small and large )D$+ C.

diZuse< large cell clea%ed or nonclea%edcell )D+

igh*grade

• H. immuno!lastic< large cell ),B+• ,. lFmpho!lastic< con%oluted or

noncon%oluted cell )+• *. small nonclea%ed cell< Burkitt[s or nonA

Burkitt[s )'#+

.appaport classi,cation

• diZuse lFmphocFtic diZerentiated)D=D+

• nodular lFmphocFtic poorlFdiZerentiated )KD+

• nodular mied< lFmphocFtic and

histiocFtic )$+

• nodular histiocFtic )H+• diZuse lFmphocFtic poorlF diZerentiated

)DDK+• diZuse mied< lFmphocFticand

histiocFtic )D$+

•diZuse histiocFtic )DH+• diZuse lFmpho!lastic )D+

• diZuse undiZerentiated< Burkitt[s or nonABurkitt[s )D&+

. E A ; +;AS))+A#)8 ;NPP.;)E.A#)VE



B-cell neoplasms

I. Precursor B-cell neoplasm: precursor B-lymphoblastic leukaemia/lymphoma

II. Peripheral B-cell neoplasms

A. B-cell chronic lymphocytic

leukaemia/prolymphocytic leukaemia/small

lymphocytic lymphoma

B. Lymphoplasmacytoid lymphoma/immunocytoma

C. Mantle cell lymphoma

D. ollicle center cell lymphoma! "ollicular

#. Pro$isional cytolo%ic %rades: I &small

cell'! II &mi(ed small and lar%e cell'! III &lar%e

cell'

). Pro$isional subtype: di""use!

predominantly small cell type

*. Mar%inal +one B-cell lymphoma #. *(tranodal &MAL,-type /- monocytoid B

cells'

). Pro$isional subtype: nodal &/-

monocytoid B cells'

. Pro$isional entity: splenic mar%inal +one

lymphoma &/- $illous

lymphocytes'

. airy cell leukaemia

. Plasmacytoma/plasma cell myeloma

I. Di""use lar%e B-cell lymphoma

#. 0ubtype: primary mediastinal &thymic' B-cell lymphoma

1. Burkitt2s lymphoma

3. Pro$isional entity: hi%h-%rade B-cell

lymphoma! Burkitt-like

,-cell and putati$e 43-cell neoplasms

I. Precursor ,-cell neoplasm: precursor ,-lymphoblasticlymphoma/leukaemia

II. Peripheral ,-cell and 43-cell neoplasms

A. ,-cell chronic lymphocytic leukaemia/prolymphocytic

leukaemia

B. Lar%e %ranular lymphocyte leukaemia

#. ,-cell type

). 43-cell type

C. Mycosis "un%oides/0e+ary2s syndrome

D. Peripheral ,-cell lymphomas! unspeci"ied

#. Pro$isional cytolo%ic cate%ories: medium-si+ed cell!

mi(ed medium and lar%e cell! lar%e cell! lymphoepithelioid cell

). Pro$isional subtype: hepatosplenic %amma/delta ,-cell

lymphoma

5. Pro$isional subtype: subcutaneous panniculitic ,-celllymphoma

*. An%ioimmunoblastic ,-cell lymphoma

. An%iocentric lymphoma

. Intestinal ,-cell lymphoma &/- enteropathy associated'

. Adult ,-cell lymphoma/leukaemia

I. Anaplastic lar%e cell lymphoma

#. CD56 -cell type

). ,-cell type

5. 4ull-cell types

1. Pro$isional entity: anaplastic lar%e cell lymphoma!

od%kin2s-likeod%kin2s disease

I. Lymphocyte predominance

II. 4odular sclerosis

III. Mi(ed cellularity

I7. Lymphocyte depletion

7. Pro$isional entity: lymphocyte-rich classical od%kin2s

disease

.$E$A$;$ +;AS))+A#)8 ;NPP.;)E.A#)VE?)S.?E.S



+lasi,carea L a limfoproliferarilorcronice

B*+ell 8eoplasms)$ Precursor B*cell neoplasm:

a$ Precursor B*l/mpho"lastic leuCemia4l/mphoma

))$ ature 'peripheral( B*cell neoplasms• B*cell chronic l/mphoc/tic leuCemia 4

small l/mphoc/tic l/mphoma• B*cell prol/mphoc/tic leuCemia• ;/mphoplasmac/tic l/mphoma• Splenic marginal one B*cell l/mphoma '4*

&illous l/mphoc/tes(• 8odal marginal one l/mphoma '4* monoc/toid

B*cells(• E3tranodal marginal one B*cell l/mphoma of

mucosa*associated l/mphoid tissue 'A;#( t/pe• air/ cell leueCmia• Plasma cell m/eloma4plasmac/toma• ollicular l/mphoma! follicle center• antle cell l/mphoma• ?iOuse large cell B*cell l/mphoma

– ediastinal large B*cell l/mphoma – )ntra&ascular large B*cell l/mphoma – Primar/ eOusion l/mphoma

• BurCittKs l/mphoma4BurCittKs cell leuCemia• B*cell proliferations of uncertain malignant

potential• ;/mphomatoid granulomatosis• Post*transplant l/mphoproliferati&e disorder

#*+ell and 8atural Jiller +ell 8eoplasms )$ Precursor # cell neoplasm:

a$Precursor #*l/mpho"lastic l/mphoma4leuCemia "$ Blastic 8J l/mphoma 'neM(

))$ ature 'peripheral( # cell and 8J*cell neoplasms• # cell prol/mphoc/tic leuCemia• #*cell granular l/mphoc/tic leuCemia• Aggressi&e 8J +ell leuCemia• Adult # cell l/mphoma4leuCemia '#;V1(• E3tranodal 8J4#*cell l/mphoma! nasal t/pe 'neM(• Enteropath/*t/pe #*cell l/mphoma

• epatosplenic gamma*delta #*cell l/mphoma• Su"cutaneous panniculitis*liCe #*cell l/mphoma• /cosis fungoides4Sar/Ks s/ndrome • Primar/ +utaneous Anaplastic large cell l/mphoma

#4null cell• Peripheral # cell l/mphoma! unspeci,ed• Angioimmuno"lastic # cell l/mphoma • Primar/ S/stemic Anaplastic large cell l/mphoma!

#4null cell• #*cell proliferation of uncertain malignant potential• ;/mphomatoid papulosis

odgCinKs ;/mphoma 'odgCinKs ?isease( 'B +ell rigin(• 8odular l/mphoc/te predominance odgCinKs

l/mphoma• +lassical odgCinKs l/mphoma

– 8odular sclerosis odgCinKs l/mphoma – ;/mphoc/te*rich classical odgCinKs l/mphoma – i3ed cellularit/ odgCinKs l/mphoma – ;/mphoc/te depletion odgCinKs l/mphoma

http://www.lymphomainfo.net/nhl/b-cell.html

http://www.lymphomainfo.net/nhl/types/lbl.html


http://www.lymphomainfo.net/nhl/types/sll.html


http://www.lymphomainfo.net/nhl/types/lpl.html

http://www.lymphomainfo.net/nhl/types/smzl.html

http://www.lymphomainfo.net/nhl/types/b-nmzl.html

http://www.lymphomainfo.net/nhl/types/malt.html


http://www.lymphomainfo.net/nhl/follicular.html


http://www.lymphomainfo.net/nhl/types/mantle.html

http://www.lymphomainfo.net/nhl/types/dlcl.html

http://www.lymphomainfo.net/nhl/types/burkitts.html

http://www.lymphomainfo.net/nhl/t-cell.html


http://www.lymphomainfo.net/nhl/types/nk-blastic.html


http://www.lymphomainfo.net/nhl/types/nk-t-nasal.html

http://www.lymphomainfo.net/nhl/types/ctcl-mf.html

http://www.lymphomainfo.net/nhl/types/alcl.html

http://www.lymphomainfo.net/nhl/types/t-ail.html


http://www.lymphomainfo.net/conditions/lyp.html

http://www.lymphomainfo.net/hodgkins/index.html

http://www.lymphomainfo.net/hodgkins/index.html

http://www.lymphomainfo.net/conditions/lyp.html


http://www.lymphomainfo.net/nhl/types/t-ail.html


http://www.lymphomainfo.net/nhl/types/ctcl-mf.html

http://www.lymphomainfo.net/nhl/types/nk-t-nasal.html



http://www.lymphomainfo.net/nhl/t-cell.html

http://www.lymphomainfo.net/nhl/types/burkitts.html

http://www.lymphomainfo.net/nhl/types/dlcl.html

http://www.lymphomainfo.net/nhl/types/mantle.html



http://www.lymphomainfo.net/nhl/types/b-nmzl.html

http://www.lymphomainfo.net/nhl/types/smzl.html

http://www.lymphomainfo.net/nhl/types/lpl.html




http://www.lymphomainfo.net/nhl/b-cell.html



Epidemiologie

• $ai rec%entela !ar!ati

• $ai rec%entela adult<incidentacreste cu

%arsta• Jarsta medie

de diagnostic

este 5A55 ani



9actori predispo"anti )1+

• ,munodefciente• ,nectii cronice• 'e masculin• Jarsta• ,storic amilial de limom• ,storic de cancer

• Epunere medicamente:imunosupresi%e< antiepileptice< $TR



9actori predispo"anti )2+

• >cupationali: – ,er!icide< pesticide< sol%enti< ade"i%i

• (lti actori: – #oloranti de par

– 9actori nutritionali

– Transu"ii sanguine



9actorii inectiosi



Lim"oamele maligne - #lai"i#are

Criterii de #lai"i#are hitologi#a:

- ti$ul #elular . #elula mi#a % #entro#it'

- #elula mare % #entro(lat' - modelul in"iltrarii . nodular

- di"u)

- anali)a imunohito#himi#a - anali)a geneti#a



Cl i"i REAL /HO % OM0'



Clai"i#area REAL /HO % OM0'Revied Euro$ean Ameri#an L1m$homa Clai"i#ation

Lim"oame #u #elule 2 :Lim"oame #u #elule 2 $re#uroare

Leu#emie lim"om lim"o(lati##u #elule 2

Lim"oame #u #elule 2 $eri"eri#e

LLC3 LL!3 lim"om #u lim"o#itemi#iImuno#itom lim"omlim"o$lamo#iti#3 2oala/aldentromLim"om de #entru "oli#ular Lim"om de )ona marginala

Leu#emia #u #elule $aroaeLim"om #u #elule de manta!lamo#itom mielomLim"om di"u) #u #elule mariLim"om 2ur4itt

Lim"oame #u #elule & :Lim"oame #u #elule & $re#uroare

Leu#emii lim"oame lim"o(lati#e#u #elule &

Lim"oame #u #elule & $eri"eri#e

LLC3 LL!LGL %leu#emia #u lim"o#itegranulare mari'Mi#oi "ungoide indrom0e)ar1Lim"oame #u #elule & $eri"eri#e3ne$e#i"i#

Lim"om angioimuno(lati#Lim"om angio#entri#Lim"om de ti$ intetinalLim"om leu#emie #u #elule & aleadultului % H&L5 6'Lim"om #u #elule mari ana$la)i#

Clai"i#area REAL /HO % OM0'




#lai"i#area #lini#a

Lim"oame #u #elule 2 :LLC3 LL!3lim"om #u lim"o#ite mi#iImuno#itom lim"omlim"o$lamo#iti#3 2oala/aldentromLim"om de #entru "oli#ular Lim"om de )ona marginala

Leu#emia #u #elule $aroae

Lim"oame #u #elule & :LLC3LGL %leu#emia #u lim"o#itegranulare mari'Mi#oi "ungoide indrom0e)ar1

LIMFOAME LE7CEMII INDOLEN&E %netratate 0v in ani'





#lai"i#area #lini#a

LIMFOAME C7 CEL7LE 2

Lim"om #u #elule de manta!lamo#itom mielomLim"om di"u) #u #elule mari

LIMFOAME C7 CEL7LE &

Leu#emia $rolim"o#itaraLim"oame #u #elule & $eri"eri#e3ne$e#i"i#

Lim"om angioimuno(lati#Lim"om angio#entri#Lim"om de ti$ intetinalLim"om #u #elule mari ana$la)i#

LIMFOAME AGRE0I5E %netratate 0v in luni'





#lai"i#area #lini#a

LIMFOAME C7 CEL7LE 2

Leu#emie lim"om lim"o(lati##u #elule 2Lim"om 2ur4itt

LIMFOAME C7 CEL7LE &

Leu#emii lim"om lim"o(lati# #u#elule &Lim"om leu#emie #u #elule & aleadultului % H&L5 6'

LIMFOAME FOAR&E AGRE0I5E %netratate 0v in a$tamani'



Lim"oamele maligne . ta(lou #lini#

0emne generale %2':

- "e(ra "ara alta #au)a

- $ierdere in greutate

- tran$iratii 0emne legate de in"iltarea tumorala

- adenomegalie

- he$atomegalie $lenomegalie

- e8traganglionara % digetiv3 re$irator3#utanat3 0NC 9'



(ggressi%e H – BurkittGs lFmphoma



(ggressi%e H – parotidin%ol%ement

d



#onuncti%al infltration in a case o indolent H)$(T+

D

/cosis fungoides: er/throderma andd ti



descuamation#utaneous TA#ellFmphoma –$Fcosis ungoides

/cosis fungoides -

cutaneous tumors



Etranodal H – thFroid and or!ital in%ol%ement

d



Lim"oamele maligne . diagnoti#

2IO!0IE ganglionara teut im$li#at

- am$renta ; E8 #itologi#

- e#tiuni in $ara"ina

; E8 hitologi#

; E8 Imunohito#himi#

- E8 imuno"enoti$are E8 geneti#



imom gastric



Lim"oamele maligne . $roto#ol

tadiali)are

Anamne)a E8 o(ie#tiv R8 &ora#e &AC &ora#e E#o A(d &AC A(domen

2io$ie medularaAnali)e la(orator: Hemograma3 50H3

F(g3 LDH3 EF3 < * mi#roglo(ulina

Ca)uri $e#iale : E8 ORL3 ED03 RMN30#intigra"ie ooaa3



imom mediastinal primiti%



Case 1. Westley C. Evans et al. J. Nucl. Med. Technol. 2011;39:19019!

"c# Co$y%&'ht 201! (NMM); all %&'hts %ese%ved

Li " l li t di li



Lim"oamele maligne . tadiali)are

%Clai"i#area Ann Ar(or'

0tadiul I . un ingur gru$ ganglionar

0tadiul II . doua gru$e ggl de a#eeai $arte a

dia"ragmului

0tadiul III . gru$e ggl de am(ele $arti aledia"ragmului

0tadiul I5 . intereare vi#erala

0u(tadii: A ; "ara emne generale

2 ; #u emne generale

International !rognoti# Inde8 I!I



International !rognoti# Inde8 I!I

Fa#tor adver Gru$ de ri# Numar de "a#tori

(tatus de $e%*o%+antaEC,- 2

Jos 0/1

no%+al Jos&nte%+ed&a% 2

ocal&a%& e4t%anodale )nalt&nte%+ed&a% 3

(tad&ul )))5)6 )nalt !/7

6a%sta 80 an&



Lim"oamele maligne - tratament

Lim"oamele indolente:

- Leu4eran

- #ura C5!: Ci#lo"o"amida =>>mgm* )i ?@-B

5in#ritin @3= mg m*

)i ?@!rednion @>> mg )i ?@-B

- Fludara(ina

- $lene#tomia

- radiotera$ia

- IN&ERFERON CLADRI2IN !EN&O0&A&IN ;HCL

- Anti#or$i Mono#lonali anti CD *> % RI&7IMA2'




Lim"oamele agreive : - Cura CHO!: Ci#lo"o"amida B>mgm* )i ?@

Adriami#in B> mgm* )i ?@

5in#ritin @3= mg m* )i ?@

!rednion @>> mg )i ?@-B

- #om(inatii #u M&3 C1toar99

- radiotera$ia

- Anti#or$i Mono#lonali anti CD *> % RI&7IMA2'

- tran$lant medular




Lim"oamele "oarte agreive :

- Cura #itotati#e imilare #u #ele din LAL

- $ro"ila8ia 0NC

- tran$lant medular

curs 8 - limfoame hodgkin si non-hodgkin

Documents