Lymphomas

Mona Lisa U. Pua, RN

UST Graduate School
Overvie w

 Neoplasms of cells of lymphoid origin

 Usu. Start in lymph nodes
 Classified according to the degree of cell
differetation and origin of the
predominant malignant cell
 Classified as Hodgkin’s or Non-Hodgkin’s
 Ho dgkin’s
Di sease

 Rare malignancy that has an impressive cure

rate
 Men > women
 2 peaks of incidence: early 20’s and after 50
years old
 Has a familial pattern
 Common in patients receiving chronic
immunosuppresive therapy
Th e Lym phatic Syst em
 Consists of two semi-independent parts
 Lymphatic vessels
 Lymphoid tissues and organs
 Lymphatic system functions
 Transport fluids back to the blood
 Play essential roles in body defense and
resistance to disease
Lym phatic
Ch ara cterist ic s
 Lymph – excess tissue fluid carried by
lymphatic vessels
 Properties of lymphatic vessels
 One way system toward the heart
 No pump
 Lymph moves toward the heart
 Milking action of skeletal muscle
 Rhythmic contraction of smooth muscle in vessel
walls
Lym phatic Ve sse ls

 Lymph Capillaries
 Walls overlap to form flap-like minivalves
 Fluid leaks into lymph capillaries
 Capillaries are anchored to connective
tissue by filaments
 Higher pressure on the inside closes
minivalves
Lym phatic Ve sse ls

Figure 12.2
Lymphat ic Vessel s

 Lymphatic
collecting vessels
 Collects lymph from
lymph capillaries
 Carries lymph to
and away from
lymph nodes

Figure 12.1
Lymphat ic Vessel s

 Lymphatic
collecting vessels
(continued)
 Returns fluid to
circulatory veins
near the heart
 Right lymphatic duct
 Thoracic duct

Figure 12.1
Lym ph

 Materials returned to the blood

 Water
 Blood cells
 Proteins
Lym ph

 Harmful materials that enter lymph

vessels
 Bacteria
 Viruses
 Cancer cells
 Cell debris
Lymph Nodes

Figure 12.3
Lym ph No de Str uctu re
 Most are kidney-shaped, less than 1 inch
long
 Cortex
 Outer part
 Contains follicles – collections of
lymphocytes
 Medulla
 Inner part
 Contains phagocytic macrophages
Lym ph No de Str uctu re

Figure 12.4
Flo w o f L ym ph Through
Nodes
 Lymph enters the convex side through
afferent lymphatic vessels
 Lymph flows through a number of
sinuses inside the node
 Lymph exits through efferent lymphatic
vessels
 Fewer efferent than afferent vessels
causes flow to be slowed
Mal ignant Lymp hom a
Heredity, exposure to carcinogens, Epstein-Barr Virus Infection

Mutation of proto-oncogens / disruption of tumor suppressor genes

Cell transformation

Transformed cell release Transformed cell release

cytokines of growth factors

Accumulation of Proliferation of
inflammatory cells malignant and non-
malignant lymph
cells

B
 Painless enlargement of one or more lymph
nodes on one side of the neck

Impaired lymph flow from serous cavity or Pleural

erosion of tumor into the pleural cavity Effusion

Mediastinal mass Compress trachea Dyspnea

B Hepatic involvement or
Jaundice
bile duct obstruction

Splenomegaly/ retroperitoneal adenopathy Abdominal pain

Bone pain
Skeletal Involvement
Suppression of Dec. RBC, C
hematopoiesis WBC, PLT

Unknown
Pruritus; Pain after drinking alcohol Anemia
cause
 C

Delayed cutaneous Impaired T Lymphocyte

hypersensitivity Function

Catabolic effect of tumor on body Inc. Susceptibility to

metabolism and selective trapping of opportunistic Infection
nutrients by rapidly growing tumor cells

B symptoms:
Tumor cell
Act on satiety Fever, night
secrete
center in sweats,
cachectin
B hypothalamus
Cachexia,
Macrophage weakness,
Supress Fatty acids not unintentional
secrete TNF
synthesis of released from wt. loss of >
lipoprotein lipoproteins 10%
lipase

Endogenous Acts on
pyrogen hypothalamus
Ho dgkin ’s Dise ase
 Unicentric in origin; initiates in a single
node
 Malignant cell is the Reed-Sternberg cell
(gigantic tumor cell that is
morphologically unique and of immature
lymphoid origin)
 Cause: Unknown, probably EBV infection
An n Ar bor St agin g
Syst em
 I- single lymph node region or a single
extralymphatic organ or site
 II- 2 or more lymph node regions on the same side
of the diaphragm or localized involvement of an
extralymphatic organ or site
 III- both sides of the diaphragm or localized
involvement of extralymphatic organ or site or
spleen or both
 IV- disseminated involvement of 1 or more
extralymphatic organs with or without associated
lymph node involvement
No n-Hodgkin ’s
Lym phoma
 Multicentric in origin and spread early to
various tissues of the body esp. liver, spleen,
bone marrow
 3x more frequent than hodgkins
 May originate from T cells, B cells and
lymphocytes
 B symptoms are less common
 More frequent involvement of GI, liver, testes
and bone marrow
 Less involvement of mediastinum
Nu rsin g Pr oble ms

 Increased Risk for infection

 Anemia
 Alteration in Nutrition: Deficiency
Journ als

Alterations to the Lymphatic System in

Hogkin’s Disease

Gerard P. Boe, PhD

Executive Director, American Medical
Technologists’ Institute for Education (AMTIE)
Hodgki n’ s Lymp hom a
di ffers from Non-
Hodgki n’ s Lymp hom a i n:
 Predictable contiguous spread from one
chain of lymph node groups to another
 Presence of the Hodgkin/Reed Sternberg
Cell
 Cells other than lymphocytes may be
present in the lymph nodes
 Never exhibits a leukemia phase
Cha nge s t hat occur in
lymphat ic sy stem in
Hodgki n’ s Di seas e:
 Anatomic= enlarged spleen and lymph
nodes
 Histiologic= fibrosis, depletion of
lymphocytes, increase eosinophils and
large reed-sternberg or hodgkins cells.
 Immune Function= Impaired cellular
immunity, usually normal humoral
immunity