Non-Hodgkin's lymphomas

Definition

Non-Hodgkin's lymphomas represent a heterogeneous and complex group of malignant neoplasms affecting the organs and cells of the lymphatic system. However, it is not uncommon for non-Hodgkin's lymphomas to also affect extra-lymphatic areas, considering that the cells of the autoimmune system are located in very many areas of the body.

Hodgkin's and non-Hodgkin's lymphoma

Hodgkin's lymphomas differ from non-Hodgkin's due to the absence, in the latter, of a particular type of abnormal cell, called Reed-Sternberg: the histological difference, although apparently derisory, is absolutely substantial for diagnostic and operational purposes. In fact, only through lymphoma biopsy, or through molecular analysis, the doctor can correctly diagnose the disease and the type of lymphoma, in order to find the most appropriate and effective therapeutic solution.

Causes

B lymphocytes and T lymphocytes represent the target of non-Hodgkin's lymphoma: they are white blood cells that belong to the immune system; when they begin to reproduce indiscriminately and unregulated in the lymph nodes, and in other areas of the body, lymphoma occurs.

Non-Hodgkin's lymphomas arise through a consistent swelling of the lymphatic glands on the neck, armpits and groin; however, in 30% of patients with non-Hodgkin's lymphoma, even the intestine, bone marrow, skin and arms are affected by the disease.

Symptoms and incidence

Unlike most lymphomas, fever and excessive night sweats almost never turn out to be substantial, while remaining typical symptoms of the advanced phase of non-Hodgkin's lymphoma.

Non-Hodgkin's lymphomas particularly affect adults between the ages of 40 and 70, with an incidence of 3-5% compared to all the various cancers. There is also a connection between non-Hodgkin's lymphomas and AIDS: in fact, there appears to be an increase in the incidence of non-Hodgkin's tumors in people with AIDS immunodeficiency. Also autoimmune diseases (eg celiac disease), smoking, infections (eg caused hall'Herpes virus), excessive exposure to UV or artificial UV rays, contact or exposure to chemical agents (eg solvents, irritating disinfectants, acids, pesticides) are possible predisposing factors for non-Hodgkin's lymphoma.

Non-Hodgkin's lymphomas, like most lymphomas in general, can present symptoms or be absolutely asymptomatic in the acute phase: in some forms of non-Hodgkin's lymphoma, the patient does not perceive any kind of disorder, consequently the neoplasm can remain silent for long periods. In other cases, however, non-Hodgkin's lymphomas can manifest themselves suddenly, aggressively and painfully; could be fatal and the patient's death could occur within a few weeks.

In this regard, non-Hodgkin's lymphomas, based on the Kiel classification [taken from the book Treatise on blood diseases, by P. Larizza] can be divided into two main major groups, which distinguish other sub-categories: slow-growing (low-grade non-Hodgkin's lymphoma) or fast-growing (high grade non-Hodgkin's lymphoma).

Slow-growing non-Hodgkin's lymphomas

These are low-grade malignant lymphomas. They are divided as follows:

Plasmocytic lymphoma
Centrocytic lymphoma
Diffuse / diffuse follicular centroblastic / follicular lymphoma
Lymphocytic lymphomas (B / T chronic lymphocytic leukemia; tricloleucocyte leukemia; T-zone lymphoma); this category also includes mycosis fungoides and the Sezary Syndrome: these are two non-Hodgkin's lymphomas that originate in the skin and for this reason are also classified among skin cancers.

Fast-growing non-Hodgkin's lymphomas

They are lymphomas with a high degree of malignancy. They are classified as follows:

Primary / secondary centroblastic lymphoma
Immunoblastic lymphoma
Burkitt's lymphoblastic lymphoma (B lymphocytes)
Lymphoblastic lymphoma with convolved cells (T lymphocytes)
Unclassifiable lymphoblastic lymphoma

Other classifications

However, a further classification based on the target cells has been reported: non-Hodgkin lymphomas involving T lymphocytes are called T-lymphocyte-derived lymphomas (the most frequent event among young people), while those affecting B-lymphocytes are called B-derived lymphomas - lymphocyte (the most common non-Hodgkin's lymphoma).

Still, a further classification of non-Hodgkin's lymphomas was first proposed by Dr. Rappaport (1966): non-Hodgkin's lymphomas were subdivided according to morphology, cell differentiation, tumor nature and appearance nodular or diffuse neoplasm.

As we have seen, the classification of non-Hodgkin tumors appears to be very complex: in this regard, the diagnosis must be absolutely unequivocal in order to be able to defeat the tumor definitively.

therapies

Fortunately, in recent years antitumor therapy has achieved positive results and has allowed many healings: chemotherapy, radiotherapy, stem cell transplantation, new biological therapies and, in some rare cases, surgical removal, are the treatments used to fight non-Hodgkin's lymphomas.

Although the number of lymphoma patients is increasing, the chances of eradicating non-Hodgkin's lymphoma are also increasing.

Summary

To fix the concepts ...

Disease	Non-Hodgkin's lymphoma: a heterogeneous and complex group of malignant neoplasms that affects the organs and cells of the lymphatic and extra-lymphatic system.
Differences with Hodgkin's lymphomas	Absence of Reed-Sternber abnormal cells . Absence of fever and excessive sweating in the acute phase.
Target of the disease	Mainly B lymphocytes and T lymphocytes (white blood cells belonging to the immune system), but crazy cells can spread to other districts.
Areas concerned	Lymphatic glands on neck, armpits, groin (especially) Intestine, bone marrow, skin and arms (in 30% of cases)
Etiopathological framework	Factors related to non-Hodgkin's lymphoma: AIDS, smoking, autoimmune diseases, infections, massive UV exposure, contact with chemical agents, genetic predisposition.
General classification	Slow-growing or low-grade non-malignant non-Hodgkin's lymphomas Fast-growing non-Hodgkin's lymphoma or high-grade malignancy T-lymphocyte-derived lymphomas lymphomas of B-lymphocyte derivation The classification is complex because for each class there are several sub-categories. The cataloging of the various non-Hodgkin's lymphomas can be carried out based on the histology of the cells, their differentiation, the origin of the disease or according to their nodular or diffuse appearance.
therapies	Chemotherapy, radiotherapy, stem cell transplantation, new biological therapies and, in some rare cases, surgical removal are the possible therapies to eradicate non-Hodgkin's lymphomas.