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Non-Hodgkin's Lymphoma
Symptoms and signs

1. Indolent lymphomas

As a group, low-grade lymphomas are characterized by indolent clinical behavior and comparatively prolonged survival (median survival, 6-10 years). Most patients have advanced- stage disease at diagnosis, and only about 10%-20% have stage I or II disease.

Follicular lymphoma

  • They usually appear above the age of 50 and present with generalized lymphadenopathy.
  • They commonly involve the bone marrow and spleen.
  • Despite the relative incurability of the disease in its advanced stages, follicular lymphoma patients tend to experience a long overall survival (8-12 years).

Lymphoplasmacytic Lymphoma

  • Lymphoplasmacytic Lymphoma is an indolent lymphoma associated with a monoclonal paraprotein of immunoglobulin M type.
  • They usually present with generalized lymph node, splenic and bone marrow involvement.
  • Some patients may develop hyperviscosity syndrome (which may lead to retinopathy, congestive heart failure and CNS dysfunction) due to excessive paraprotein secretion.
  • Patients may also experience chronic cold agglutinin disease.

Marginal zone lymphomas

  • Nodal marginal zone lymphomas involve the nodes and are called monocytoid B-cell lymphomas
  • Extranodal marginal zone lymphoma involves the extranodal sites (gastrointestinal tract, thyroid, lung, breast, skin), they are called mucosa-associated lymphatic tissue (MALT) lymphomas.

Splenic marginal zone lymphoma

  • Splenic marginal zone lymphoma is an indolent lymphoma that is marked by massive splenomegaly and peripheral blood and bone marrow involvement, usually without adenopathy.
  • Splenectomy may result in prolonged remission, otherwise it is treated as low grade lymphoma.
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2. Intermediate to high grade lymphoma

The clinical manifestations of intermediate- and high-grade NHLs are diverse and depend on the site of disease involvement. These tumors have a rapid growth rate and present as painless masses that cause symptoms when they infiltrate tissues or obstruct organs.

  • Lymphomas more frequently affects the lymph nodes, spleen, liver, and bone marrow, but any extranodal site may also be primarily involved.

  • As with Hodgkin's disease, NHL also presents with systemic B symptoms, including fever, which may or may not have the Pel-Ebstein relapsing pattern; drenching night sweats; and more than 10% weight loss. Generalized pruritus may also be present.
  • Nonparathyroid hormone induced hypercalcemia occurs in approximately 10% of patients.
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