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Boala Hodgkin
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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• $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+
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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#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.
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T(B>&#,,# ,B>((
H>DC,
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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.
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HodgkinGslFmphoma
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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• 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.
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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• 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(
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)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.
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• ;adiografe toracica
• #T piept< a!domen sipel%is pentru adefni determinarile oculte
• PE#*+# 'tomogra,e cuemisie de poitroni( - este
standardul
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.adiolog/
#hest RAraF< #Tscan
(!dominalultrasound
KET scan+# scan *ediastinall/mphadenopath/
+hest *ra/ - enlarged
mediastinum
PE#*scan - meta"olicall/ acti&emediastinal mass
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• 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$
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+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$< fcat sau alte locali"ari etranodale+.• ( ara semne constitutionale• B semne B• (dditional su!scripts applica!le to anF disease stage:• R !ulkF disease )Uidening o mediastinum !F 336 or mass 1/cm+
• E in%ol%ement o a single etranodal site contiguous or proimal to knoUn nodal site.• #' clinical stage• K' pathological stage
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Tratament
)nitial - e&aluarea stadiului si factorilorde prognostic nefa&ora"il
Boala localiata! stadiul )*))
Boala a&ansata! stadiul )))*)V
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EV;<#)E< P.=8S#)+
#u tratament A / – 0/6 din pacienti sunt in ;#pe termen lung
actori de prognostic nefa&ora"il:
V histologie #$ si DV %arsta /
V se masculin
V simptome B
V J'H / mm@hV stadiu ,,,@,J
V !ulkF disease
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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+
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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+
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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@.
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+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.
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.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
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#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.
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LIMFOAMELE MALIGNE
NONHODGKINIENE
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ORGANELE LIMFOIDE:
Centrale: - maduva hematogena
- timuul
!eri"eri#e: - ganglioni
- $lina
- teut lim"oid ataatmu#oaelor % MAL&'
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=anglionullimfatic
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Lim"oamele maligne - de"initie
• Gru$ heterogen de (oli neo$la)i#e #u
originea in #elulele itemului imun
- in#identa *- + , #a)uri noi an
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+lasi,carile &echi ale limfoamelorsi schemele de tipiare
=rupul limfoamelor este di&ers$ ?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*
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.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
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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
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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
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+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
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Epidemiologie
• $ai rec%entela !ar!ati
• $ai rec%entela adult<incidentacreste cu
%arsta• Jarsta medie
de diagnostic
este 5A55 ani
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9actori predispo"anti )1+
• ,munodefciente• ,nectii cronice• 'e masculin• Jarsta• ,storic amilial de limom• ,storic de cancer
• Epunere medicamente:imunosupresi%e< antiepileptice< $TR
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9actori predispo"anti )2+
• >cupationali: – ,er!icide< pesticide< sol%enti< ade"i%i
• (lti actori: – #oloranti de par
– 9actori nutritionali
– Transu"ii sanguine
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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9actorii inectiosi
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Lim"oamele maligne - #lai"i#are
Criterii de #lai"i#are hitologi#a:
- ti$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
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Cl i"i REAL /HO % OM0'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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$la)i#
Clai"i#area REAL /HO % OM0'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Clai"i#area REAL /HO % OM0'
#lai"i#area #lini#a
Lim"oame #u #elule 2 :LLC3 LL!3lim"om #u lim"o#ite mi#iImuno#itom lim"omlim"o$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'
Clai"i#area REAL /HO % OM0'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Clai"i#area REAL /HO % OM0'
#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$la)i#
LIMFOAME AGRE0I5E %netratate 0v in luni'
Clai"i#area REAL /HO % OM0'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Clai"i#area REAL /HO % OM0'
#lai"i#area #lini#a
LIMFOAME C7 CEL7LE 2
Leu#emie lim"om lim"o(lati##u #elule 2Lim"om 2ur4itt
LIMFOAME C7 CEL7LE &
Leu#emii lim"om lim"o(lati# #u#elule &Lim"om leu#emie #u #elule & aleadultului % H&L5 6'
LIMFOAME FOAR&E AGRE0I5E %netratate 0v in a$tamani'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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(ggressi%e H – BurkittGs lFmphoma
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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(ggressi%e H – parotidin%ol%ement
d
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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#onuncti%al infltration in a case o indolent H)$(T+
D
/cosis fungoides: er/throderma andd ti
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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descuamation#utaneous TA#ellFmphoma –$Fcosis ungoides
/cosis fungoides -
cutaneous tumors
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Etranodal H – thFroid and or!ital in%ol%ement
d
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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#
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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imom gastric
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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 $e#iale : E8 ORL3 ED03 RMN30#intigra"ie ooaa3
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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imom mediastinal primiti%
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Case 1. Westley C. Evans et al. J. Nucl. Med. Technol. 2011;39:19019!
"c# Co$y%&'ht 201! (NMM); all %&'hts %ese%ved
Li " l li t di li
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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 $arti aledia"ragmului
0tadiul I5 . intereare vi#erala
0u(tadii: A ; "ara emne generale
2 ; #u emne generale
International !rognoti# Inde8 I!I
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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International !rognoti# Inde8 I!I
Fa#tor adver Gru$ 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&
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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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$i Mono#lonali anti CD *> % RI&7IMA2'
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Lim"oamele maligne - tratament
Lim"oamele agreive : - Cura CHO!: Ci#lo"o"amida B>mgm* )i ?@
Adriami#in B> mgm* )i ?@
5in#ritin @3= mg m* )i ?@
!rednion @>> mg )i ?@-B
- #om(inatii #u M&3 C1toar99
- radiotera$ia
- Anti#or$i Mono#lonali anti CD *> % RI&7IMA2'
- tran$lant medular
7/23/2019 Curs 8 - Limfoame Hodgkin Si Non-Hodgkin
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Lim"oamele maligne - tratament
Lim"oamele "oarte agreive :
- Cura #itotati#e imilare #u #ele din LAL
- $ro"ila8ia 0NC
- tran$lant medular