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6 out of 10

All of the following statements-about Burkitt's lymphoma are true, Except: (PGI May 2009)

A B cell lymphoma

B 8, 14 translocation

C Can present as an abdominal mass

D Radiotherapy is the treatment of choice

Ans. D

Radiotherapy is the treatment of choice

Extra Edge: Important translocation to be remembered


Associated Malignancy

t (8 – 14)

i. Burkitt’s lymphoma

ii. ALL (FAB type L3)

iii. Immunoblastic B cell lymphoma

t (15 –17)

Promyelocytic leukemia (M3 – AML)

t (4 – 11)


t (11 – 14)

i. CLL

ii. Mantle cell lymphoma

t (14-18)

B cell lymphomas

T (8 – 14)

Burkitt cell

Table - Infectious Agents Associated with the Development of Lymphoid Malignancies (Ref. Hari- 18th ed., Pg.921, table 110.4)

Infectious Agent

Lymphoid Malignancy

Epstein-Barr virus

1. Burkitt's lymphoma

2. Post–organ transplant lymphoma

3. Primary CNS diffuse large B cell lymphoma

4. Hodgkin's disease

5. Extranodal NK/T cell lymphoma, nasal type


1. Adult T cell leukemia/lymphoma


1. Diffuse large B cell lymphoma

2. Burkitt's lymphoma

Hepatitis C virus

Lymphoplasmacytic lymphoma

Helicobacter pylori

Gastric MALT lymphoma

Human herpesvirus 8

Primary effusion lymphoma

Multicentric Castleman's disease

Note: CNS, central nervous system; HTLV, human T cell lymphotropic virus; MALT, mucosa-associated lymphoid tissue; NK, natural killer.

Clinical features

1. Most patients are asymptomatic. Or may have fever, night sweats, or weight loss.

2. Patients with indolent lymphomas may have waxing and waning adenopathy for several months before diagnosis, although persistent nodal enlargement is more common.

3. Extranodal disease most often involve the stomach, lung, and bone, resulting in symptoms characteristic of the affected organ. Involvement of Oropharyngeal lymphoid tissue (Waldeyer Ring) causes sore throat and obstructive breathing.

4. If bone marrow is involve that lead to pancytopenia.

5. Skin is involve in T cell lymphoma.

Staging and diagnosis

The Ann Arbor staging system used to classify Hodgkin's disease is also used to stage non-Hodgkin's lymphomas.

Table - International Prognostic Index for NHL (Ref. Hari-. 18th ed., Pg. 925, table 110.9)

Five clinical risk factors:

1. Age ≥60 years

2. Serum LDH levels elevated

3. Performance status ≥2 (ECOG) or ≤70 (Karnofsky)

4. Ann Arbor stage III or IV

5. >1 site of extranodal involvement


1. Radiation therapy. Non-Hodgkin's lymphomas are very radiosensitive. It is use for localized stage 1 disease but that is rare.

2. Chemotherapy is the main treatment.

a. Low-grade indolent lymphomas = chlorambucil or cyclophosphamide,

b. High grade NHL = Chemotherapy (Most Common regimen is CHOP (cyclophosphamide, doxorubicin, vin­cristine, and prednisone)

c. Rituximab is also used

Recent Advance - New Drug

Ibritumomab: It is useful in the treatment of relapsed or refractory low-grade, follicular or transformed B-cell NHL (Non-Hodgkin’s lymphoma).

Clinical differences between Hodgkin and non Hodgkin lymphomas (Ref. Robbins (Basic Pathology 8th ed.) Pg. 459)

Hodgkin lymphoma

Non-Hodgkin lymphoma

More often localized to a single axial group of nodes (cervical, mediastinal, para-aortic)

More frequent involvement of multiple peripheral nodes

Orderly spread by contiguity

Noncontiguous spread

Mesenteric nodes and Waldeyer ring rarely involved

Mesenteric nodes and Waldeyer ring commonly involved

Extranodal involvement uncommon

Extranodal involvement common

Hematology Flashcard List

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