This document discusses lymphoma, including definitions, classifications, risk factors, etiology, and prevalence. It defines lymphoma as malignant tumors of lymphoid tissue characterized by abnormal proliferation of B or T cells. Lymphomas are classified into Hodgkin's and non-Hodgkin's types. Risk factors for Hodgkin's lymphoma include age, viral infections, family history and weakened immunity. Non-Hodgkin's lymphoma risk factors include age, infections, chemicals, immunodeficiency and inflammation. Worldwide, non-Hodgkin's lymphoma prevalence is higher than Hodgkin's lymphoma. Prevalence data is also presented for Saudi Arabia.

1. Mr.Abdulaziz R. Alanzi
Medical Student, Al-Imam University
Riyadh – Saudi Arabia

2. Road Map
Definition
Classification
Risk Factors
Etiology
Prevalence – World Wide
Prevalence – Saudi Arabia

3. References
1. Harrison’s Principles of Internal Medicine Book 17th edition
2. Kumar et al: Robbins Basic Pathology Book 8th edition
3. World Health Organization (WHO)
4. Medscape Reference
5. Surveillance Epidemiology and End Results (SEER)
6. Cancer Center, University of Kansas
7. Right Diagnosis

4. Definition
•Malignant tumors of lymphoid
tissue, characterized by the abnormal
proliferation of B or T cells in the lymphoid
tissue.
Source: Kumar et al: Robbins Basic Pathology Book 8E

5. Lymphoma
Hodgkin’s lymphoma Non-Hodgkin’s lymphoma
Nodular lymphocyte-
predominant
Hodgkin’s lymphoma
Classical Hodgkin’s
lymphoma:
Nodular sclerosis HL
Lymphocyte-rich HL
Mixed cellularity HL
Lymphocyte -
depleted HL
B cell lymphomas T/NK cell lymphomas
Precursor B cell
lymphoma
Mature B cell
lymphoma
Precursor T cell
lymphoma
Mature T/NK cell
lymphoma
The WHO classification (2001)
Source: World Health Organization (WHO)

6. Non-Hodgkin LymphomaHodgkin Lymphoma
More frequent involvement of multiple peripheral
nodes
More often localized to a single axial group of
nodes (cervical, mediastinal, para-aortic)
Noncontiguous spreadOrderly spread by contiguity
Mesenteric nodes and Waldeyer ring commonly
involved
Mesenteric nodes and Waldeyer ring rarely
involved
Extranodal involvement commonExtranodal involvement uncommon
Table 12-10. Clinical Differences Between Hodgkin and Non-Hodgkin Lymphomas
Source: Kumar et al: Robbins Basic Pathology Book 8E
Classification

7. • Age: The disease peaks at ages 15 to 40 and at 55 and older.
• Exposure to environmental poisons, such as Agent Orange
• Family history of the disease, although lymphoma has only a weak genetic
link
• Gender: Hodgkin lymphoma is more common in males than females
• History of infectious mononucleosis or Epstein-Barr virus
• Prolonged use of human growth hormone
• Weakened immune system, including infection with HIV
Source: http://www.kucancercenter.org/cancer-information/specialties-and-treatment/lymphoma/prevention
RF - Hodgkin Lymphoma

8. • Age: The likelihood of getting NHL increases as you get older.
• Bacterial infection: Infection with Helicobacter pylori increases the risk of
lymphoma involving the stomach.
• Gender: Non-Hodgkin lymphoma is more common in males than females.
• Exposure to farming chemicals or fertilizers, chemicals used to dissolve
rubbers or glues, chemicals used to make rubber products, asbestos and
arsenic increases the risk of developing NHL.
• Weakened immune system: NHL is most common among those who have an
impaired immune system or a severe autoimmune disease. It also occurs
among those who take medicines to suppress the immune system following
an organ transplant.
• Viral infection: Infection with Epstein-Barr virus or Human Immunodeficiency
Virus (HIV) increases the risk of developing NHL.
RF – Non-Hodgkin Lymphoma
Source: http://www.kucancercenter.org/cancer-information/specialties-and-treatment/lymphoma/prevention

9. Source: http://emedicine.medscape.com/article/201886-overview#aw2aab6b2b3
Etiology - Hodgkin Lymphoma
• EBV, may be involved in the pathogenesis. In as many as
50% of cases, the tumor cells are EBV-positive.
• Patients with HIV infection have a higher incidence of
Hodgkin lymphoma compared with the population
without HIV infection.
Infectious
agents
• Approximately 1% of patients with Hodgkin
lymphoma have a family history of the disease.
Genetic
predisposition
• May have a protective effect against
lymphomagenesis through mechanisms that may be
independent of vitamin D
UV radiation
exposure

10. Source: http://emedicine.medscape.com/article/201886-overview#aw2aab6b2b3
Etiology – Non-Hodgkin Lymphoma
• Epstein-Barr virus (EBV), Human T-cell leukemia virus type 1
(HTLV-1) , Hepatitis C virus (HCV), Kaposi sarcoma–
associated herpesvirus (KSHV) , Helicobacter pylori infection.
Infectious agents
• The t(14;18)(q32;q21) translocation is the most common
chromosomal abnormality associated with NHL.Chromosomal translocations
• chemicals (eg, pesticides, herbicides, solvents, organic
chemicals, wood preservatives, dusts, hair dye), chemotherapy, and
radiation exposure.
Environmental factors
• Congenital immunodeficiency states, AIDS, Celiac disease.Immunodeficiency states
• Sjögren syndrome and Hashimoto thyroiditis.
Chronic inflammation

11. Etiology – Q
Which of these agents will
not cause HL?
• HIV Infection
• Genetic predisposition
• UV radiation
• Non of the above

12. • Data taken from SEER (Surveillance Epidemiology and End
Results) http seer.cancer.gov
• Prevelance includes any person alive on January 1, 2009
who had been diagnosed with lymphoma at any point prior
to January 1, 2009 and includes persons with active disease
and those who are cured of their disease.
Prevalence – World Wide
1- Non-Hodgkin Lymphoma 2- Hodgkin Lymphoma

13. Non-Hodgkin Lymphoma On January 1, 2009 , in US
Source: Surveillance Epidemiology and End Results (SEER) http seer.cancer.gov/statfacts/html/nhl.html
Prevalence – World Wide
1- Non-Hodgkin Lymphoma: 484,336
252,111 men 232,225 women

14. Prevalence – World Wide
Source: Surveillance Epidemiology and End Results (SEER) http seer.cancer.gov/statfacts/html/nhl.html
Hodgkin Lymphoma On January 1, 2009 , in US
2- Hodgkin Lymphoma: 174,908
90,425 men 84,483 women

15. Prevalence – World Wide
Which is More common?
OrHodgkin Non-Hodgkin

16. Source: Harrison’s Principles of Internal Medicine 17th edition
Figure: Relative Frequency of Lymphoid Malignancies

17. Prevalence – Saudi Arabia

18. Source: http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/stats-country.htm
Prevalence – Saudi Arabia

19. Prevalence – Saudi Arabia
Source: http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/stats-country.htm

20. .pdf0611_0600_2009_3_15/1503applications.emro.who.int/emhj/http://Source: WHO
Prevalence – Saudi Arabia

21. d0pa@hotmail.com
@AbdulazizEnazi
http://imamu.academia.edu/AbdulazizAlanzi