Diseases of Lymphatics

1. DISEASES OF LYMPHATICS

2. LYMPHOMA

3. LYMPHOMA
• Neoplastic condition arising from lymphoproliferative stem cells
• 3rd most common pediatric malignancy.
• Comprises 15% of Pediatric Cancers

4. LEUKEMIA
• Neoplasms that develop in the bonemarrow cells
• Lymphoblastic
• Acute
• Chronic
• Myelogenous
• Acute
• Chronic

5. REAL (Revised European American
Lymphoma) Classification
• B-Cell Neoplasms
• Precursor B Cell Neoplasms – ALL, LBL
• Peripheral B Cell Neoplasms – B Cell related NHL
• T-Cell Neoplasms
• Precursor T Cell Neoplasms – ALL, LBL
• Peripheral T Cell Neoplasms – T Cell related NHL
• Hodgkin’s Lymphoma
• Predominant HL – Nodular Sclerosing Type
• Classical HL – Nodular Sclerosis, Lymphocyte Rich, Mixed Cellularity, Lymphocyte Depletion
• Precursor Lymphoid Neoplasms
• Immuno-deficiency-associated Lymphoproliferative disorders

6. Etiology
• Age – Common in Young
• Sjogren’s Syndrome :- Autoimmune disease;- lacrimal/salivary glands
• Wiskott-Aldrich Syndrome :- Eczema-Thrombocytopenia-
Immunodeficiency Syndrome
• Bloom’s Syndrome :- Short, Sensitive to Sunlight, Immunodeficiency
• Infection :- HIV, Epstein-Barr, H.pylori
• Occupation :- Herbicides, Hair Dye Workers
• Ionizing Radiation
• Smoking, Tobacco Consumption

7. ETIOLOGY
• Hodgkin’s Lymphoma is most common type. More common in male.
Bimodal presentation (20-30; >50). Nodular Sclerosis is most common
type of HL.
• Non Hodgkin’s Lymphoma is more aggressive. More common in
females. Middle Aged and Elderly. Poor Prognosis
• Burkitt’s Lymphoma is Highly Aggressive

8. CLINICAL FEATURES
• Cervical Lymphadenopathy
• Smooth, Firm, Non-tender, Discrete, Rubbery Consistency
• Spleenomegaly
• Hepatomegaly
• Obstructive Jaundice
• Fever
• Weight Loss
• Dyspnea, Chest Pain, Dysphagia due to Mediastinal mass
• Fatigue, Fever, Petechiae, Athralgia

9. Ann-Brborr Clinical Staging
• Stage 1 – Confined to 1 group of Lymph nodes
• Stage 2 – More than one group of Lymph Nodes on one side of
diaphragm
• Stage 3 – Nodes involved on both sides of diaphragm
• Stage 4 – Extra nodal Involvement
• L – Liver
• S – Spleen
• B – Presence of constitutional symptoms
• A – Absense of constitutional symptoms

10. Tuberculosis
• Mycobacterium tuberculosis
• Immuno-deficient/Immunocompromised

11. Clinal Features
• Pulmonary TB – Chronic Cough, Lethargy, Weight Loss, Fever
• Extrapulmonary TB
• Cervical Lymphadenopathy
• Firm, tender, Matted, Skin changes. Later Stages -> Fluctuation present (Abscess)
• Ulcers
• Bursting of caseous lymph nodes. Cold Abscess bursts to form ulcers.
• Painful
• Thin, Undermined Edges, pale granulation tissue
• Pleural Effusion
• Abdomen

13. ORAL and Maxillofacial MALIGNANCIES
• Squamous Cell Carcinoma is most Common type
• Salivary Gland Tumors
• Melanomas
• Adenocarcinomas
• Basal Cell Carcinomas
• Secondaries
• Tobacco Chewing

14. Clinical Features
• Pre-Malignant Lesions
• Leukoplakia, Erythroplakia, Chronic Hyperplastic Candidiasis, Oral Submucosal
Fibrosis, Syphilitic glossitis
• Swellings
• Hard, Mobile-Fixed, Usually non-tender, Progressive
• Ulcers
• Oval/Circular may be irregular, Everted Edges, Necrotic Floor

20. MANAGEMENT

21. INVESTIGATIONS
• FNAC –
• Core Needle Biopsy, Wedge Biopsy, Incisional biopsy
• Excision Biopsy
• Bone Marrow Biopsy – Leukemias
• IMAGING – Chest Xray
• USG – Neck, Thorax, Abdomen
• CT Scan – Head, Neck, Thorax, Abdomen. PET Scan

22. SURGERIES
• Wide Excision

23. Partial Glossectomy
HemiGlossectomy
Near Total Glossectomy
Total Glossectomy

27. Radiotherapy
• Stage 1 and Stage 2 of Hodgkin’s Lymphoma
• Inoperable/Recurrence of Malignancies
• External Beam High Cobalt RadioTherapy
• Above the diaphragm – “Y” field therapy covering Cervical, Axillary
and mediastinal Lymph Nodes.
• Below the Diaphragm = Inverted “Y” field therapy covering aortic,
Para-Aortic Lymphnodes. May cause infertility

28. Chemotherapy
• Stage 3 and 4 HL. All NHLs
• Inoperable/Recurrence of Malignancies
• CHOP – Cyclophosphomide, Hydro-oxyduano-Rubicin, Oncovin,
Prednisolone
• ABVD – Adramycin, Bleomycin, Vincristine, Decar-bazine

29. THANK YOU