Non-Hodgkin’s Lymphoma ( NHL ) Disease: Etiology, Classification, Clinical Manifestation, & Management


Non-Hodgkin’s Lymphoma is a heterogeneous group of malignant neoplasms of immune affecting all ages. NHL comprises a group of malignancies with a common origin in the lymphoid cells.

Etiology of Non-Hodgkin’s Lymphoma

  • Unknown
  • Although viruses have been implicated
  • No hereditary, ethnic, or dietary risk factors have been associated with NHL
  • An increased risk is associated with immunodeficiency states, an autoimmune disorder, and infectious physical and chemical agents.
  • As with Hodgkin’s Disease, a viral or bacterial cause have been implicated

Classification of Non-Hodgkin’s Lymphoma

Terminology describing NHL is complex, inconsistent part and ambiguous and several classifications exist. Rappat has widely used classification, developed in 1956, distinguishes two major histopathological patterns; nodular and diffuse. These two patterns in NHL illustrate two different pathologic states. The nodular (and diffuse, well-differentiated lymphocytic) pattern involves nodal and extranodal sites. The diffuse pattern doesn’t show the cell aggregates that are evident in the nodular pattern.


Clinical Manifestation of Non-Hodgkin’s Lymphoma

NHL original outside the lymphoid the method of spread can be unpredictable, and the majority of patients have widely disseminated disease at the time of diagnosis. Primary manifestation is a painless lymphoid enlargement.

The patient most often has non-reader peripheral lymphadenopathy that may often bulk.


Several sites of involvement in NHL are not common in HD, such as Waldeyer’s ring (lymphoid tissue that encircles the tonsils), the stomach, the small and large bowel, mesenteric lymph nodes, the thyroid, the skin, the pancreas, the kidneys and the Central Nervous System.

With diffuse NHL, clinical manifestations are variable and generally involve more systemic findings. Patients also may experience systemic B symptoms including the liver and spleen may moderately enlarge the symptoms that may occur include unexplained fever, night sweat, weight loss plus symptoms of affected organs.


Diagnosis of Non-Hodgkin’s Lymphoma

  • Blood work includes a CBC, ESR and peripheral smear to rule out other cause of lymphadenopathy such as mononucleosis. Blood culture and other serological studies for viral and autoimmune disease provide important differential information.
  • Elevated lactate dehydrogenase (LDH) levels may be seen in advanced NHL.
  • CT-MRI Scan
  • Renal and liver function test
  • A lymph node biopsy is an important diagnostic tool. The following are indications for biopsy
  • Adenopathy for longer than 3 weeks, which progresses in size or spreads to other areas.
  • B symptoms that cannot be attributed to other causes
  • Abnormal blood test results indicative of lymphoma
  • Radiograph that suggests possible extranodal involvement

Because of the aggressive nature of AIDS-related NHL, any symptomatic client at increased risk or known to be positive for HIV should have a biopsy to rule out high-grade lymphoma.

Management of Non-Hodgkin’s Lymphoma

Treatment of NHL involves radiotherapy and chemotherapy. Ironically, more aggressive lymphomas or more responsive to treatment and more likely to be used. In contrast, indolent lymphomas have a naturally long route. But, are differently effectively treat.

Radiotherapy alone may be an effective treatment of stage I disease but the combination of radiation therapy and chemotherapy is used for other stages.

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