Huy t h c
102
Map 6.5 U lympho Hodgkin và Non-Hodgkin
U LYMPHO HODGKIN
U lympho Hodgkin là gì?
Là m t nhóm nh ng b nh lí ác tính hi m g p. Có 4 dư i nhóm mô
h c ph bi n nh t là:
1 Giàu t bào lympho.
2 Xơ n t.
3 H n h p t bào.
4 Nghèo t bào lympho.
Nguyên nhân
Chưa rõ nguyên nhân.
Y u t nguy cơ bao g m:
•
Nam gi i.
•
Nhi m Epstein–Barr virus (EBV).
•
Suy gi m mi n d ch, như: b nh nhân HIV.
•
Ti p xúc v i đ c ch t.
Tri u ch ng
•
Sưng nhưng không đau các h ch b ch huy t.
•
S t cân không rõ nguyên nhân.
•
S t (s t >38 C, đ m hôi đêm, s t cân).
U tân sinh t bào B
U tân sinh t bào T
U lympho th Burkitt:
•
Có liên quan t i EBV
•
t[8;14]
U lympho t bào B l n lan t a.
U lympho t bào áo nang:
t[11;14]
U lympho th nang:
•
t[14;18]
•
Xu t hi n bcl-2.
U lympho t bào T ngư i l n;
nguyên nhân do virus HTLV-1.
H i ch ng Sézary.
U LYMPHO NON-HODGKIN’S
U lympho non-Hodgkin’s là gì?
Là m t nhóm các b nh lý ác tính có căn nguyên t lympho B ho c lympho T.
Nguyên nhân
Chưa rõ nguyên nhân.
Y u t nguy cơ bao g m:
•
Gi i nam.
•
Nhi m trùng, như: EBV, Helicobacter pylori, human herpes
virus (HHV)-8, viêm gan C.
•
Suy gi m mi n d ch, như: b nh nhân HIV.
Signs and symptoms
•
Painless lymphadenopathy.
•
Unintentional weight loss.
•
Fever.
•
Dyspnoea.
•
Splenomegaly.
•
Hepatomegaly.
Investigations
•
Bloods: FBC, WCC, U&Es, CRP, ESR, lactate dehydrogenase, creatinine,
alkaline phosphatase, serum cytokine levels, soluble CD25 level.
•
Radiology: X-ray, CT scan, PET scan.
•
Other: lymph node biopsy (Ann Arbor classification).
Treatment
•
Conservative: patient education and referral to Macmillan nurses.
•
Medical: depends on causes and severity (Ann Arbor classification);
R-CHOP regimen: rituximab, cyclophosphamide, hydroxydaunomycin,
vincristine, prednisolone; other agents used are cisplatin, etoposide and
methotrexate.
Complications
•
Increased risk of infection.
•
Recurrence and metastasis.
•
Increased risk of cardiovascular disease.
•
Complications of chemotherapy.
•
Neurological complications.
•
Dyspnoea.
•
Splenomegaly.
•
Hepatomegaly.
Investigations
•
Bloods: FBC, WCC, U&Es, CRP, ESR, lactate dehydrogenase, creatinine,
alkaline phosphatase, serum cytokine levels.
•
Histology: Reed–Sternberg cells are seen.
•
Radiology: X-ray, CT scan, PET scan.
•
Other: lymph node biopsy (Ann Arbor classification).
Treatment
•
Conservative: patient education and referral to Macmillan nurses.
•
Medical: depends on Ann Arbor classification; AVBD regimen:
doxorubicin, vinblastine, bleomycin, dacarbazine; BEACOPP regimen:
bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine,
procarbazine, prednisolone.
Complications
•
Increased risk of infection.
•
Recurrence and metastasis.
•
Increased risk of cardiovascular disease.
•
Complications of chemotherapy.
•
Neurological complications.
MAP 6.5
U lympho Hodgkin và Non-Hodgkin
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