Pathogenesis of Lymphoma: Key Diagnostic and Clinical Features
Based on the evidence, bone marrow biopsy may be warranted in the diagnosis and staging of lymphoma.
Diagnostic Features of Lymphoma
- The presence of Reed-Sternberg cells is a critical diagnostic feature for Hodgkin lymphoma, not something to be disregarded 1
- Bone marrow biopsy is an essential component of lymphoma staging and diagnosis, particularly for detecting bone marrow infiltration which occurs in 3-18% of Hodgkin lymphoma cases and is more common in certain subtypes 1, 2
- Excisional lymph node biopsy remains the gold standard for initial diagnosis of lymphoma, as fine-needle aspiration (FNA) or core needle biopsy alone is generally not suitable for primary diagnosis 3, 4
- Immunophenotypic studies are crucial for accurate classification of many lymphoma subtypes, including peripheral T-cell lymphomas and diffuse large B-cell lymphomas 3
Clinical Manifestations and Presentation
- Lymphoma patients commonly manifest intra-abdominal symptoms, contrary to the statement that they are unlikely to do so 5
- Bowel obstruction can occur in lymphoma patients, particularly in those with gastrointestinal involvement 3
- Lymphoma typically presents as painless adenopathy, with systemic symptoms (fever, unexplained weight loss, night sweats) occurring in more advanced disease stages 5
- Submandibular lymph node enlargement is not pathognomonic for lymphoma and should not be the sole basis for diagnosis or exclusion; multiple conditions can cause lymphadenopathy in this region 3
Staging and Assessment
- The Lugano Classification has modernized recommendations for evaluation, staging, and response assessment of both Hodgkin and non-Hodgkin lymphoma 6
- FDG-PET/CT has been formally incorporated into standard staging for FDG-avid lymphomas 6
- Bone marrow biopsy is warranted in lymphoma staging, though it may not be indicated for routine staging of all Hodgkin lymphoma and most diffuse large B-cell lymphomas with negative PET findings 6, 2
- Progressive disease should be histologically documented to rule out transformation, especially if LDH levels are rising, a single site is growing disproportionately, extranodal disease develops, or new B symptoms appear 3
Epidemiology and Risk Factors
- Non-Hodgkin lymphoma accounts for approximately 90% of all lymphomas, while Hodgkin lymphoma accounts for about 10% 7
- Risk factors for lymphoma include family history, autoimmune diseases, HIV infection, HCV seropositivity, high body mass as a young adult, certain occupational exposures, and infectious diseases 6
- Recent epidemiologic data suggest a worldwide increase in Non-Hodgkin lymphoma incidence (approximately 30% in 5 years prior to 2010) 6
Treatment Considerations
- Treatment approaches differ between lymphoma subtypes, with non-Hodgkin lymphoma typically treated with regimens like R-CHOP, while Hodgkin lymphoma is treated with combined chemotherapy regimens such as ABVD 5
- Chemotherapy toxicities include neuropathy, cardiotoxicity, and secondary cancers, which should be considered in treatment selection 5
- Patients with lymphoma should receive appropriate vaccinations due to the immunosuppressive nature of the condition 5
In conclusion, bone marrow biopsy is indeed warranted in the diagnosis and staging of lymphoma, making option B the correct statement among the choices provided.