Enlargements in lymph nodes (lymphadenopathies) can occur for many reasons. Although infections (bacterial, viral…) are one of the first reasons that come to the minds of patients, nowadays, physicians are increasingly asking “Have I become lymphoma?” “Although it is sometimes extremely pessimistic, this question should not be found unjustified, since lymphomas are one of the many reasons that enlarge the lymph nodes.
Lymph node enlargements can occur for many reasons. Their differential diagnosis should be made by performing complete blood count (hemgram – CBC), blood smear (peripheral smear), blood biochemistry, visual examinations (lung radiography, ultrasonography, computed tomography…), if necessary, biopsies.
Some of the lymph node enlargements may develop for benign (benign) and some for malignant (malignant) reasons. Numerous diseases such as tuberculosis, infectious mononucleosis, brucellosis, AIDS, lymphocytic leukemias, connective tissue diseases (lupus, rheumatoid arthritis), cancer metastases should be considered in the differential diagnosis of bacterial, viral, fungal and other microorganisms.
When it comes to our topic, lymphomas constitute a very large group of diseases. We examine lymphomas under two headings as Hodgkin and non-Hodgkin lymphomas. Here, first of all, I would like to talk about non-Hodgkin lymphomas (HDL – NHL), which have increased in frequency in the last 40-50 years, involve almost every tissue and organ, have many subgroups, and show very different clinical courses.
While the disease was seen in about 11 out of 100,000 people in the eighties, it increased in the early 2000s to reach 20 per 100,000. In other words, the incidence of the disease has almost doubled. The frequency of the disease is increasing gradually depending on age and environmental conditions. The use of drugs that adversely affect the immune system (immunosuppressive drugs) and diseases such as AIDS contribute greatly to the formation of lymphomas. The immune system loses its strength with increasing rates of organ transplants (transplants), radiotherapies, chemotherapy and drugs that suppress this system, and the environment is prepared for the formation of lymphoma. Add to this our increasing exposure to environmental carcinogens, we should be surprised why the disease is so common. In addition to what we have mentioned before, autoimmune diseases, inflammations and congenital (congenital) immune deficiencies also facilitate the formation of lymphomas (HDL).
As for the symptoms of the disease; Often the first thing that attracts the attention of patients is the slow and painless growth of peripheral lymph nodes (neck, underarms, groins…) and sometimes fast. Lymph nodes, which are mostly painless and can shrink from time to time, may confuse patients and cause the situation to be ignored. Fever, night sweats, weight loss, even itching are other signs and symptoms that may suggest lymphomas. Especially if the fever typically rises above 38 degrees C, the patient can be referred to the doctor quickly. Many organs and tissues are involved in non-Hodgkin lymphomas (HDL). For this reason, it is also possible that very different complaints occur depending on the places of involvement. Involvement of many places including the skin, central nervous system (CNS), tonsils (tonsils), stomach, small intestine, spleen, liver, ovaries, bone marrow, thorax, lymph nodes and organs in the abdomen can cause many different complaints and cause symptoms.
When it comes to subgroups of lymphomas, which can be summarized under two subheadings as B-cell lymphomas (approximately 88%) and T-cell lymphomas (12%), we can talk about a large number of subtypes with detailed pathological methods. These detailed pathological examinations and the course of the disease make very important contributions to treatment approaches. For example, while lymphomas with some positive pathological features are only followed, the treatment of some lymphomas is planned very intensively. Therefore, we can easily say that the quality of the tissue biopsy specimen and the experience of the pathology laboratory in hematopathology are of great importance. The details of the pathology, such as clinical findings, course of the disease, molecular and immunophenotypic features, directly determine the type of treatment to be performed and the prognosis (result of the disease). In addition, features such as age, performance status of the patient, advanced stage and prevalence of the disease are also important prognostic factors.
I would like to address treatment and other issues in another article.
Stay healthy.
Prof. Dr. V. Akın Uysal
Hematology Specialist
