Lymphomas of the Head and Neck Workup

  • Author: Kieron M Dunleavy, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 1, 2010
 

Laboratory Studies

Laboratory studies of the following are indicated.

  • Complete blood cell count
  • Serum chemistries including calcium, phosphate, and uric acid levels
  • Liver function, including lactate dehydrogenase values (An elevated level of lactate dehydrogenase is an adverse prognostic biomarker.)
  • ESR in HL
  • HIV and hepatitis B and C viruses, as clinically indicated
Next

Imaging Studies

Chest radiography is essential.

CT scanning of the chest, abdomen, and/or pelvis is necessary for the evaluation of mediastinal, retroperitoneal, and mesenteric adenopathy. CT scans miss splenic involvement in 20-30% of cases of limited stage HL.

CT scanning of the head and/or neck is mandatory for patients with a head and neck presentation; localized disease; or symptoms such as cranial neuropathies, hearing loss, vertigo, or visual changes. The images below depict CT scan changes.

CT scan of a patient with a natural killer (NK)/T-CT scan of a patient with a natural killer (NK)/T-cell lymphoma of the right nasal cavity and maxillary sinus. CT scan 6 months after treatment with 4 cycles of CT scan 6 months after treatment with 4 cycles of DA-EPOCH (ie, infused etoposide, doxorubicin, and vincristine with bolus cyclophosphamide and prednisone). CT scan of a patient with a recurrence of stage I-CT scan of a patient with a recurrence of stage I-AE angiocentric lymphoma of the left maxillary sinus, treated 7 years earlier with 4 cycles of ProMACE-MOPP (ie, prednisone, methotrexate, Adriamycin, cyclophosphamide, etoposide–mechlorethamine [nitrogen mustard], vincristine, procarbazine, and prednisone) and 3960 cGy of radiation. CT scan 2 years after salvage therapy. CT scan 2 years after salvage therapy.

MRI is indicated for evaluating the brain and/or spinal cord as indicated.

Positron emission tomography (PET) scanning should be ordered as indicated.

Previous
Next

Other Tests

Immunohistochemical analysis of the tumor is essential for diagnosis and may aid in identifying monoclonal antibody targets such as CD20 (rituximab) or CD52 (alemtuzumab). Cytogenetic analysis may be useful in select cases.

Polymerase chain reaction analysis helps in evaluating for B- or T-cell clonality or for minimal residual disease, eg, t(14;18).

Previous
Next

Procedures

The following procedures may be helpful:

  • Nasopharyngeal laryngoscopy is essential. Perform this as the initial investigation to evaluate for a neoplasm of the upper aerodigestive tract that is accessible for biopsy.
  • Fine-needle aspiration cytology is also essential. This test is useful for the initial investigation of neck lymphadenopathy for differentiating squamous cell carcinoma from lymphomas, thyroid tumors, and salivary gland tumors.
  • Excisional lymph-node biopsy is essential in HL and NHL.
    • Needle aspiration and/or biopsy are not adequate for the primary histologic diagnosis because the architectural features of the tissue are important.
    • A biopsy sample should be obtained from the lump through an incision that can itself be excised and incorporated into a radical neck dissection if the histology indicates squamous cell carcinoma. In most cases, the unfixed node should be sent immediately to the laboratory for analysis.
  • Bone marrow aspiration and biopsy are also essential. Results are positive in as many as 70% of patients with indolent NHL. In disseminated disease, malignant cells may be found in the bone marrow, spinal fluid, ascites fluid, or pleural fluid.
  • Lumbar puncture may be indicated.
    • Lumbar puncture should be performed routinely in all patients with HIV infection in addition to patients with specific histologic subtypes such as Burkitt lymphoma and lymphoblastic lymphoma.
    • Lumbar puncture is also used when possible symptoms of CNS disease are present after head CT or MRI shows no evidence of mass effect.
    • In addition to cytology, the CSF should be evaluated with flow cytometry, as recent evidence has demonstrated that cytology may not help in detecting some cases with positive results on flow cytometry.
  • Staging laparotomy or laparoscopy for HL may be needed. CT and other imaging modalities are not reliable in diagnosing occult splenic and nodal disease.
    • Historically, staging laparotomy was often included in the initial evaluation of patients with HL, as this was the only way to detect occult splenic disease. Because chemotherapy is usually incorporated into the initial treatment of HL, it is rarely done now, and really indicated only in patients in whom the assessment is required to optimize treatment.
    • Staging laparotomy includes biopsy of selected lymph nodes in the retroperitoneum, splenectomy, and several needle and wedge biopsy procedures in the liver. Laparoscopy with laparoscopic sonographic probes can be used to detect small intrahepatic and lymph-node metastases, with a sensitivity and specificity that approaches those of laparotomy.
    • In the past, the initial clinical stage changed in nearly one third of all patients with HL because of staging laparotomy. About one third of normal-sized spleens were found to be infiltrated with tumor, and 35% of patients with clinical splenomegaly had no histologic evidence of disease. However, a randomized study did not demonstrate a survival advantage in patients with surgically staged disease compared with those with clinically staged disease.
    • The use of prognostic factors is replacing staging laparotomy in identifying HL patients suitable for radiotherapy alone.
  • Diagnostic tonsillectomy may be indicated if lymphoma of the tonsils is suspected.
    • Risk factors for malignancy in the tonsils are tonsillar asymmetry, a history of cancer, palpable firmness or a visible lesion of the tonsil, neck mass, unexplained weight loss, and constitutional symptoms.
    • In a study of 476 consecutive adults undergoing tonsillectomy, no patient without at least 1 of the risk factors listed above had malignancy on pathologic evaluation of the tonsils.
Previous
Next

Histologic Findings

Accurate histologic diagnosis is the main guide for the modality of treatment to be used in NHL. A pathologist experienced in lymphoma diagnosis uses immunophenotyping by immunocytochemistry and/or flow cytometry to aid diagnosis. Special stains can be used, such as staining for follicular dendritic cells to highlight residual architecture in differentiating MALT from non-MALT lymphoma. Of interest, 80% of lymph-node infarctions are associated with a final diagnosis of lymphoma.

Previous
Next

Staging

A lymphoma specialist should perform staging and treatment.

  • The Ann Arbor staging system is used to stage lymphomas. Although it was originally designed for HL and based on the contiguous lymphatic mode of spread of HL, it is used for cases of NHL in which hematogenous dissemination is prevalent. The Ann Arbor staging classification is as follows:
    • Stage I - Involvement of a single lymph node region or lymphoid structure
    • Stage II - Involvement of 2 or more lymph node regions on the same side of the diaphragm or localized contiguous involvement of only 1 extralymphatic site and lymph node region
    • Stage III - Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm and possibly the spleen
    • Stage IV - Disseminated involvement of 1 or more extralymphatic organs with or without lymph node involvement and/or involvement of the bone marrow or liver
  • Other designations are as follows:
    • Letter designations
      • A - Asymptomatic, or B constitutional symptoms: This type is characterized by unexplained, persistent or recurrent fever with temperature higher than 38°C or by recurrent and drenching night sweats within 1 month, or by unexplained loss of more than 10% the person's body weight within 6 months.
      • E - Extranodal: This form is characterized by limited and direct extension into extralymphatic organ from an adjacent lymph node.
      • X - Bulky disease: In this form, the width of the mediastinal tumor is greater than one third the transthoracic diameter at T5/6, or the diameter of the tumor diameter is larger than 10 cm.
    • Suffices
      • Suffix B indicates the presence of systemic symptoms.
      • Suffix A indicates the absence of systemic symptoms.
      • E indicates the presence of localized extralymphatic disease.
    • Stage IV indicates disseminated disease, or multifocal extranodal, bone marrow, or liver involvement. Bone involvement must be separated from bone marrow involvement because the latter is always defined as disseminated disease.
  • The clinical stage is defined by the extent of disease based on physical findings and findings on other noninvasive studies. The pathologic stage is defined by data obtained from invasive tests, including biopsy of specimens obtained from different sites, usually during staging laparotomy.
  • Treatment and prognosis in both HL and NHL depends on the disease stage, on biomarkers, and on tumor biology. In NHL and in some types of HL, the histologic subtype dictates therapy.
  • In the past, early-stage HL was usually treated with radiotherapy alone, but now, it is generally treated with a combination of radiotherapy and chemotherapy. Disseminated disease is treated by using chemotherapy with or without radiotherapy.
  • In some patients with indolent NHL who have early stage localized disease, radiotherapy alone may be an option. For aggressive lymphomas, chemotherapy is standard, but may be used in conjunction with radiotherapy. Radiotherapy is the primary treatment modality in early stage NK/T-cell lymphomas.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Kieron M Dunleavy, MD  Investigator/Attending Physician, National Cancer Institute

Kieron M Dunleavy, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Coauthor(s)

Erik Kass, MD  Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia

Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Medical Association, and American Rhinologic Society

Disclosure: Nothing to disclose.

Wyndham Wilson, MD, PhD  Senior Investigator, Division of Clinical Sciences, National Institutes of Health National Cancer Institute

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Kelley, MD  Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center

Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Karen H Calhoun, MD, FACS, FAAOA  Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Sissolak G, Sissolak D, Jacobs P. Human immunodeficiency and Hodgkin lymphoma. Transfus Apher Sci. Feb 3 2010;[Medline].

  2. [Best Evidence] Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Fermé C. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. Jun 20 2005;23(18):4117-26. [Medline]. [Full Text].

  3. Witzig TE, Flinn IW, Gordon LI, Emmanouilides C, Czuczman MS, Saleh MN. Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. J Clin Oncol. Aug 1 2002;20(15):3262-9. [Medline].

  4. Dunleavy K, Little RF, Pittaluga S, Grant N, Wayne AS, Carrasquillo JA, et al. The role of tumor histogenesis, FDG-PET, and short course EPOCH with dose-dense rituximab (SC-EPOCH-RR) in HIV-associated diffuse large B-cell lymphoma. Blood. Feb 3 2010;[Medline].

  5. Advani R, Rosenberg SA, Horning SJ. Stage I and II follicular non-Hodgkin's lymphoma: long-term follow-up of no initial therapy. J Clin Oncol. Apr 15 2004;22(8):1454-9. [Medline].

  6. Ahn YC, Lee KC, Kim DY, Huh SJ, Yeo IH, Lim DH. Fractionated stereotactic radiation therapy for extracranial head and neck tumors. Int J Radiat Oncol Biol Phys. Sep 1 2000;48(2):501-5. [Medline].

  7. Alizadeh AA, Eisen MB, Davis RE, Ma C, Lossos IS, Rosenwald A. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature. Feb 3 2000;403(6769):503-11. [Medline].

  8. Andre M, Henry-Amar M, Blaise D, Colombat P, Fleury J, Milpied N. Treatment-related deaths and second cancer risk after autologous stem-cell transplantation for Hodgkin's disease. Blood. Sep 15 1998;92(6):1933-40. [Medline].

  9. Aparicio J, Segura A, Garcera S, Oltra A, Santaballa A, Yuste A. ESHAP is an active regimen for relapsing Hodgkin's disease. Ann Oncol. May 1999;10(5):593-5. [Medline].

  10. Batchelor T, Carson K, O'Neill A, Grossman SA, Alavi J, New P. Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol. Mar 15 2003;21(6):1044-9. [Medline].

  11. Bea S, Zettl A, Wright G, Salaverria I, Jehn P, Moreno V. Diffuse large B-cell lymphoma subgroups have distinct genetic profiles that influence tumor biology and improve gene-expression-based survival prediction. Blood. Nov 1 2005;106(9):3183-90. [Medline].

  12. Beaty MM, Funk GF, Karnell LH, Graham SM, McCulloch TM, Hoffman HT. Risk factors for malignancy in adult tonsils. Head Neck. Aug 1998;20(5):399-403. [Medline].

  13. Bessell EM, MacLennan KA, Toghill PJ, Ellis IO, Fletcher J, Dowling FD. Suprahyoid Hodgkin's disease stage IA. Radiother Oncol. Nov 1991;22(3):190-4. [Medline].

  14. Bishop PC, Rao VK, Wilson WH. Burkitt's lymphoma: molecular pathogenesis and treatment. Cancer Invest. 2000;18(6):574-83. [Medline].

  15. Boivin JF, Hutchison GB, Zauber AG, Bernstein L, Davis FG, Michel RP. Incidence of second cancers in patients treated for Hodgkin's disease. J Natl Cancer Inst. May 17 1995;87(10):732-41. [Medline].

  16. Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F, Valagussa P. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol. Jul 15 2004;22(14):2835-41. [Medline].

  17. Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. Nov 19 1992;327(21):1478-84. [Medline].

  18. Carde P, Hagenbeek A, Hayat M, et al. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. Nov 1993;11(11):2258-72. [Medline].

  19. Cerroni L, Zochling N, Putz B, Kerl H. Infection by Borrelia burgdorferi and cutaneous B-cell lymphoma. J Cutan Pathol. Sep 1997;24(8):457-61. [Medline].

  20. Chanan-Khan A, Czuczman MS. Bcl-2 antisense therapy in B-cell malignant proliferative disorders. Curr Treat Options Oncol. Aug 2004;5(4):261-7. [Medline].

  21. Cheung MM, Chan JK, Lau WH, Foo W, Chan PT, Ng CS. Primary non-Hodgkin's lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol. Jan 1998;16(1):70-7. [Medline].

  22. Cleary KR, Osborne BM, Butler JJ. Lymph node infarction foreshadowing malignant lymphoma. Am J Surg Pathol. Jul 1982;6(5):435-42. [Medline].

  23. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. Jan 24 2002;346(4):235-42. [Medline].

  24. Colombat P, Salles G, Brousse N, Eftekhari P, Soubeyran P, Delwail V. Rituximab (anti-CD20 monoclonal antibody) as single first-line therapy for patients with follicular lymphoma with a low tumor burden: clinical and molecular evaluation. Blood. Jan 1 2001;97(1):101-6. [Medline].

  25. Coltrera MD. Primary T-cell lymphoma of the thyroid. Head Neck. Mar 1999;21(2):160-3. [Medline].

  26. Cosset JM, Henry-Amar M, Meerwaldt JH, Carde P, Noordijk EM, Thomas J. The EORTC trials for limited stage Hodgkin's disease. The EORTC Lymphoma Cooperative Group. Eur J Cancer. 1992;28A(11):1847-50. [Medline].

  27. Darrington DL, Vose JM, Anderson JR, Bierman PJ, Bishop MR, Chan WC. Incidence and characterization of secondary myelodysplastic syndrome and acute myelogenous leukemia following high-dose chemoradiotherapy and autologous stem-cell transplantation for lymphoid malignancies. J Clin Oncol. Dec 1994;12(12):2527-34. [Medline].

  28. Davis TA, White CA, Grillo-López AJ, Velásquez WS, Link B, Maloney DG. Single-agent monoclonal antibody efficacy in bulky non-Hodgkin's lymphoma: results of a phase II trial of rituximab. J Clin Oncol. Jun 1999;17(6):1851-7. [Medline].

  29. Dean RM, Bishop MR. Allogeneic hematopoietic stem cell transplantation for lymphoma. Clin Lymphoma. Mar 2004;4(4):238-49. [Medline].

  30. Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. Jun 12 2003;348(24):2386-95. [Medline].

  31. Diehl V, Stein H, Hummel M, Zollinger R, Connors JM. Hodgkin's lymphoma: biology and treatment strategies for primary, refractory, and relapsed disease. Hematology Am Soc Hematol Educ Program. 2003;225-47. [Medline].

  32. Diehl V, Thomas RK, Re D. Part II: Hodgkin's lymphoma--diagnosis and treatment. Lancet Oncol. Jan 2004;5(1):19-26. [Medline].

  33. DiGiuseppe JA, Corio RL, Westra WH. Lymphoid infiltrates of the salivary glands: pathology, biology and clinical significance. Curr Opin Oncol. May 1996;8(3):232-7. [Medline].

  34. Dunleavy K, Butrynski J, Steinberg S, et al. Phase II study of EPOCH infusional chemotherapy in relapsed or refractory Hodgkin's lymphoma (HL): a report on toxicity, efficacy and prognostic indicators of outcome. J Clin Oncol. 22:6598. [Full Text].

  35. Ekstrand BC, Lucas JB, Horwitz SM, Fan Z, Breslin S, Hoppe RT. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood. Jun 1 2003;101(11):4285-9. [Medline].

  36. Ellison E, LaPuerta P, Martin SE. Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration. Head Neck. May 1999;21(3):239-46. [Medline].

  37. Engels EA, Chatterjee N, Cerhan JR, Davis S, Cozen W, Severson RK. Hepatitis C virus infection and non-Hodgkin lymphoma: results of the NCI-SEER multi-center case-control study. Int J Cancer. Aug 10 2004;111(1):76-80. [Medline].

  38. Ferreri AJ, Guidoboni M, Ponzoni M, De Conciliis C, Dell'Oro S, Fleischhauer K. Evidence for an association between Chlamydia psittaci and ocular adnexal lymphomas. J Natl Cancer Inst. Apr 21 2004;96(8):586-94. [Medline].

  39. Freedman AS, Nadler LM. Malignancies of lymphoid cells (Chapter 113). Harrison's Online. 1999;Part 6, Section 2.

  40. Friedberg JW, Freedman AS. High-dose therapy and stem cell transplantation in follicular lymphoma. Ann Hematol. May 1999;78(5):203-11. [Medline].

  41. Gilliam AC, Wood GS. Cutaneous lymphoid hyperplasias. Semin Cutan Med Surg. Jun 2000;19(2):133-41. [Medline].

  42. Gisselbrecht C. Autologous stem cell transplantation in aggressive non-Hodgkin's lymphoma. Hematol Cell Ther. Aug 1996;38(4):297-304. [Medline].

  43. Grufferman S, Cole P, Smith PG, Lukes RJ. Hodgkin's disease in siblings. N Engl J Med. Feb 3 1977;296(5):248-50. [Medline].

  44. Gutierrez M, Chabner BA, Pearson D, Steinberg SM, Jaffe ES, Cheson BD. Role of a doxorubicin-containing regimen in relapsed and resistant lymphomas: an 8-year follow-up study of EPOCH. J Clin Oncol. Nov 1 2000;18(21):3633-42. [Medline].

  45. [Best Evidence] Habermann TM, Weller EA, Morrison VA, Gascoyne RD, Cassileth PA, Cohn JB. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol. Jul 1 2006;24(19):3121-7. [Medline].

  46. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. Dec 1999;17(12):3835-49. [Medline].

  47. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. Sep 1 1994;84(5):1361-92. [Medline].

  48. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. Nov 19 1998;339(21):1506-14. [Medline].

  49. Hegde U, Filie A, Little RF, Janik JE, Grant N, Steinberg SM. High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: the role of flow cytometry versus cytology. Blood. Jan 15 2005;105(2):496-502. [Medline].

  50. Hiddemann W, Forstpointner R, Kneba M, et al. The Addition of Rituximab to Combination Chemotherapy with CHOP Has a Long Lasting Impact on Subsequent Treatment in Remission in Follicular Lymhoma but Not in Mantle Cell Lymphoma: Results of Two Prospective Randomized Studies of the German Low Grade Ly. Blood. 2004;104:161. [Full Text].

  51. Horning SJ, Hoppe RT, Breslin S, Bartlett NL, Brown BW, Rosenberg SA. Stanford V and radiotherapy for locally extensive and advanced Hodgkin's disease: mature results of a prospective clinical trial. J Clin Oncol. Feb 1 2002;20(3):630-7. [Medline].

  52. Horning SJ, Weller E, Kim K, Earle JD, O'Connell MJ, Habermann TM. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin's lymphoma: Eastern Cooperative Oncology Group study 1484. J Clin Oncol. Aug 1 2004;22(15):3032-8. [Medline].

  53. Horning SJ, Williams J, Bartlett NL, Bennett JM, Hoppe RT, Neuberg D. Assessment of the stanford V regimen and consolidative radiotherapy for bulky and advanced Hodgkin's disease: Eastern Cooperative Oncology Group pilot study E1492. J Clin Oncol. Mar 2000;18(5):972-80. [Medline].

  54. Jaffe ES, Harris NL, Diebold J, Muller-Hermelink HK. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. A progress report. Am J Clin Pathol. Jan 1999;111(1 Suppl 1):S8-12. [Medline].

  55. Jemal A. 225.

  56. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. Jul-Aug 2009;59(4):225-49. [Medline].

  57. Karmiris TD, Grigoriou E, Tsantekidou M, Spanou E, Mihalakeas H, Baltadakis J. Treatment of early clinically staged Hodgkin's disease with a combination of ABVD chemotherapy plus limited field radiotherapy. Leuk Lymphoma. Sep 2003;44(9):1523-8. [Medline].

  58. Kieserman SP, Finn DG. Non-Hodgkin's lymphoma of the external auditory canal in an HIV-positive patient. J Laryngol Otol. Aug 1995;109(8):751-4. [Medline].

  59. Kwak LW. Translational development of active immunotherapy for hematologic malignancies. Semin Oncol. Jun 2003;30(3 Suppl 8):17-22. [Medline].

  60. Landgren O, Björkholm M, Konradsen HB, Söderqvist M, Nilsson B, Gustavsson A. A prospective study on antibody response to repeated vaccinations with pneumococcal capsular polysaccharide in splenectomized individuals with special reference to Hodgkin's lymphoma. J Intern Med. Jun 2004;255(6):664-73. [Medline].

  61. Lauer SA. Ocular adnexal lymphoid tumors. Curr Opin Ophthalmol. Oct 2000;11(5):361-6. [Medline].

  62. Lecuit M, Abachin E, Martin A. Immunoproliferative small intestinal disease associated with Campylobacter jejuni. N Engl J Med. Jan 15 2004;350(3):239-48. [Medline].

  63. Lenz G, Dreyling M, Hiddemann W. Mantle cell lymphoma: established therapeutic options and future directions. Ann Hematol. Feb 2004;83(2):71-7. [Medline].

  64. Lenz G, Hiddemann W, Dreyling M. The role of fludarabine in the treatment of follicular and mantle cell lymphoma. Cancer. Sep 1 2004;101(5):883-93. [Medline].

  65. Little R, Wittes RE, Longo DL, Wilson WH. Vinblastine for recurrent Hodgkin's disease following autologous bone marrow transplant. J Clin Oncol. Feb 1998;16(2):584-8. [Medline].

  66. Little RF, Pittaluga S, Grant N. Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology. Blood. Jun 15 2003;101(12):4653-9. [Medline].

  67. Loeffler M, Brosteanu O, Hasenclever D, Sextro M, Assouline D, Bartolucci AA. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group. J Clin Oncol. Mar 1998;16(3):818-29. [Medline].

  68. Lohri A, Barnett M, Fairey RN, O'Reilly SE, Phillips GL, Reece D. Outcome of treatment of first relapse of Hodgkin's disease after primary chemotherapy: identification of risk factors from the British Columbia experience 1970 to 1988. Blood. May 15 1991;77(10):2292-8. [Medline].

  69. Mack TM, Cozen W, Shibata DK, Weiss LM, Nathwani BN, Hernandez AM. Concordance for Hodgkin's disease in identical twins suggesting genetic susceptibility to the young-adult form of the disease. N Engl J Med. Feb 16 1995;332(7):413-8. [Medline].

  70. McCarthy H, Ottensmeier CH, Hamblin TJ, Stevenson FK. Anti-idiotype vaccines. Br J Haematol. Dec 2003;123(5):770-81. [Medline].

  71. Mendenhall NP. The role of radiation in the management of Hodgkin's disease: an update. Cancer Invest. 1999;17(1):47-55. [Medline].

  72. Miller TP, Dahlberg S, Cassady JR, Adelstein DJ, Spier CM, Grogan TM. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med. Jul 2 1998;339(1):21-6. [Medline].

  73. Nathu RM, Mendenhall NP, Almasri NM, Lynch JW. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Head Neck. May 1999;21(3):247-54. [Medline].

  74. Ng AK, Li S, Neuberg D, Silver B, Stevenson MA, Fisher DC. Comparison of MOPP versus ABVD as salvage therapy in patients who relapse after radiation therapy alone for Hodgkin's disease. Ann Oncol. Feb 2004;15(2):270-5. [Medline]. [Full Text].

  75. Pfreundschuh M, Trumper L, Kloess M. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. Aug 1 2004;104(3):626-33. [Medline].

  76. Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rudolph C. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. Aug 1 2004;104(3):626-33. [Medline].

  77. Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rübe C. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. Aug 1 2004;104(3):634-41. [Medline].

  78. Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rübe C. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. Aug 1 2004;104(3):634-41. [Medline].

  79. Pfreundschuh M, Trümper L, Osterborg A, Pettengell R, Trneny M, Imrie K. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol. May 2006;7(5):379-91. [Medline].

  80. Poiesz BJ, Papsidero LD, Ehrlich G, Sherman M, Dube S, Poiesz M. Prevalence of HTLV-I-associated T-cell lymphoma. Am J Hematol. Jan 2001;66(1):32-8. [Medline].

  81. Pratt BL, Greene FL. Role of laparoscopy in the staging of malignant disease. Surg Clin North Am. Aug 2000;80(4):1111-26. [Medline].

  82. Prosnitz LR, Farber LR, Kapp DS, Scott J, Bertino JR, Fischer JJ. Combined modality therapy for advanced Hodgkin's disease: 15-year follow-up data. J Clin Oncol. Apr 1988;6(4):603-12. [Medline].

  83. Reece DE. Evidence-based management of Hodgkin's disease: the role of autologous stem cell transplantation. Cancer Control. May-Jun 2000;7(3):266-75. [Medline].

  84. Rehm PK. Gallium-67 scintigraphy in the management: Hodgkin's disease and non-Hodgkin's lymphoma. Cancer Biother Radiopharm. Aug 1999;14(4):251-62. [Medline].

  85. Ries LA, Eisner MP, Kosary CL, et al, eds. SEER cancer statistics review 1973-1998. Available at: http://seer.cancer.gov/. Bethesda, MD: National Cancer Institute. 2001. [Full Text].

  86. Romaguera JE, Fayad L, Rodriguez MA, Broglio KR, Hagemeister FB, Pro B. High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol. Oct 1 2005;23(28):7013-23. [Medline].

  87. Santini G, Chisesi T, Nati S, Porcellini A, Zoli V, Rizzoli V. Fludarabine, cyclophosphamide and mitoxantrone for untreated follicular lymphoma: a report from the non-Hodgkin's lymphoma co-operative study group. Leuk Lymphoma. Jun 2004;45(6):1141-7. [Medline].

  88. Schnell R, Borchmann P, Schulz H, Engert A. Current strategies of antibody-based treatment in Hodgkin's disease. Ann Oncol. 2002;13 Suppl 1:57-66. [Medline].

  89. Siegel RS, Pandolfino T, Guitart J, Rosen S, Kuzel TM. Primary cutaneous T-cell lymphoma: review and current concepts. J Clin Oncol. Aug 2000;18(15):2908-25. [Medline].

  90. Sohn SK, Baek JH, Kim DH, Jung JT, Kwak DS, Park SH. Successful allogeneic stem-cell transplantation with prophylactic stepwise G-CSF primed-DLIs for relapse after autologous transplantation in mantle cell lymphoma: a case report and literature review on the evidence of GVL effects in MCL. Am J Hematol. Sep 2000;65(1):75-80. [Medline].

  91. Sparano JA, Lee JY, Kaplan LD, Levine AM, Ramos JC, Ambinder RF, et al. Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated, B-cell non-Hodgkin's lymphoma. Blood. Dec 29 2009;[Medline].

  92. Spicer J, Smith P, Maclennan K, Hoskin P, Hancock B, Linch D, et al. Long-term follow-up of patients treated with radiotherapy alone for early-stage histologically aggressive non-Hodgkin's lymphoma. Br J Cancer. Mar 22 2004;90(6):1151-5. [Medline].

  93. Staudt MR, Kanan Y, Jeong JH, Papin JF, Hines-Boykin R, Dittmer DP. The tumor microenvironment controls primary effusion lymphoma growth in vivo. Cancer Res. Jul 15 2004;64(14):4790-9. [Medline]. [Full Text].

  94. Stewart FM. Indications and relative indications for stem cell transplantation in non-Hodgkin's lymphoma. Leukemia. Jul 1993;7(7):1091-4. [Medline].

  95. Straus DJ, Portlock CS, Qin J, Myers J, Zelenetz AD, Moskowitz C, et al. Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease. Blood. Dec 1 2004;104(12):3483-9. [Medline].

  96. Ströhmann B, Haake K. [Nasal cavity and paranasal sinus malignancies in the ENT clinic of Charité since 1959]. Laryngorhinootologie. Mar 1991;70(3):138-41. [Medline].

  97. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues.

  98. Terry JH, Loree TR, Thomas MD, Marti JR. Major salivary gland lymphoepithelial lesions and the acquired immunodeficiency syndrome. Am J Surg. Oct 1991;162(4):324-9. [Medline].

  99. Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP, Kontopidou FN, Dimopoulou MN, Boutsis DE, et al. Hodgkin's lymphoma in first relapse following chemotherapy or combined modality therapy: analysis of outcome and prognostic factors after conventional salvage therapy. Eur J Haematol. May 2002;68(5):289-98. [Medline].

  100. Viviani S, Santoro A, Negretti E, Bonfante V, Valagussa P, Bonadonna G. Salvage chemotherapy in Hodgkin's disease. Results in patients relapsing more than twelve months after first complete remission. Ann Oncol. 1990;1(2):123-7. [Medline].

  101. Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberg SM. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol. Jun 1 2008;26(16):2717-24. [Medline].

  102. Wilson WH, Grossbard ML, Pittaluga S. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood. Apr 15 2002;99(8):2685-93. [Medline].

  103. Winter JN, Weller EA, Horning SJ, Krajewska M, Variakojis D, Habermann TM. Prognostic significance of Bcl-6 protein expression in DLBCL treated with CHOP or R-CHOP: a prospective correlative study. Blood. Jun 1 2006;107(11):4207-13. [Medline].

  104. Wirth A, Wolf M, Prince HM. Current trends in the management of early stage Hodgkin's disease. Aust N Z J Med. Aug 1999;29(4):535-44. [Medline].

  105. Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma. J Clin Oncol. May 15 2002;20(10):2453-63. [Medline].

  106. Wotherspoon AC. Gastric lymphoma of mucosa-associated lymphoid tissue and Helicobacter pylori. Annu Rev Med. 1998;49:289-99. [Medline].

  107. Yu KH, Yu SC, Teo PM, Chan AT, Yeo W, Chow J. Nasal lymphoma: results of local radiotherapy with or without chemotherapy. Head Neck. Jul 1997;19(4):251-9. [Medline].

  108. Yuen AR, Rosenberg SA, Hoppe RT, Halpern JD, Horning SJ. Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin's disease. Blood. Feb 1 1997;89(3):814-22. [Medline]. [Full Text].

 
Previous
Next
 
CT scan of a patient with a natural killer (NK)/T-cell lymphoma of the right nasal cavity and maxillary sinus.
CT scan 6 months after treatment with 4 cycles of DA-EPOCH (ie, infused etoposide, doxorubicin, and vincristine with bolus cyclophosphamide and prednisone).
CT scan of a patient with a recurrence of stage I-AE angiocentric lymphoma of the left maxillary sinus, treated 7 years earlier with 4 cycles of ProMACE-MOPP (ie, prednisone, methotrexate, Adriamycin, cyclophosphamide, etoposide–mechlorethamine [nitrogen mustard], vincristine, procarbazine, and prednisone) and 3960 cGy of radiation.
CT scan 2 years after salvage therapy.
Fiberoptic nasal examination of a patient with natural killer (NK)/T-cell lymphoma of the right nasal cavity and maxillary sinus.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.