• The diagnosis of non-Hodgkin lymphoma encompasses a wide spectrum of lymphoid-derived tumors
• More than 10 distinct tumor subtypes with variable biologic behavior
• Non-Hodgkin lymphoma may originate from B cells, T cells, or histiocytes
• In contrast to Hodgkin lymphoma, lymph node tumor involvement is more likely to spread in a noncontinous fashion in non-Hodgkin lymphoma
• Prognosis and treatment is more dependent on the grade and type of malignancy in contrast to the importance of clinical stage in Hodgkin lymphoma
• Functionally separated into low-grade and high-grade groups
• 33% of cases arise outside of the lymph nodes: oropharynx, paranasal sinuses, thyroid, GI tract, liver, testicles, skin, bone marrow, and CNS
• Most common extranodal site is the stomach, accounting for 50% of all GI lymphomas
• Most accepted classification system is the Revised European-American Lymphoma (REAL) classification
• Risk factors for the development of lymphoma:
• Wiscott-Aldrich syndrome
• Celiac disease
• Prior chemotherapy
• History of radiation therapy
• Immunosuppressive therapy
• Human T-cell lymphotropic virus type 1 infection
• Sjögren syndrome
• Extranodal lymphoma risk factors:
• Nontender enlargement of lymph nodes
• Constitutional symptoms:
-Drenching night sweats
• Gastric lymphoma symptoms and signs include epigastric pain, weight loss, and frequently a palpable epigastric mass
• Imaging findings are specific to the location and type of lymphoma
• Chest film: May demonstrate mediastinal adenopathy
• CT scan: Main staging tool used to demonstrate areas of adenopathy
• Detailed history of risk factors and presence of constitutional symptoms
• Thorough physical exam assessing all lymph node beds
• Routine laboratory testing
• Excisional biopsy of enlarged lymph node
• Bone marrow biopsy
• CT scans of the neck, chest, abdomen, and pelvis
• Gastric lymphoma work-up also includes esophagogastroduodenscopy with biopsy and brush cytology
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