OVERVIEW
B-cell lymphomas are solid tumors arising from B cells and include Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. There are numerous subtypes, with classical Hodgkin’s lymphoma and nodular lymphocyte-dominant Hodgkin’s lymphoma, now considered to be tumors of B-cell origin. Five types of B-cell non-Hodgkin’s lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, mucosa-associated lymphoid tissue lymphoma (MALT), small lymphocytic lymphoma/chronic lymphocytic leukemia, and condylomatous lymphoma (MCL), are the most common, accounting for three-quarters of all non-Hodgkin’s lymphomas.The prognosis and treatment of B-cell lymphomas depends on the specific type of lymphoma as well as on the staging grading.
Questions you may have
Is B-cell lymphoma contagious?
B-cell lymphoma, a type of lymphoma, is not an infectious disease and is not contagious.
B-cell lymphoma is a type of malignant lymphoma that originates from B-cells, and there are two types of Hodgkin’s lymphoma (e.g., classic Hodgkin’s lymphoma, nodal lymphocyte-dominant Hodgkin’s lymphoma) and non-Hodgkin’s lymphoma (e.g., anterior lymphoid tumors, mature B-cell tumors).
The cause of B-cell lymphoma is not clear for the time being, and it may be related to infection by pathogenic microorganisms such as EBV and Hepatitis B virus, abnormalities in immune function, genetic mutations and other hereditary factors, etc. It is not a contagious disease, and is therefore not contagious and will not be transmitted to others.
B-cell lymphoma should be diagnosed and treated in a timely manner in order to slow down the progression of the disease and improve the prognosis.
Etiology
The cause of the disease is not known, and is related to immunodeficiency, viral infection, environmental factors, etc.
Symptoms
Lymphoma can invade almost any tissues and organs of the body, and is a systemic disease. Therefore, the clinical manifestations of lymphoma are varied. In addition to chronic, progressive, painless lymph node enlargement, it often manifests other systemic involvement or systemic symptoms. The clinical manifestations have certain common features, but at the same time, there are great differences according to different pathological types, sites of invasion and scopes.
1. Progressive enlargement of lymph nodes
The most typical manifestation is painless, progressive enlargement of lymph nodes in superficial areas, with smooth surface, tough texture, ping-pong feeling or hardness like the tip of the nose. In the advanced stage, they may fuse with each other, adhere to the skin, become inactive, or even form ulcers; enlargement of lymph nodes in the neck and supraclavicular lymph nodes is the most common, followed by axillary and inguinal lymph nodes. There are also patients with deep lymph node enlargement as the main manifestation, such as mediastinal, abdominal, pelvic lymph node enlargement, the onset of the disease is more insidious, often due to the enlarged lymph nodes may have an impact on the surrounding tissues and organs or compression, and cause the corresponding symptoms to be detected in the clinic. For example, huge mediastinal lymph nodes may compress the superior vena cava, resulting in blood return obstruction, which is manifested as swelling of the face and neck, chest tightness, chest pain, dyspnea, etc. Huge pelvic and abdominal lymph nodes may compress the gastrointestinal tract, ureter or bile ducts, resulting in intestinal obstruction, pyelolithiasis or jaundice, and causing abdominal pain and distension.
2. Clinical manifestations of primary organs and involved organs
Lymphoma can invade organs other than lymphatic system, manifesting as invasion, destruction, compression or obstruction of corresponding organs. For example, gastrointestinal lymphoma behaves like gastric cancer and intestinal cancer, with symptoms such as abdominal pain, gastrointestinal ulcers, bleeding, obstruction and compression, etc. Skin lymphoma is often misdiagnosed as psoriasis, eczema, dermatitis, etc. If it invades the cranium and brain, it may cause headache, blurred vision, speech disorder, confusion, personality change, sensory and motor disorders in part of body and limbs, or even paralysis; and if it invades the skeleton, it may lead to bone pain and bone fracture; Lymphoma originating in nasal cavity may have nasal congestion, runny nose and nose bleeding, similar to the manifestation of nasopharyngeal carcinoma.
3. Systemic symptoms
Systemic symptoms such as fever, night sweating, fatigue and lethargy, lack of appetite, rash, itching, anemia and so on may appear before or at the same time of discovering enlarged lymph nodes.
Examination
1. Histopathologic examination
Pathological diagnosis is the “gold standard” for B-cell lymphoma and all malignant tumors, and B-cell immunophenotype is helpful for classification.
2. Other examinations
Lymphocytes, lymph nodes and lymphatic tissues are distributed all over the body, which determines that lymphoma is a kind of systemic disease. There is often more than one lesion at the onset of the disease, and except for hair, nails and cornea, all parts of the body with lymphatic tissues and lymph nodes may be invaded, including blood and bone marrow. Therefore, after the diagnosis of lymphoma is clear, the location, number and size of the lesions in the whole body should be comprehensively evaluated and examined for two purposes: (1) to stage the disease: for the same type of lymphoma, if it is staged differently, the principle of treatment, course of treatment and prognosis often differ greatly; (2) to keep the basic data of the early stage of the disease, which is convenient for the evaluation of the efficacy of the therapeutic program after treatment, and the decision of continuing the original program or adjusting the dosage or changing to a more effective program. (b) Retain basic data in the early stages of treatment to facilitate evaluation of the efficacy of the treatment regimen after treatment and to decide whether to continue the original regimen or to adjust the dose or change to a more effective regimen. Different types of lymphoma and different sites of disease require different examinations, but generally include ultrasound examination of superficial lymph nodes (including at least bilateral cervical, submandibular, supraclavicular, axillary, and inguinal lymph nodes), chest-enhanced CT examination, abdominal/pelvic-enhanced CT examination or ultrasound, and bone marrow aspiration smear or biopsy. Nasopharyngeal, gastrointestinal, and respiratory endoscopy, or lumbar puncture for cerebrospinal fluid may also be required at times to clarify whether the central nervous system has been invaded, and if necessary, injections of chemotherapeutic agents.
In addition, routine checks of blood, liver and kidney functions, blood sugar, blood lipids, lactate dehydrogenase, β2 microglobulin, erythrocyte sedimentation rate, electrocardiogram or cardiac ultrasound, as well as infections such as viral hepatitis, AIDS, and syphilis are also required. These items are mainly to determine whether the patient’s physical condition can tolerate chemotherapy. Whether important organs such as heart, lungs, liver and kidneys have serious functional defects, and whether other departmental treatments are needed. Whether the chemotherapeutic drugs and doses need to be adjusted. Whether there are any adverse factors affecting the prognosis, etc.
Diagnosis
Clinical manifestations of lymphoma are varied, and when lymphoma is suspected clinically, pathological section examination (biopsy) of lymph nodes or other involved tissues or organs must be done to confirm the diagnosis of lymphoma pathologically.
Differential diagnosis
1. Chronic lymphadenitis
There are obvious foci of infection, often with focal lymph node enlargement, pain and tenderness, usually not more than 2-3 cm, redness, swelling, heat and pain in acute attack, which can be significantly improved by anti-inflammatory treatment.
2. Tuberculous lymphadenitis
It is often combined with pulmonary tuberculosis, with positive OT test, localized lesions may sometimes show limited fluctuation or ulceration, and anti-tuberculosis treatment is effective.
3. Lymph node metastatic cancer
In lymph node metastatic cancer, the lymph nodes are often hard, and the texture of lymph nodes varies when more than one lymph node is transferred, and the primary foci can be found, and the whole body lymph nodes are seldom enlarged.
4. Acute and chronic lymphocytic leukemia
It is common that the superficial lymph nodes are enlarged, hard, without pressure and pain, not adherent, often with hepatosplenomegaly; bone marrow aspiration and lymph node biopsy show leukemic changes.
5. Eosinophilic lymphogranuloma
Some patients have multiple enlarged lymph nodes, which clinically resembles malignant lymphoma, responds well to radiation or chemotherapy and has a good prognosis. This kind of patients may sometimes have bilateral parotid gland enlargement, the number of eosinophils in the blood is increased, and the pathology also has obvious characteristics.
6. Infectious mononucleosis
Infectious mononucleosis is characterized by fever and generalized lymph node enlargement, but abnormal blood picture and positive eosinophilic agglutination reaction can be distinguished.
7. Sarcoidosis
In addition to superficial lymph node enlargement, it can also cause hilar lymph node enlargement and pulmonary nodular lesions. A large number of multinucleated giant cells similar to Langham cells can be seen in the smear of lymph node puncture, but there is no caseous lesion.
8. Nodular disease
The kveim skin test is positive in 60% to 90% of cases; lymph node biopsy shows epithelioid cell granulomas without R-S cells.
9. Giant lymphadenopathy (Castleman disease)
It is a rare lymphadenopathy between benign and malignant. The etiology is unknown, it may be a local or systemic infection, inflammation with the involvement of neurohumoral factors, stimulating lymph node proliferation. The main pathologic features are marked vascular proliferation and hyalinization or with plasmacytosis due to varying antibody reactivity. They are generally divided into three types, i.e. plasma cell type, hyaline vascular type and intermediate type. Clinically, there are two types: focal type and multicenter type, the former is a limited mass, and the latter is often a multi-site lymph node enlargement. The lumps are smooth and painless, and some of the nodes are fused. Some cases of multicenter type can be transformed to malignant lymphoma.
10. Necrotizing lymphadenitis
Necrotizing lymphadenitis, also known as Kikuchi’s disease or Kikuchi-Fujimoto’s disease, is a non-neoplastic lymph node enlargement disease, which is a reactive hyperplastic lesion of lymph nodes. It mainly affects young adults and is slightly more common in women than in men. Clinically, it has a subacute course, with the main symptoms being persistent high fever, enlarged lymph nodes with no or mildly decreased white blood cells, and ineffective antibiotic treatment. In a few cases, the disease can be recurrent, with multiple organ system involvement and even death. The misdiagnosis rate of this disease can be as high as 30%～80%.
11. Giant lymph node hyperplasia
It is a kind of lymph node enlargement of unknown cause, which mainly invades the thoracic cavity, with the mediastinum being the most common, and may also invade the hilum and the lungs.
12. Pseudolymphoma
Often occurs outside the lymph nodes, such as orbital and stomach pseudolymphoma. Tuberculous lymphadenitis: sometimes it is difficult to distinguish it from malignant lymphoma. More typical patients often have tuberculosis.
Treatment
B-cell lymphoma is highly heterogeneous, so the treatment varies greatly. Lymphomas of different pathological types and stages differ greatly in terms of treatment intensity and prognosis, and systemic treatment is generally taken as the main treatment, combined with local treatment. The treatment methods of lymphoma mainly consist of the following, but the specific patients should be analyzed according to the actual situation of the patients.
1. Radiation therapy
Certain types of lymphoma can be treated with radiotherapy alone in the early stage. Radiotherapy can also be used as consolidation therapy after chemotherapy and adjuvant therapy during transplantation.
2.Chemotherapy
Chemotherapy for lymphoma mostly adopts combination chemotherapy, especially in recent years, systemic chemotherapy combined with targeted therapy drugs and biological agents, and many types of lymphoma patients have obvious curative effect.
3. Bone marrow transplantation
Autologous hematopoietic stem cell transplantation can be considered for patients under 60 years of age who can tolerate high-dose chemotherapy in medium and high-risk patients. Allogeneic hematopoietic stem cell transplantation can also be considered for some young patients with relapse or bone marrow invasion.
4. Surgical treatment
Limited to biopsy or complication management; combined with hypersplenism without contraindications, those who have the indication of splenectomy can have their spleen cut in order to improve the blood picture and create favorable conditions for future chemotherapy.
Questions you may be concerned about
Cost of Non-Hodgkin’s B-cell Lymphoma Treatment
The treatment cost of non-Hodgkin’s B-cell lymphoma varies according to the patient’s condition, and the treatment modes are also different, which can be divided into drug treatment, surgical resection treatment and radiation treatment, and each kind of treatment is about 30,000 to 100,000 yuan.
1. Drug therapy: it is suitable for patients with mild disease to control the disease, mainly using drugs such as B-cell tyrosine kinase inhibitor, histone deacetylase inhibitor, rituximab, etc. At the same time, it may also use some immunomodulating drugs such as lenalidomide, etc. The cost of drug therapy is lower than that of surgery. The cost of medication is lower than the cost of surgery, which is about 30,000~50,000 dollars.
2. Surgical resection treatment: the local tumor will be removed, which is more suitable for patients with lymphoma of lymphatic tissue extra-nodal marginal zone, lymphoma of splenic marginal zone and so on. Comprehensive physical examination is needed before surgery, and the preoperative cost plus surgery cost is about 100,000 dollars.
3. Radiation therapy: Radiation is mainly used to irradiate the concentrated area of tumor cells in order to destroy the tumor cells and kill them. Generally, it is necessary to carry out 6 times, totaling 60,000 yuan.
However, the price varies among different manufacturers, different dosage forms, different packages and different regions, so you can consult your local hospital for the specific price.