Resumo
Definição
History and exam
Key diagnostic factors
- Sintomas B (febre, sudorese noturna, perda de peso)
- fadiga/mal-estar
Other diagnostic factors
- linfadenopatia
- esplenomegalia
- hepatomegalia
- dispneia
- tosse
- desconforto abdominal
- cefaleia
- alteração do estado mental
- deficits neurológicos focais
- dor torácica
- dor óssea, dorsalgia
- icterícia
- palidez
- púrpura
- lesões cutâneas
- anormalidades neurológicas no exame
- mastalgia
- edema ou massa na mama
Risk factors
- idade >50 anos
- sexo masculino
- Vírus Epstein-Barr (EBV)
- vírus linfotrópico de células T humanas tipo 1 (HTLV-1)
- herpes-vírus humano tipo 8 (herpes-vírus associado ao sarcoma de Kaposi)
- Helicobacter pylori
- doença celíaca
- vírus da imunodeficiência humana (HIV)
- vírus da hepatite C (HCV)
- Síndrome de Sjögren
- Síndrome de Wiskott-Aldrich
- ataxia-telangiectasia
- uso de medicamentos imunomoduladores
- transplante de órgãos
- Borrelia burgdorferi
- Coxiella burnetii
- Chlamydia psittaci
- Campylobacter jejuni
- artrite reumatoide
- lúpus eritematoso sistêmico (LES)
- imunodeficiência comum variável
- Síndrome de Chediak-Higashi
- Síndrome de Klinefelter
- pesticidas
- herbicidas à base de fenóxidos
- implantes mamários
Diagnostic investigations
1st investigations to order
- Hemograma completo com diferencial
- esfregaço de sangue periférico
- perfil metabólico completo (incluindo testes da função hepática [TFHs])
- lactato desidrogenase (LDH) sérica
- ácido úrico
- biópsia de linfonodos
- biópsia (sítios extranodais, por exemplo, cérebro, pele)
- biópsia ou aspirado da medula óssea
- imuno-histoquímica
- citometria de fluxo
- PET com fluordesoxiglucose (FDG)-CT
Investigations to consider
- biópsia percutânea com agulha grossa
- biópsia por aspiração com agulha fina (AAF)
- teste genético
- sorologia para hepatite B e C
- teste de vírus da imunodeficiência humana (HIV)
- Exame para vírus Epstein-Barr (EBV)
- teste para vírus linfotrópico de células T humanas (HTLV)
- RNM (cérebro, coluna)
- ultrassonografia (mama, axila)
- punção lombar
- endoscopia e colonoscopia
- eletroforese de proteínas séricas com imunofixação
- imunoglobulinas quantitativas
- microglobulina beta-2 sérica
- Teste para Helicobacter pylori
- angiografia sincronizada multinuclear (MUGA)
- ecocardiografia
Treatment algorithm
linfomas agressivos de células B
linfomas de células T agressivos
linfomas de células B indolentes
linfomas de células T indolentes
Contributors
Authors
Julie E. Chang, MD
Associate Professor
Department of Medicine, Section of Hematology & Oncology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
JEC has been paid for time served on advisory boards for MorphoSys, BeiGene, and Genentech. JEC has research funding from Genentech and Celgene.
Acknowledgements
Dr Julie Chang would like to gratefully acknowledge Dr Esther Chan, Dr Chin Hin Ng, Dr Melissa Ooi, Dr Michelle Poon, Dr Boris Kobrinsky, and Dr Kenneth B. Hymes, previous contributors to this topic.
Disclosures
EC, CHN, MO, BK, and KBH declare that they have no competing interests. MP has received sponsorship from Sanofi and Janssen to attend conferences.
Peer reviewers
Leonidas G. Koniaris, MD
Associate Professor Surgery
Department of Cell Biology and Anatomy
University of Miami School of Medicine
Coral Gables
FL
Disclosures
LGK declares that he has no competing interests.
Shankaranarayana Paneesha, MD, MRCP, FRCPath
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Disclosures
SP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: B-cell lymphomas [internet publication].Full text
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: T-cell lymphomas [internet publication].Full text
Tilly H, Gomes da Silva M, Vitolo U, et al. Diffuse large B-cell lymphoma (DLBCL): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26(suppl 5):v116-25.Full text Abstract
Vitolo U, Seymour JF, Martelli M, et al. Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep;27(suppl 5):v91-102.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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