2025 – PAGE 275 – HEMATOLOGY & ONCOLOGY

PEDIATRIC LYMPHOMAS

NOTE: Break the lymphomas up into Hodgkin’s versus non-Hodgkin’s lymphomas. Hodgkin’s = GOOD PROGNOSIS. Non-Hodgkin’s = NON-good prognosis!

(DOUBLE TAKE) DEFINITIONS/PEARLS: Leukemias and lymphomas are both LYMPHOblastic disorders of T and B cells.

• LEUKEMIA: Bone marrow biopsy shows > 25% blasts
• LYMPHOMA: Bone marrow biopsy shows < 25% blasts, and NONTENDER lymphadenopathy is present somewhere (neck, mediastinum, groin, etc.).
• CELL LINES IMAGE: www.pbrlinks.com/PEDIALEUKEMIAS1

PEARL: Leukemia—Look for increased leukocytes (WBCs) in the blood and marrow. The primary leukemia in kids is ALL. It’s doubtful that you would be tested on anything else.

(DOUBLE TAKE) HODGKIN’S LYMPHOMA

Hodgkin’s lymphoma accounts for almost HALF of lymphoma cases and has a GOOD prognosis with GOOD cure rates. Signs and symptoms progress in a stepwise fashion. Look for a TEENAGE patient with NONTENDER CERVICAL or SUPRACLAVICULAR lymphadenopathy. It always starts this way! That will then be accompanied by fevers, fatigue, night sweats, and weight loss. Later in the course, there is also generalized lymphadenopathy. On labs, the patient may have a normal or high LEUKOcyte count (WBC), but must have either high or low LYMPHOcytes. DIAGNOSE with an excisional node biopsy and note REED STERNBERG CELLS, which are usually of B-cell origin.

PEARL: Your differential may include TB or Atypical Mycobacteria. For a NEGATIVE PPD, choose Hodgkin’s. For a slightly positive PPD (5-10 mm), choose Atypical Mycobacteria. For a PPD that is > 15 mm, choose MTB.

IMAGE: www.pbrlinks.com/HODGKINS1 = RS Cells

MNEMONIC: REED Sternberg cells kind of look like OWLS’ EYES, so imagine a STERN OWL wearing glasses and REEDing a book on a farm. The farmer comes outside and takes a shot at the OWL. He misses the OWL but hits the book. The OWL flies away SAFELY (high cure rate). Whew! That owl really “HODGED” a bullet.

NON-HODGKIN LYMPHOMA (NHL)

A preadolescent child with a non-tender mass in the HEAD, NECK, or abdomen will likely be presented for Non-Hodgkin lymphoma (AKA NHL or non-Hodgkins or non-Hodgkin’s lymphoma). The mass is usually rapidly-growing. The LEUKOcyte count may be normal, while other cell lines may be low due to marrow infiltration.

• BURKITT’S B-CELL LYMPHOMA: This is a B-cell, non-Hodgkin’s lymphoma that is associated with the Epstein Barr Virus (EBV) and results in a translocation, t(8,14).
  • MNEMONIC: Burkitt’s = B cell = eBv = t(B,14)