Non-Hodgkin's lymphoma in children

Non-Hodgkin's lymphomas in children is a collective name for a group of systemic malignant tumors of the immune system that originate from cells of extramedullary lymphoid tissue.

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Epidemiology of non-Hodgkin's lymphomas

The incidence of childhood non-Hodgkin's lymphomas in Europe, North America and Russia is 6-10 cases per 1,000,000 children. Non-Hodgkin's lymphomas account for 5-7% of all malignant tumors in childhood. The peak incidence is 5-10 years, children under 3 years of age are extremely rarely ill. Among patients under 14 years of age, boys significantly predominate: the ratio of boys to girls is, according to domestic authors, 3.2:1. In adolescents, this indicator changes due to the increase in the frequency of non-Hodgkin's lymphomas in girls and is 1.4:1.

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Symptoms of Non-Hodgkin's Lymphoma in Children

The anamnesis is short-term, symptoms of biological activity are noted in no more than 10-15% of patients. Clinical manifestations are determined mainly by the localization and mass of the tumor. In children, 40-50% of non-Hodgkin's lymphomas are initially localized in the abdominal cavity: in the ileocecal region, appendix, ascending colon, mesenteric and other groups of intra-abdominal lymph nodes. An enlarged abdomen with a generally satisfactory condition of the child may be the first symptom of the disease. During physical examination, a tumor can be palpated or ascites, hepatosplenomegaly can be detected.

Symptoms of Non-Hodgkin's Lymphoma

Classification of non-Hodgkin's lymphomas

Non-Hodgkin's lymphomas are tumors of lymphoid cells of various histogenetic origins and degrees of differentiation. The group includes more than 25 diseases. Differences in the biology of non-Hodgkin's lymphomas are due to the characteristics of the cells that form them. It is the constituent cells that determine the clinical picture, sensitivity to therapy, and long-term prognosis. Specific non-random chromosomal translocations and receptor rearrangements are known for most lymphomas, which are of key importance in pathogenesis.

Classification of non-Hodgkin's lymphomas

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Diagnosis of non-Hodgkin's lymphomas in children

The complex of necessary diagnostic studies in case of suspected non-Hodgkin's lymphoma includes the following measures.

• Collection of anamnesis and detailed examination with assessment of the size and consistency of all groups of lymph nodes.
• Clinical blood test with platelet count (usually no abnormalities, cytopenia is possible).
• Biochemical blood test with assessment of liver and kidney function, determination of LDH activity, an increase of which has diagnostic value and characterizes the size of the tumor.
• Bone marrow examination to detect tumor cells - puncture from three points with myelogram calculation; determines the percentage of normal and malignant cells, their immunophenotype.
• Lumbar puncture with morphological examination of the cerebrospinal fluid cytopreparation to determine damage to the central nervous system (possible presence of tumor cells in the cerebrospinal fluid).

Diagnosis of non-Hodgkin's lymphomas

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Treatment of non-Hodgkin's lymphomas in children

Of fundamental importance is adequate treatment of initial syndromes caused by the localization and mass of the tumor (compression syndromes) and metabolic disorders due to its disintegration (tumor lysis syndrome). In non-Hodgkin's lymphoma, therapeutic measures begin immediately upon admission of the patient to the hospital with ensuring venous access, deciding on the need and nature of infusion and antibacterial therapy. Initial therapy is carried out through a peripheral catheter, catheterization of the central vein is performed under general anesthesia simultaneously with diagnostic procedures. Monitoring of biochemical parameters is mandatory for timely detection of metabolic disorders.

How is non-Hodgkin lymphoma treated?