Lymphoma

Last updated: March 25, 2026
Table Of Contents
  1. Overview
  2. WHO Classification of Lymphoma

Overview

Lymphomas are tumours arising from lymphoid cells. They have a much less dramatic presentation than leukaemias, and are classified into 2 major groups – Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma – based on morphology and immunophenotype.

Definition of terms

TermDefinition
Hodgkin’s lymphomaLymphoma that is characterized by Reed-Sternberg cells on biopsy and mediastinal involvement.
Non-hodgkin lymphomaEvery other lymphoma that does not fit the characteristics of Hodgkin lymphoma
Aggressive non-Hodgkin lymphomaLymphomas with a high incidence in HIV/AIDS (AIDS-defining malignancies). They include diffuse large B-cell lymphoma, Burkitt’s lymphoma nd plasmablastic lymphoma.

Ann Arbor Staging of Lymphoma

***Modifiers: Nodal (N), Extranodal (E), B-symptoms absent/Asymptomatic(A), B symptoms present (B), Bulky disease (X)

StageSites involved
IOne Lymph node site
IITwo or more lymph node sites on one side of the diaphragm
IIITwo or more lymph node sites on both sides of the diaphragm
IVExtranodal sites (lungs, liver, bone marrow, etc.) with or without lymph node involvement
  • Sites of origin of lymphomas
    • Lymph nodes
    • Spleen
    • Thymus
    • Liver
    • Bone Marrow
    • Mucosa-Associated Lymphatic Tissue
    • Skin
  • Extranodal sites that may be affected by lymphoma
    • Brain
    • Skin
    • Gastrointestinal and Respiratory Tract
    • Salivary gland
    • Eye
    • Testes
    • Ovary
    • Cervix
  • Risk factors
    • EBV virus – Burkitt’s lymphoma, diffuse large B-cell lymphoma, and natural killer cell lymphoma
      • First described in Uganda
      • 30-40% of the viral genome is found in Burkitt’s lymphoma
      • EBV LMP-2 is detected in 90% of Burkitt’s lymphomas
    • Immunodeficiency – Diffuse Large B-cell lymphoma
    • Malaria – endemic Burkitt’s lymphoma
    • Plant phorbol esters (Euphorbia terucalis)
      • induces t(8;14) in 1% of lymphoblastoid cell lines (BL)
  • Signs and symptoms
    • Lymphadenopathy
      • Arise within lymph nodes or organized lymphatic tissue – Peyer’s patches, conjunctiva, parapharynx, Waldeyer’s ring, and thymus
      • Multicentric at presentation and diagnosis
      • Hodgkin lymphoma starts at a localized region (a “pure lymphoma”)
    • Leukaemic phase
      • Cells can invade the Bone marrow and Peripheral blood, establishing a leukemic phase
      • This is why lymphomas are referred to as a “disease spectrum”. An example is SLL/CLL.
  • Differentials
    • Metastasis
    • Reactive node – painful lymphadenopathy
      • Tuberculosis
      • Acute HIV syndrome
    • Sarcoidosis

WHO Classification of Lymphoma

  • Mature B-cell neoplasms
    • B-cell CLL/SLL
    • B-cell prolymphocytic leukemia
    • Lymphoplasmacytic lymphoma (including Waldenstrom macroglobulinemia)
    • Splenic marginal zone lymphoma
    • Hairy cell leukemia
    • Plasma cell neoplasms
      • Multiple myeloma
      • Plasmacytoma
      • Monoclonal immunoglobulin deposition disease
      • Heavy chain disease
    • Extranodal marginal zone B-cell lymphoma (MALT lymphoma)
    • Nodal marginal zone B-cell Lymphoma
    • Follicular lymphoma
    • Primary cutaneous follicle center lymphoma
    • Mantle cell lymphoma
    • Diffuse Large B-cell lymphoma (NOS)
    • Diffuse Large B-cell lymphoma associated with chronic inflammation
    • EBV-positive diffuse large B-cell lymphoma (NOS)
    • Lymphomatoid granulomatosis
    • Primary mediastinal (thymic) large B-cell lymphoma
    • Intravascular large B-cell lymphoma
    • ALK+ large B-cell lymphoma
    • Plasmablastic lymphoma
    • Primary effusion lymphoma
    • Large B-cell lymphoma arising in HHV8-associated multicentric Castleman’s disease
    • Burkitt lymphoma or Leukemia
  • Mature T-cell and NK-cell neoplasm
    • T-cell prolymphocytic leukemia
    • T-cell large granular lymphocyte leukemia
    • Aggressive NK cell leukemia
    • Adult T-cell leukemia or lymphoma
    • Extranodal NK/ T-cell lymphoma (nasal type)
    • Enteropathy-associated T-cell lymphoma
    • Hepatosplenic T-cell lymphoma
    • Blastic NK cell lymphoma
    • Mycosis fungoides (Sezary syndrome)
    • Primary cutaneous CD30-positive T-cell lymphoproliferative disorders
    • Peripheral T-cell lymphoma (NO)
    • Angioimmunoblastic T-cell lymphoma
    • Anaplastic large cell lymphoma (ALK-positive and ALK-negative types)
    • Breast plant-associated anaplastic large cell lymphoma
  • Precursor lymphoid neoplasms
    • B-lymphoblastic leukemia or lymphoma (NOS)
    • B-lymphoblastic leukemia or lymphoma with recurrent genetic abnormalities
    • T-lymphoblastic leukemia or lymphoma
  • Hodgkin lymphoma
    • Classical Hodgkin lymphoma
      • Lymphocyte-rich
      • Mixed cellularity Hodgkin lymphoma
      • Nodular sclerosis form of Hodgkin lymphoma
      • Lymphocyte-depleted or not depleted
    • Nodular lymphocyte-predominant Hodgkin lymphoma
  • Immunodeficiency-associated lymphoproliferative disorders
    • Associated with a primary immune disorder
    • Associated with HIV
    • Post-transplant
    • Associated with MTX therapy
    • Primary CNS lymphoma
Reference Intervals ›
Biochemistry
ACTHP: <80 ng/L
ALTP: 5–35 U/L
AlbuminP: 35–50 g/L
AldosteroneP: 100–500 pmol/L
Alk. phosphataseP: 30–130 U/L
α-AmylaseP: 0–180 IU/dL
α-FetoproteinS: <10 kU/L
Angiotensin IIP: 5–35 pmol/L
ADHP: 0.9–4.6 pmol/L
ASTP: 5–35 U/L
BicarbonateP: 24–30 mmol/L
BilirubinP: 3–17 μmol/L
BNPP: <50 ng/L
CRPP: <10 mg/L
CalcitoninP: <0.1 mcg/L
Calcium (ionized)P: 1.0–1.25 mmol/L
Calcium (total)P: 2.12–2.60 mmol/L
ChlorideP: 95–105 mmol/L
CholesterolP: <5.0 mmol/L
VLDLP: 0.128–0.645 mmol/L
LDLP: <2.0 mmol/L
HDLP: 0.9–1.93 mmol/L
Cortisol AMP: 450–700 nmol/L
Cortisol MidnightP: 80–280 nmol/L
CK ♂P: 25–195 U/L
CK ♀P: 25–170 U/L
CreatinineP: 70–100 μmol/L
FerritinP: 12–200 mcg/L
FolateS: 2.1 mcg/L
FSHP: 2–8 U/L ♂; >25 menopause
GGT ♂P: 11–51 U/L
GGT ♀P: 7–33 U/L
Glucose (fasting)P: 3.5–5.5 mmol/L
Growth hormoneP: <20 mu/L
HbA1C (DCCT)B: 4–6%
HbA1C (IFCC)B: 20–42 mmol/mol
Iron ♂S: 14–31 μmol/L
Iron ♀S: 11–30 μmol/L
Lactate (venous)P: 0.6–2.4 mmol/L
Lactate (arterial)P: 0.6–1.8 mmol/L
LDHP: 70–250 U/L
LHP: 3–16 U/L
MagnesiumP: 0.75–1.05 mmol/L
OsmolalityP: 278–305 mosmol/kg
PTHP: 0.8–8.5 pmol/L
PotassiumP: 3.5–5.3 mmol/L
Prolactin ♂P: <450 U/L
Prolactin ♀P: <600 U/L
PSAP: 0–4 mcg/mL
Protein (total)P: 60–80 g/L
Red cell folateB: 0.36–1.44 μmol/L
Renin (erect)P: 2.8–4.5 pmol/mL/h
Renin (recumbent)P: 1.1–2.7 pmol/mL/h
SodiumP: 135–145 mmol/L
TBGP: 7–17 mg/L
TSHP: 0.5–4.2 mU/L
T4P: 70–140 nmol/L
Free T4P: 9–22 pmol/L
TIBCS: 54–75 μmol/L
TriglyceridesP: 0.50–2.3 mmol/L
T3P: 1.2–3.0 nmol/L
Troponin TP: <0.1 mcg/L
Urate ♂P: 210–480 μmol/L
Urate ♀P: 150–390 μmol/L
UreaP: 2.5–6.7 mmol/L
Vitamin B12S: 0.13–0.68 nmol/L
Vitamin DS: 50 nmol/L
Arterial Blood Gases
pH7.35–7.45
PaCO₂4.7–6.0 kPa
PaO₂>10.6 kPa
Base excess±2 mmol/L
Urine
Cortisol (free)<280 nmol/24h
Hydroxyindole acetic acid16–73 μmol/24h
Hydroxymethylmandelic acid16–48 μmol/24h
Metanephrines0.03–0.69 μmol/mmol cr.
Osmolality350–1000 mosmol/kg
17-Oxogenic steroids ♂28–30 μmol/24h
17-Oxogenic steroids ♀21–66 μmol/24h
17-Oxosteroids ♂17–76 μmol/24h
17-Oxosteroids ♀14–59 μmol/24h
Phosphate (inorganic)15–50 mmol/24h
Potassium14–120 mmol/24h
Protein<150 mg/24h
Protein/creatinine ratio<3 mg/mmol
Sodium100–250 mmol/24h
Haematology
WCC4.0–11.0 ×10⁹/L
RBC ♂4.5–6.5 ×10¹²/L
RBC ♀3.9–5.6 ×10¹²/L
Hb ♂130–180 g/L
Hb ♀115–160 g/L
PCV ♂0.4–0.54 L/L
PCV ♀0.37–0.47 L/L
MCV76–96 fL
MCH27–32 pg
MCHC300–360 g/L
RDW11.6–14.6%
Neutrophils2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes1.0–4.5 ×10⁹/L (20–45%)
Eosinophils0.04–0.44 ×10⁹/L (1–6%)
Basophils0–0.10 ×10⁹/L (0–1%)
Monocytes0.2–0.8 ×10⁹/L (2–10%)
Platelets150–400 ×10⁹/L
Reticulocytes0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time10–14 s
APTT35–45 s
Paediatric
Pulse Rate (bpm)
Neonate140–160
Infant <1yr120–140
1–5 years110–130
5–12 years80–120
>12 years70–100
Respiratory Rate (tachypnoea)
0–2 months≥60/min
2–12 months≥50/min
1–5 years≥40/min
>5 years≥30/min
Blood Pressure (mmHg)
Term65/45
1 year75/50
4 years85/60
8 years95/65
10 years100/70
Weight Formulas
3–12 months(a + 9)/2 kg
1–6 years2a + 8 kg
>6 years(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn13–20
1 month11–18
2 months10–15
1–2 years10–13
>2 years11–14
MUAC (6 months–5 years)
Obese>17.5 cm
Normal13.5–17.4 cm
At risk12.5–13.4 cm
Moderate malnutrition11.5–12.4 cm
Severe malnutrition<11.5 cm
Developmental Milestones
Social smile1.5 months
Head control4 months
Sits unsupported7 months
Crawls10 months
Stands unsupported10–12 months
Walks12–13 months
Talks18 months
CSF WBC (/mm³)
Term newborn0–25
>2 weeks0–5
Calculator ›

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