PE26.9 | Lymphoma in Children — Summary & Reflection

KEY TAKEAWAYS

Lymphoma in children — key points:

• Hodgkin lymphoma (HL): Reed-Sternberg cells; EBV association ~40%; painless rubbery lymphadenopathy; B symptoms (fever, night sweats, >10% weight loss); contiguous spread → Ann Arbor staging; excellent prognosis (cure >90–95%); treatment = ABVD ± involved-field radiotherapy.

• Burkitt NHL: Mature B-cell; MYC translocation t(8;14); 'starry-sky' histology; EBV ~100% endemic, ~20–30% sporadic; endemic = jaw/orbital; sporadic (India) = abdominal mass; fastest-growing tumour; intensive short-course chemo (CODOX-M/IVAC); TLS prophylaxis mandatory before chemo.

• T-lymphoblastic lymphoma: T-cell, mediastinal mass, SVC syndrome; ≥25% marrow blasts → reclassify as T-ALL; ALL-type protocols; CNS prophylaxis.

• Key distinction: HL = contiguous nodal spread, no extranodal disease; NHL = non-contiguous, extranodal from the start (jaw, abdomen, marrow, CNS).

• Mediastinal mass + lymphoma = airway emergency — never administer GA without expert airway assessment and preparation.

• Diagnosis always requires tissue biopsy — excisional node biopsy preferred; FNAC alone is inadequate.

• Staging: Ann Arbor (HL, Stages I–IV, suffix A/B); Murphy/St Jude (NHL, Stages I–IV including CNS/marrow).

REFLECT

Work through Kolb's experiential learning cycle:

Concrete Experience: In the opening case, how did the pattern of lymphadenopathy (bilateral, cervical + axillary + mediastinal) combined with B symptoms and the age of the patient (adolescent male) guide your immediate differential diagnosis toward Hodgkin lymphoma before any biopsy result was available?

Reflective Observation: Consider a 6-year-old who presents with a massively distended abdomen and ascites — initially worked up for a surgical abdomen. How would you argue for adding lymphoma to the differential, and what single investigation (biopsy vs ascitic tap vs CT) would most efficiently establish the diagnosis?

Abstract Conceptualisation: The distinction between HL and NHL is not merely academic — it drives entirely different staging systems, treatment protocols, and counselling. In one paragraph, explain why Ann Arbor staging is logical for HL but inadequate for NHL, based on the biological difference in spread patterns.

Active Experimentation: In your next ward or OPD posting, practise a structured lymph node examination: record size, consistency, tenderness, fixation, and anatomical station for every enlarged node you encounter. Document the accompanying systemic features and form a differential diagnosis before the consultant's assessment.