B symptoms

Last updated

B symptoms are a set of symptoms, namely fever, night sweats, and unintentional weight loss, that can be associated with both Hodgkin lymphoma and non-Hodgkin lymphoma. These symptoms are not specific to lymphomas, especially each one considered individually, and even as a trio they are not pathognomonic for lymphomas, but the presence of the trio is sensitive enough for lymphomas to warrant diagnostic investigation and differential diagnosis. The presence or absence of B symptoms has prognostic significance in lymphomas and is reflected in their staging.

Contents

Description and nomenclature

B symptoms are so called because Ann Arbor staging of lymphomas includes both a number (I–IV) and a letter (A or B). [1] "A" indicates the absence of systemic symptoms, while "B" indicates their presence.

B symptoms include:

Prognostic importance

The presence of B symptoms is a marker for more advanced disease with systemic, rather than merely local, involvement. B symptoms are a clear negative prognostic factor in Hodgkin lymphoma. [2] The relevance of B symptoms in non-Hodgkin lymphoma is less clear, although B symptoms tend to correlate with disease that is either more widespread or of a higher histologic grade. [3]

Relative importance of specific B symptoms

It has been suggested that, in Hodgkin lymphoma, fever and weight loss are much more prognostically significant than night sweats. In one series of patients with early-stage Hodgkin disease, the presence or absence of night sweats had no impact on cure rates and outcome. However, fever and weight loss had a pronounced negative impact on cure and survival rates, regardless of treatment modality. [4]

"B symptoms" in other diseases

Similar systemic symptoms can be found in non-cancerous states such as tuberculosis and various inflammatory or rheumatologic conditions. In these settings, the term "B symptoms" is sometimes colloquially applied to refer to such systemic or constitutional symptoms. However, in a pure sense, the term "B symptoms" is restricted to lymphoma staging. Also seen in chronic lymphocytic leukemia, Hodgkin's Lymphoma, Burkitt's Lymphoma.[ citation needed ]

Related Research Articles

Non-Hodgkin lymphoma Type of cancer of lymph nodes

Non-Hodgkin lymphoma (NHL) also known as Non-Hodgkin's lymphoma is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness. Other symptoms may include bone pain, chest pain, or itchiness. Some forms are slow-growing while others are fast-growing.

Lymphoma Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood and lymph tumors that develop from lymphocytes. In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

Post-transplant lymphoproliferative disorder (PTLD) is the name given to a B cell proliferation due to therapeutic immunosuppression after organ transplantation. These patients may develop infectious mononucleosis-like lesions or polyclonal polymorphic B-cell hyperplasia. Some of these B cells may undergo mutations which will render them malignant, giving rise to a lymphoma.

AIDS-related lymphoma describes lymphomas occurring in patients with acquired immunodeficiency syndrome (AIDS).

Panniculitis Medical condition

Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.

Anaplastic large-cell lymphoma Medical condition

Anaplastic large cell lymphoma (ALCL) refers to a group of non-Hodgkin lymphomas in which aberrant T cells proliferate uncontrollably. Considered as a single entity, ALCL is the most common type of peripheral lymphoma and represents ~10% of all peripheral lymphomas in children. The incidence of ALCL is estimated to be 0.25 cases per 100,000 people in the United States of America. There are four distinct types of anaplastic large cell lymphomas that on microscopic examination share certain key histopathological features and tumor marker proteins. However, the four types have very different clinical presentations, gene abnormalities, prognoses, and/or treatments.

Ann Arbor staging is the staging system for lymphomas, both in Hodgkin's lymphoma and non-Hodgkin lymphoma. It was initially developed for Hodgkin's, but has some use in NHL. It has roughly the same function as TNM staging in solid tumors.

Follicular lymphoma Medical condition

Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells normally occupy the follicles in the germinal centers of lymphoid tissues such as lymph nodes. The cancerous cells in FL typically form follicular or follicle-like structures in the tissues they invade. These structures are usually the dominant histological feature of this cancer.

T-cell lymphoma Medical condition

T-cell lymphoma is a rare form of cancerous lymphoma affecting T-cells. Lymphoma arises mainly from the uncontrolled proliferation of T-cells and can become cancerous.

Mediastinal tumors Medical condition

A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are neurogenic tumors, usually found in the posterior mediastinum, followed by thymoma (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.

Intravascular lymphomas Medical condition

Intravascular lymphomas (IVL) are rare cancers in which malignant lymphocytes proliferate and accumulate within blood vessels. Almost all other tyes of lymphoma involve the proliferation and accumulation of malignant lymphocytes in lymph nodes, other parts of the lymphatic system, and various non-lymphatic organs but not in blood vessels.

Diffuse large B-cell lymphoma Type of blood cancer

Diffuse large B-cell lymphoma (DLBCL) is a cancer of B cells, a type of lymphocyte that is responsible for producing antibodies. It is the most common form of non-Hodgkin lymphoma among adults, with an annual incidence of 7–8 cases per 100,000 people per year in the US and UK. This cancer occurs primarily in older individuals, with a median age of diagnosis at ~70 years, although it can occur in young adults and, in rare cases, children. DLBCL can arise in virtually any part of the body and, depending on various factors, is often a very aggressive malignancy. The first sign of this illness is typically the observation of a rapidly growing mass or tissue infiltration that is sometimes associated with systemic B symptoms, e.g. fever, weight loss, and night sweats.

Mantle cell lymphoma Medical condition

Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma (NHL), comprising about 6% of NHL cases. There are only about 15,000 patients presently in the United States with mantle cell lymphoma. It is named for the mantle zone of the lymph nodes.

Aggressive lymphoma Medical condition

Aggressive lymphoma, also known as high-grade lymphoma, is a group of fast growing non-Hodgkin lymphoma.

Lymphatic disease is a class of disorders which directly affect the components of the lymphatic system.

Hodgkin lymphoma Type of blood and immune-system cancer

Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells are present in the patient's lymph nodes. The condition was named after the English physician Thomas Hodgkin, who first described it in 1832. Symptoms may include fever, night sweats, and weight loss. Often, nonpainful enlarged lymph nodes occur in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy.

Epstein–Barr virus–associated lymphoproliferative diseases are a group of disorders in which one or more types of lymphoid cells, i.e. B cells, T cells, NK cells, and histiocytic-dendritic cells, are infected with the Epstein–Barr virus (EBV). This causes the infected cells to divide excessively, and is associated with the development of various non-cancerous, pre-cancerous, and cancerous lymphoproliferative disorders (LPDs). These LPDs include the well-known disorder occurring during the initial infection with the EBV, infectious mononucleosis, and the large number of subsequent disorders that may occur thereafter. The virus is usually involved in the development and/or progression of these LPDs although in some cases it may be an "innocent" bystander, i.e. present in, but not contributing to, the disease.

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is a malignancy of B cells. B-cells are lymphocytes that normally function in the humoral immunity component of the adaptive immune system by secreting antibodies that, for example, bind to and neutralize invasive pathogens. Among the various forms of B-cell lymphomas, THRLBCL is a rarely occurring subtype of the diffuse large B-cell lymphomas (DLBCL). DLBCL are a large group of lymphomas that account for ~25% of all non-Hodgkin lymphomas worldwide. THRLBCL is distinguished from the other DLBCL subtypes by the predominance of non-malignant T-cell lymphocytes and histiocytes over malignant B-cells in its tumors and tissue infiltrates.

Indolent lymphoma Medical condition

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow-growing non-Hodgkin lymphomas (NHLs). Because they spread slowly, they tend to have fewer signs and symptoms when first diagnosed and may not require immediate treatment. Symptoms can include swollen but painless lymph nodes, unexplained fever, and unintended weight loss.

Mature T-cell lymphoma, also called peripheral T-cell lymphoma, is a group of rare, aggressive lymphomas that develop from mature white blood cells and originate from lymphoid tissues outside of the bone marrow. Mature T-cell lymphoma is under the category of non-Hodgkin lymphoma. Mature T-cell lymphomas account for 10% to 15% of all lymphomas and is more common in Asia than in Europe and America. Its common subtypes include angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma and peripheral T-cell lymphoma not otherwise specified. While different subtypes have variable symptoms, common symptoms include enlarged painless lymph nodes, fever, weight loss, rash and night sweats.

References

  1. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (November 1971). "Report of the Committee on Hodgkin's Disease Staging Classification". Cancer Res. 31 (11): 1860–1. PMID   5121694.
  2. Reevaluation of prognostic significance of symptoms in Hodgkin's disease. Gobbi PG; Cavalli C; Gendarini A; Crema A; Ricevuti G; Federico M; Di Prisco U; Ascari E. Cancer 1985 Dec 15;56(12):2874–80.
  3. Malignant lymphoma: the histology and staging of 473 patients at the National Cancer Institute. Anderson T; Chabner BA; Young RC; Berard CW; Garvin AJ; Simon RM; DeVita VT Jr. Cancer 1982 Dec 15;50(12):2699–707.
  4. Stage I to IIB Hodgkin's disease: the combined experience at Stanford University and the Joint Center for Radiation Therapy. Crnkovich MJ; Leopold K; Hoppe RT; Mauch PM. J Clin Oncol 1987 Jul;5(7):1041–9.