Lymphoma

ISSN 2398-2942

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Introduction
Pathogenesis
Diagnosis
Treatment
Outcomes
Further Reading

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Synonym(s): Malignant lymphoma, Lymphosarcoma, LSA

Introduction

Definition: neoplasm arising from lymphoid tissues, in any area of the body.
Most common hemopoietic neoplasm, 7-24% of all canine malignant neoplasms, 83% of all canine hematopoietic malignancies.
Forms: multicentric, thymic, alimentary, cutaneous, CNS, hepatic, renal and others. Can be intermediate/high grade or indolent.
Signs: depend on form, eg malaise, polydipsia, polyuria, respiratory distress, vomiting, diarrhea, constipation. Multicentric usually presents feeling well and owners notice 'lumps under jaw'.
Diagnosis: fine needle aspirate and cytology. Biopsy can be used to better define histologic variants and guide therapy and prognosis. Flow cytometry and PARR can help further with definitive diagnosis.
Treatment: cytotoxic drugs, surgery or radiation therapy can be used to treat localized problematic masses. Radiation therapy can be used for consolidation of tumor following chemotherapy (eg half body radiation therapy). Bone marrow transplantation. Immunotherapy is under development.
Prognosis: poor if no treatment for intermediate/high grade. Fair for indolent lymphomas.
Print off the owner factsheet on Canine lymphoma to give to your client.

Presenting signs

Depend on the extent and anatomic location of the tumor.
Lethargy.
Marked lymphadenopathy Lymphadenopathy (multicentric lymphoma).
Dyspnea/cough (thymic lymphoma Thymoma ).
Vomiting/diarrhea/anorexia (alimentary lymphoma Alimentary tract: neoplasia ).

Polydipsia/polyuria secondary to hypercalcemia Hypercalcemia: overview (multicentric thymic lymphoma, may be any form).
Hepatosplenomegaly Abdominal organomegaly.
Fever.
Extranodal sites - cutaneous masses, crusting or scaling skin lesions with epitheliotropic T-cell lymphoma Skin: epitheliotropic lymphoma, nasal congestion, anterior uveitis, glaucoma.

Acute presentation

Respiratory distress due to pleural effusion Pleural: effusion (thymic or mediastinal lymphoma).
Precaval syndrome (mediastinal lymphoma).
Intestinal obstruction (alimentary lymphoma) (very rare).
Seizure, paralysis, paresis (CNS lymphoma).

Age predisposition

Middle aged (median 6-9 years old).
May be seen in very young dogs.

Gender predisposition

Decreased risk is reported in intact females. Males may be more prone for T cell lymphoma.

Breed/Species predisposition

Higher incidence in:
- Golden Retrievers Retriever: Golden.
- German Shepherd Dog. German Shepherd Dog
- Scottish Terriers Scottish Terrier.
- Basset Hounds Basset Hound.
- Boxers Boxer - boxers tend to develop T-cell lymphomas.
- Cocker Spaniels English Cocker Spaniel.
- Rottweilers Rottweiler.
- Bernese mountains Bernese Mountain Dog.
- Bullmastiffs Bullmastiff.
- Airedales Airedale Terrier.
- Pitbulls.
- Irish Setters Irish Setter.
- Bulldogs Bulldog.
Lower incidence: Dachshunds Dachshund and Pomeranians Pomeranian.

Cost considerations

Cytotoxic agents, radiation therapy, bone marrow transplantation.
Not possible to define overall cost initially as depends on response to treatment, side effects, time of relapse.

Pathogenesis

Etiology

Unknown.
Genetic and molecular factors: gain of canine chromosomes 13 and 31, loss of chromosome 14, increase in in duration of first remission and overall survival time in dogs with trisomy 13, germline and somatic genetic mutations as well as altered oncogene/tumor suppressor gene expression have been reported in dogs.
Environmental factors (none definitively proven): herbicides (2,4-D), use of chemicals (paint or solvents), use of pesticides, exposure to strong magnetic fields, exposure to tobacco smoke, proximity to environmental waste.
Impaired immune function is associated with higher risk of developing lymphoma.

Pathophysiology

Malignant proliferation of lymphoid cells arising in any area containing lymphoid tissue → focal or diffuse masses in intestine, skin, thymus or lymph nodes → may progress to extranodal sites, eg liver, spleen, bone marrow.
Most common anatomic form, in order of decreasing prevalence: multicentric (80% of dogs with lymphoma), gastrointestinal, mediastinal, cutaneous. Rarer extranodal forms include for example renal, CNS, ocular, hepatosplenic, intravascular.
Can be due to malignant proliferation of B, T cell lines, or NK cells.
60-80% are B cell origin, 10-38% T cell, 22% mixed B and T cell, < 5% cel.
T cell tumors have a worse prognosis and poorer survival than B cell tumors.
All large cell T cell tumors should be treated as highly malignant and carry a poor prognosis. Small cell T-cell tumors can be very indolent with long term survival.
Paraneoplastic effects Neoplasia: paraneoplastic disease, eg hypercalcemia Hypercalcemia: overview (reported in 10-40% of dogs with lymphoma, most common with mediastinal form and T immunophenotype), immune-mediated thrombocytopenia Immune-mediated thrombocytopenia, anemia.

Timecourse

Rapidly fatal (4-6 weeks) without treatment for intermediate/high grade.
Months to years of survival for indolent lymphomas (with the exception of nodal marginal zone lymphoma) sometimes even without treatment.

Diagnosis

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Treatment

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Outcomes

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Other Sources Of Information

Vail D M, Pinkerton M, Young K M (2020) Hematopoietic tumours. In: Withrow & MacEwen’s Small Animal Clinical Oncology. 6th edn. Saunders pp 688-711.
Kansas State University modified UW-Madison lymphoma protocol for dogs Lymphoma: chemotherapy protocols.