Radiation Oncology/NHL/Lymphoblastic

Can present either as Acute Lymphoblastic Leukemia (ALL) or as lymphoblastic lymphoma (LBL) Lymphoblastic lymphoma seen more commonly in children and adolescents -- account for 1/2 of pediatric lymphomas. May spread to gonads or CNS "sanctuary sites. Can be either T-cell precursor or B-cell precursor: Precursor B-cell Most commonly presents as ALL, rarely as LBL Commonly bone marrow failure; clinical signs pallor, fatigue, bleeding, fever, infection; labs cytopenias Extranodal sites commonly involved (hepatomegaly, splenomegaly, CNS disease, testicular enlargement, cutaneous infiltration) Adverse features: very high WBC, symptomatic CNS disease, unfavorable cytogenic abnormalities (eg t(9;22)) Precursor T-cell: Commonly high WBC counts, mediastinal mass, lymphadenopathy, hepatosplenomegaly Can present with bone marrow failure, although typically less severe than precursor B-cell ALL/LBL Common presentation is young men with mediastinal mass/pleural effusions CNS involvement common