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