Skinny Lymphoma

Really, it’s cutaneous but that doesn’t roll of the tongue as well as skinny. In the past 7-8 months, 3 pathology reports came back as lymphoma, from patients 18-75. That was at a dermatology clinic, in three years and five months I hadn’t seen one and the clinic sees A LOT of patients. Coincidence? Probably. Alien implants going haywire and causing cancers in abductees? No but that would make an interesting story line. I’m more partial to secret societies beaming 5G to every household and causing the human race to die off. Still probably not but you’ll find me in my Faraday Cage.

Enough of that, let me set my tin foil hat on my ark crystal, it needs to recharge. Lymphoma? Isn’t that a malignancy of the lymph system? Yes indeed it is young grasshopper, specifically arising from lymphocytes. Lymphocytes are white blood cells (part of the immune system) and make up between 18-45% of all circulating white blood cells. 

There are a huge amount of variety in subtypes of lymphoma, check the NIH reference I list below for a probably incomplete list. Broadly there are Hodgkins and non-Hodgkins (NHL) varieties. With Hodgkin’s lymphoma (HL) being less common. HL is diagnosed by the presence of big cells with multiple nuclei called Reed-Sternberg cells and typically starts in lymph nodes in the chest, neck or armpits. Whereas NHL can pop up anywhere, HL tends to be more predictable (moving in a logical fashion from node to node) and diagnosed much earlier than NHL (~38 vs >55). 

From what I have ready NHL is also more likely to metastasize and have a random distribution. Both present with swollen lymph nodes, B symptoms (fever, weight loss, night sweats), as well as anemia, fatigue, pruritis, and possible organomegaly. The hypothesized risks run the gamut from EBV (which causes all cancers and disease), HIV, HCV, HHV-8, autoimmune diseases, prior chemotherapy or radiation, environmental toxins, and genetics. Whew that’s a lot. Probably don’t smoke too, just better off in every way. 

What was I talking about? Oh yeah, a rash of cases at a dermatology clinic. See what I did there? Cutaneous forms of lymphoma are not uncommon as far as lymphomas go. So it makes sense that they would be mistaken as cysts or more common non-melanoma skin cancers. The ones I had heard of before were Sezary syndrome and mycosis fungoides, but this does not cover them all by a long shot. It’s an interesting idea for new healthcare peoples like me, keeping an open mind for these things. It really did look like and feel like a cyst, Cest la vie. Unconventional presentations are interesting for sure. 

Anyways, I get that I didn’t even scratch the surface but I wanted to get my basics down. I’m starting work on an oncology unit here in Minnesota and stoked to get down to business. Y’all have a fantastic weekend. Love y’all. 

References 

Image of Reed-Sternberg cell from Wikipedia 

Lymphoma from StatPearls

Non-Hodgkins Lymphoma from StatPearls

Several Cutaneous Lymphoma pages from StatPearls