Radiation Oncology/NHL/Lymphoblastic

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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