Difference Between Lipoma and Lymphoma
Lipoma and Lymphoma are both types of growths in the body. Lipoma is a benign, non-cancerous growth of fat cells, typically harmless and painless. On the other hand, lymphoma is a type of cancer that begins in the lymphatic system, which can progress and become life-threatening, requiring immediate medical attention.
What is the difference between lymphoma and lipoma?
Lymphoma and lipoma are two distinct tumour types that develop in different tissues and also differ in characteristics and prognoses.
Lipomas are generally benign (not cancerous) tumours that form in the layer of fatty tissue under the skin. They can occur anywhere throughout the body, and are usually painless, and most often do not cause symptoms. Importantly, lipomas do not metastasise or spread to other parts of the body [1].
On the other hand, lymphomas are cancerous tumours that originate in the lymphatic system, a part of the body's immune system. There are more than 70 types of lymphoma, which can be broadly classified into Hodgkin's lymphoma and non-Hodgkin's lymphoma. This classification depends on the presence of a type of cell called Reed-Sternberg cells. These cells are large, atypical cells that sometimes contain more than one nucleus, and are present in Hodgkin lymphoma tumours [2]. Lymphomas can present with a variety of symptoms, including swollen lymph nodes, fatigue, unexplained weight loss, and night sweats. Unlike lipomas, lymphomas are malignant and can spread to other parts of the body if not treated [3].
What is lipoma and what is its diagnosis and treatment?
A lipoma is a non-cancerous tumour composed primarily of fat tissue. Lipomas are the most common soft tissue tumours, and can develop in every part of the body. They present as a lump under the skin, typically soft to the touch with a dough-like texture, mobile (can be moved around a few millimeters) and generally small (usually smaller than 5 centimetres)
While they are usually painless, some patients can experience pain or restriciton in movement if the lipoma is located close to a joint. Lipomas are slow-growing and usually first appear between 40 and 60 years of age [2, 4]. The causes for lipoma are unknown, with a potential genetic contribution that, however, needs further robust investigation to be confirmed.
Prognosis and treatment for lipoma
As lipomas are not cancerous, the prognosis is very good. Lipomas do not pose a threat to the patient, and most patient opt for treatment only when their lipoma presents with discomfort, or starts to grow.
Lipomas are diagnosed by physical examination, and sometimes ultrasound is used. A doctor may take a biopsy - a small sample of the lipoma to confirm it is not cancerous (sometimes lipomas can resemble liposarcomas, which are cancerous). Further imaging (CT or MRI) may be used if a liposarcoma is suspected.
The most common treatment for lipomas is surgical removal. The surgery itself is not complicated and can be done in-office with local anaesthesia. The doctor makes an incision in the skin to remove the lipoma and then sews up the incision [4]. Lipomas can also be removed by liposuction, however this may only reduce the size of the lipoma and not remove it entirely. While generally useful for larger lipomas, liposuction can be made more complicated and less effective by overly fibrous lesions [5]. Studies showed that treatment with liposuction is generally successful, with no recurrences seen in two studies in a 12-month follow-up window [2, 6].
Another treatment option is mesotherapy, where an injection is administered in the lipoma to dissolve the fat cells. This has been shown to reduce the volume of lipomas with very few minor complications and excellent cosmetic outcomes, as scarring is eliminated with the injection [7]. The injection approach can be made more effective with ultrasound guidance, where a complete removal of 70.59% of lipomas was reported [8]. The choice of treatment depends on the size, location and number of lymphomas and the patient's preferences. It is important to discuss all diagnostic and treatment considerations
However, the choice of treatment depends on the size, location, and number of lipomas, as well as the patient's preference and overall health. It's important to discuss all treatment options with a healthcare provider to determine the best approach.
What is lymphoma?
Lymphoma is a term that encompasses malignant (cancerous) neoplasms originating from lymphocytes - white blood cells. There are more than 70 subtypes, which are traditionally classified into two categories: Hodgkin and non-Hodgkin lymphoma. Lymphoma can potentially arise from any lymphoid tissue (any tissue with white blood cells) in the body, making it a diverse and complex group of diseases [9].
Each subtype of lymphoma has specific clinical, morphological, immunophenotypic, and genetic characteristics. The most common subtype of non-Hodgkin lymphoma is B-cell lymphoma, which accounts for approximately 85% of all lymphoma cases. Other subtypes include follicular lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma, small cell lymphocytic lymphoma/chronic lymphocytic leukemia, and prolymphocytic leukemia. Interestingly, the incidence and frequency of specific subtypes of lymphoma can vary geographically [10, 11, 12].
What are the symptoms of lymphoma?
As lymphomas are very heterogeneous, they can present with a variety of symptoms that can sometimes be overlooked due to their nonspecific nature. The most common symptom is swelling in the lymph nodes, which are organs of the immune system located in multiple areas of the body such as the neck, upper chest, armpit, stomach, and groin. The swelling presents with the presence of small soft nodules under the skin [3, 2, 6, 1].
Fatigue is another common symptom - this can range from mild to severe and is often attributed by patients to insufficient sleep and/or bad diet. It is important to discuss persistent fatigue with a doctor [2, 6, 1]. This fatigue may also be associated with weight loss, potentially due to loss of appetite and/or stomach pain, which are also associated with lymphoma [3, 2, 6, 1].
Fever, chills and night sweats are also commonly reported with lymphomas [3, 2, 6, 1]. If they persist, it is important to consult with a doctor. Other symptoms can include itching and skin symptoms such as rashes, shortness of breath (especially with advanced tumours that affect the lungs), cough, pain or feelings of fullness below the ribs, easy bruising or petechiae (small spots of bleeding under the skin) [3, 2, 6, 1].
As lymphomas can occur anywhere in the body, the symptoms usually coincide with the location. Tumours in the head and neck may present with symptoms such as pain or difficulty with swallowing (odynophagia or dysphagia), while lymphomas in the abdomen may cause epigastric pain and nausea [5].
Diangosis of lymphoma
As the symptoms of lymphoma can overlap with other illnesses, the first, and perhaps most important step in the diagnostic pathway is the collection and analysis of the patient's medical history and a clinical examination of the swollen lymph nodes.
The most important step of the diagnosis is a biopsy and its examination. A needle is inserted into the lymph node under local anaesthetic and a sample of the tissue is taken. A biopsy is the single most important tool in lymphoma diagnosis [13]. The biopsy is followed by a histopathological examination where the tissue is stained with dyes that bind to specific proteins or cell types and the staining patterns are observed under the microscope.
Immunohistochemistry and flow cytometry are used to identify the cell of origin and its and classify the lymphoma. These are also useful for determining the patient's prognosis [14]. As there are genetic components to lymphoma development and progression, a technique called fluorescence in situ hybridization (FISH) is used to detect abnormalities in the chromosomes of the cancerous cells (chromosomes are units where DNA is stored, tightly packed), and other mutations that may be present in lymphoma cells [15]. Additional genetic (molecular) testing had become an integral part of lymphoma diagnosis. DNA and RNA sequencing or qPCR can be used to determine prognosis, as well as guide therapeutic decisions with therapies targeting a certain mutations (such as analysis of BTK, PLCG2, and BCL2 for therapy with ibrutinib and venetoclax [16].
Diagnostic imaging is also routinely performed. Ultrasound of the lymph nodes is useful to diagnose non-Hodgkin lymphomas, where lymph node swelling is present. CT or MRI can be used to advanced disease, as well to monitor relapse to an extent. However, positron emission tomography (PET) using 2fluoro-2-deoxy-d-glucose the gold standard in staging, monitoring, and detecting relapse in both Hodgkin's and non-Hodgkin lymphoma [17].
The heterogeneity of lymphomas largely shapes the diagnostic pathway. Interdisciplinary communication in the clinic between the oncologists, haematologists, radiologists, pathologists and biomedical scientists is crucial for an accurate diagnosis and a pesonalised management plan for every patient [15].
Treatment and Prognosis of Lymphoma
The treatment of lymphoma depends on the grade and stage of the disease.
High-grade lymphomas (more advanced disease with worse prognosis) typically require systemic, cytotoxic chemotherapy. The frontline treatment for Non-Hodgkin lymphoma a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), sometimes with rituximab (R-CHOP). Hodgkin lymphoma is treated with combined chemotherapy regimens such as ABVD, Stanford V, or BEACOPP, often in combination with radiotherapy.
Localized, low-grade lymphomas (often with better prognosis) can often be managed with local radiotherapy, the purpose of which is to kill the cells by radiation and shrink the tumours. There are now a variety of targeted therapeutics, which can be administered following a specific molecular finding. These can be administered in combination with chemotherapy or radiotherapy to increase its effectiveness or alone. Cellular therapies, such as chimeric antigen receptor T-cells (CAR-T) are also avialable and are showing promise in lymphoma management [18, 19, 20].
The prognosis of lymphoma varies widely depending on the subtype and stage of the disease, as well as the patient's age and fitness.
For example, Hodgkin lymphomas in young patients have a generally good prognosis. Plasma cell neoplasms, on the other hand, have a poorer prognosis. Despite modern treatment generally being effective, the clinical course of lymphoma is often characterised by multiple remissions and relapses. Fortunately, there is a large body of research exploring alternative therapeutics with the aim to improve the standard of care of lymphoma.
