Richter transformation
Updates to Article Attributes
Richter transformation is defined as the development of high-grade non-Hodgkin lymphoma (NHL) in patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL).
It has been expanded to include other lymphoid malignancies that develop in CLL patients, including Hodgkin disease, prolymphocytic leukaemia (T-PLL), the Hodgkin variant of Richter transformation, small non-cleaved cell lymphoma, lymphoblastic lymphoma, and hairy cell leukaemia 8. Lymph node biopsy is required for the diagnosis of Richter transformation.
Epidemiology
Richter transformation is observed in about 5-10% of patients with chronic lymphocytic leukaemia 5.
Clinical presentation
Patients present with an aggressive disease course, with rapidly enlarging lymph nodes, hepatomegaly, splenomegaly, and elevated serum lactate dehydrogenase (LDH) levels. Systemic symptoms include weight loss, fever, and drenching night sweats. Abdominal pain may be a consequence of further hepatic and/or splenic enlargement.
Pathology
The nodal disease can potentially occur anywhere in the body. The disease can also present as distinct mass-like lesions 1.
Extranodal involvement is rare and can involve the gastrointestinal tract, central nervous system, skin, eye, lung, kidney, or testis.
Aetiology
The molecular mechanisms involved are poorly understood. Richter transformation may be triggered by viral infections, common in immunosuppressed patients, such as Epstein-Barr infection. Multiple genetic defects have been described that may cause CLL cell proliferation and eventual transformation 8.
Radiographic features
CT
Development of lymphadenopathy, particularly retroperitoneal, and splenomegaly in a context of known CLL.
Nuclear medicine
PET-CT may play a role and nodes show high FDG uptake 3,9.
Treatment and prognosis
Treatment strategies include chemotherapy regimens given for aggressive lymphoma or acute lymphoblastic leukaemia (ALL), with or without monoclonal antibodies, allogeneic stem cell transplantation, and, rarely, radiotherapy.
The disease responds poorly to therapy. Prognosis is poor, with a mean survival duration of 5-8 months for patients on therapy 8.
History and etymology
It was first described by the American pathologist, Maurice N Richter in 1928 4.
-<p><strong>Richter transformation</strong> is defined as development of high-grade <a title="Non-Hodgkin lymphoma" href="/articles/non-hodgkin-lymphoma">non-Hodgkin lymphoma (NHL)</a> in patients with <a title="Chronic lymphocytic leukaemia (CLL)" href="/articles/chronic-lymphocytic-leukaemia">chronic lymphocytic leukaemia (CLL)</a> or <a href="/articles/small-lymphocytic-lymphoma">small lymphocytic lymphoma</a>.</p><p>It has been expanded to include other lymphoid malignancies that develop in CLL patients, including <a href="/articles/hodgkin-lymphoma">Hodgkin disease</a>, <a title="T-cell prolymphocytic leukaemia" href="/articles/t-cell-prolymphocytic-leukaemia-1">prolymphocytic leukaemia (T-PLL)</a>, the Hodgkin variant of Richter transformation, small non-cleaved cell lymphoma, lymphoblastic lymphoma, and hairy cell leukaemia <sup>8</sup>. Lymph node biopsy is required for the diagnosis of Richter transformation.</p><h4>Epidemiology</h4><p>Richter transformation is observed in about 5-10% of patients with chronic lymphocytic leukaemia <sup>5</sup>. </p><h4>Clinical presentation</h4><p>Patients present with an aggressive disease course, with rapidly enlarging lymph nodes, <a title="Hepatosplenomegaly" href="/articles/hepatosplenomegaly">hepatosplenomegaly</a>, and <a title="elevated serum lactate dehydrogenase (LDH) levels" href="/articles/elevated-serum-lactate-dehydrogenase-ldh-levels">elevated serum lactate dehydrogenase (LDH) levels</a>. Systemic symptoms include <a title="Weight loss" href="/articles/weight-loss">weight loss</a>, <a title="Fever" href="/articles/fever">fever</a>, and <a title="night sweats" href="/articles/night-sweats">drenching night sweats</a>. Abdominal pain may be a consequence of further hepatic and/or splenic enlargement.</p><h4>Pathology</h4><p>The nodal disease can potentially occur anywhere in the body. The disease can also present as distinct mass-like lesions <sup>1</sup>.</p><p>Extranodal involvement is rare and can involve the gastrointestinal tract, central nervous system, skin, eye, lung, kidney, or testis.</p><h5>Aetiology</h5><p>The molecular mechanisms involved are poorly understood. Richter transformation may be triggered by viral infections, common in immunosuppressed patients, such as Epstein-Barr infection. Multiple genetic defects have been described that may cause CLL cell proliferation and eventual transformation <sup>8</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>Development of <a title="Lymphadenopathy" href="/articles/lymph-node-enlargement">lymphadenopathy</a> and <a title="Splenomegaly" href="/articles/splenomegaly">splenomegaly</a> in a context of known CLL.</p><h5>Nuclear medicine</h5><p>PET-CT may play a role and nodes show high FDG uptake <sup>3,9</sup>. </p><h4>Treatment and prognosis</h4><p>Treatment strategies include chemotherapy regimens given for aggressive lymphoma or <a title="Acute lymphoblastic leukaemia" href="/articles/acute-lymphoblastic-leukaemia">acute lymphoblastic leukaemia (ALL)</a>, with or without monoclonal antibodies, allogeneic stem cell transplantation, and, rarely, radiotherapy.</p><p>The disease responds poorly to therapy. Prognosis is poor, with a mean survival duration of 5-8 months for patients on therapy <sup>8</sup>.</p><h4>History and etymology</h4><p>It was first described by the American pathologist, <strong>Maurice N Richter</strong> in 1928 <sup>4</sup>.</p>- +<p><strong>Richter transformation</strong> is defined as the development of high-grade <a href="/articles/non-hodgkin-lymphoma">non-Hodgkin lymphoma (NHL)</a> in patients with <a href="/articles/chronic-lymphocytic-leukaemia">chronic lymphocytic leukaemia (CLL)</a> or <a href="/articles/small-lymphocytic-lymphoma">small lymphocytic lymphoma (SLL)</a>.</p><p>It has been expanded to include other lymphoid malignancies that develop in CLL patients, including <a href="/articles/hodgkin-lymphoma">Hodgkin disease</a>, <a href="/articles/t-cell-prolymphocytic-leukaemia-1">prolymphocytic leukaemia (T-PLL)</a>, the Hodgkin variant of Richter transformation, small non-cleaved cell lymphoma, lymphoblastic lymphoma, and hairy cell leukaemia <sup>8</sup>. Lymph node biopsy is required for the diagnosis of Richter transformation.</p><h4>Epidemiology</h4><p>Richter transformation is observed in about 5-10% of patients with chronic lymphocytic leukaemia <sup>5</sup>. </p><h4>Clinical presentation</h4><p>Patients present with an aggressive disease course, with rapidly enlarging lymph nodes, <a title="Hepatomegaly" href="/articles/hepatomegaly">hepatomegaly</a>, <a title="Splenomegaly" href="/articles/splenomegaly">splenomegaly</a>, and elevated serum lactate dehydrogenase (LDH) levels. Systemic symptoms include weight loss, fever, and drenching night sweats. Abdominal pain may be a consequence of further hepatic and/or splenic enlargement.</p><h4>Pathology</h4><p>The nodal disease can potentially occur anywhere in the body. The disease can also present as distinct mass-like lesions <sup>1</sup>.</p><p>Extranodal involvement is rare and can involve the gastrointestinal tract, central nervous system, skin, eye, lung, kidney, or testis.</p><h5>Aetiology</h5><p>The molecular mechanisms involved are poorly understood. Richter transformation may be triggered by viral infections, common in immunosuppressed patients, such as Epstein-Barr infection. Multiple genetic defects have been described that may cause CLL cell proliferation and eventual transformation <sup>8</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>Development of <a href="/articles/lymph-node-enlargement">lymphadenopathy</a>, particularly retroperitoneal, and <a href="/articles/splenomegaly">splenomegaly</a> in a context of known CLL.</p><h5>Nuclear medicine</h5><p>PET-CT may play a role and nodes show high FDG uptake <sup>3,9</sup>. </p><h4>Treatment and prognosis</h4><p>Treatment strategies include chemotherapy regimens given for aggressive lymphoma or <a href="/articles/acute-lymphoblastic-leukaemia">acute lymphoblastic leukaemia (ALL)</a>, with or without monoclonal antibodies, allogeneic stem cell transplantation, and, rarely, radiotherapy.</p><p>The disease responds poorly to therapy. Prognosis is poor, with a mean survival duration of 5-8 months for patients on therapy <sup>8</sup>.</p><h4>History and etymology</h4><p>It was first described by the American pathologist, <strong>Maurice N Richter</strong> in 1928 <sup>4</sup>.</p>
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