Linfoma
Autor: Patoloblogger | Publicado: 2012-06-23T00:20:00-07:00


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O linfoma
é&nbsp;um conjunto de neoplasias (câncer)
que se inicia a partir de uma célula do sistema imunitário, o linfócito.
Esta anomalia é&nbsp;resultado de danos no material genético da célula, levando a mutações
do DNA
do linfócito que propiciará a esta célula, vantagem proliferativa havendo um
crescimento excessivo e descontrolado das células neoplásicas. Estas últimas
acumulam-se resultando em massas tumorais nos linfonodos e até mesmo, em outros locais do
organismo.

Existem
dois tipos de linfoma: o linfoma de Hodgkin e o linfoma não-Hodgkin.



Linfoma de Hodgkin

&nbsp; 





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Este
surge quando um linfócito, geralmente o linfócito B, se transforma em uma
célula maligna, crescendo descontroladamente e se disseminando pelo corpo.
Dentro dos linfonodos, haverá a produção de cópias idênticas
às células neoplásicas. Após um tempo, pode haver a disseminação dessas células
para os tecidos adjacentes, e quando não tratada pode afetar outras partes do
organismo. O linfoma de Hodgkin, a disseminação dos tumores se dá de grupos de linfonodos para outros grupos de linfonodos através da circulação linfática. Mais
comumente, este tipo de neoplasia se localiza no mediastino.



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Fatores de Risco

Existem
alguns fatores de risco para que haja o desenvolvimento dessa doença,
como: pessoas com o sistema imunitário comprometido, pode ser devido à doenças
genéticas hereditárias, infecção pelo vírus HIV, uso de medicamentos
imunossupressores, parentes de pessoas que apresentaram esta doença também
possui maior chance de vir a ter.



Sintomas

Os sintomas
irão depender da sua localização. Pode ocorrer em qualquer região do corpo, mas
quando seu desenvolvimento se dá em linfonodos
próximos da pele, do pescoço, das axilas e da virilha, os sintomas incluirão linfonodos
aumentados e indolores nesses locais do corpo. Caso ocorra na região
torácica, os sintomas podem ser de tosse, dispnéia e dor torácica. Quando se
localiza na pelve e na cavidade abominal, os sintomas podem ser de plenitude e
distensão do abdômen. Outros sintomas incluem febre, fadiga, sudorese noturna, perda
de peso e prurido.



Diagnóstico

O diagnóstico para
determinar seu tipo específico pode ser vários, sendo que a biópsia é considerada
obrigatória. Dentre os tipos desse exame estão:

Biópsia excisional ou insicional: o médico remove todo o
     linfonodo através de uma incisão na pele (excisional), ou uma pequena
     parte (insicional);
Biópsia de medula óssea: exame conhecido como mielograma,
     onde é
     retirado um fragmento de osso junto com medula óssea com a utilização de
     uma agulha. Embora esse método de diagnóstico não determine o tipo de
     linfoma, e importante para determinar a extensão da doença;


Outros exames também são
importantes na detecção do linfoma e determinação de sua localização, como
exames de imagem (raio-X,
tomografia computadorizada, ressonância magnética, entre outros). Exames
complementares que auxiliam na determinação das características específicas das
células tumorais incluem: imunohistoquímica,
estudos de citogenética e estudo de genética molecular.

Após ser
diagnosticada, a Doença de Hodgkin é&nbsp;classificada e seu estágio é
avaliado para que seja determinado o tratamento.



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Linfoma não-Hodgkin

&nbsp;



Este tipo
de linfoma engloba mais de 40 tipos distintos. Os parcos fatores de risco para
esse tipo de linfoma são:

Comprometimento do sistema
     imune: pessoas imunodeficientes, doenças genéticas hereditárias, uso de
     drogas imunossupressoras e infecção pelo vírus HIV.
Exposição química: pesticidas,
     solventes,
     fertilizantes, entre outros.
Exposição a altas doses de
     radiação.


Assim
como no outro tipo de linfoma, o diagnóstico é feito através de vários
tipos de exame. Existem vários tipos de biópsia que podem ser realizadas:

Biópsia excisional ou insicional;
Punção
     aspirativa por agulha fina;
Biópsia e aspiração da medula óssea;
Punção lombar.


Exames de
imagem também são feitos, como: raio-x, tomografia computadorizada, ressonância
magnética, cintilografia, entre outros. Junto a esses exames, realiza-se também
estudos celulares, como: imunohistoquímica, estudos de citogenética, citometria
de fluxo e estudos de genética molecular.



Tratamento

O
protocolo de tratamento de ambos os linfomas é determinado pelo médico de acordo com seu
tipo e seu estadiamento, mas na maioria dos casos é realizada quimioterapia,
radioterapia e a imunoterapia,
que a cada dia tem sido mais utilizada em associação com a quimioterapia.