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Two other features may be used to assess prognosis in B cell CLL, but neither has yet been incorporated into a staging classification. At least two subsets of CLL have been identified based on the cytoplasmic expression of ZAP-70; expression of this protein, which is usually expressed in T cells, identifies a subgroup with poorer prognosis. A less powerful subsetting tool is CD38 expression. CD38+ tumors tend to have a poorer prognosis than CD38– tumors. The initial evaluation of a patient with Hodgkin's disease or non-Hodgkin's lymphoma is similar. In both situations, the determination of an accurate anatomic stage is. | Chapter 105. Malignancies of Lymphoid Cells Part 9 Two other features may be used to assess prognosis in B cell CLL but neither has yet been incorporated into a staging classification. At least two subsets of CLL have been identified based on the cytoplasmic expression of ZAP-70 expression of this protein which is usually expressed in T cells identifies a subgroup with poorer prognosis. A less powerful subsetting tool is CD38 expression. CD38 tumors tend to have a poorer prognosis than CD38- tumors. The initial evaluation of a patient with Hodgkin s disease or non-Hodgkin s lymphoma is similar. In both situations the determination of an accurate anatomic stage is an important part of the evaluation. The staging system is the Ann Arbor staging system originally developed for Hodgkin s disease Table 105-8 . Table 105-8 The Ann Arbor Staging System for Hodgkin s Disease Stage Definition I Involvement of a single lymph node region or lymphoid structure e.g. spleen thymus Waldeyer s ring II Involvement of two or more lymph node regions on the same side of the diaphragm the mediastinum is a single site hilar lymph nodes should be considered lateralized and when involved on both sides constitute stage II disease III Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm IIIi Subdiaphragmatic involvement limited to spleen splenic hilar nodes celiac nodes or portal nodes III2 Subdiaphragmatic involvement includes paraaortic iliac or mesenteric nodes plus structures in III1 IV Involvement of extranodal site s beyond that designated as E More than one extranodal deposit at any location Any involvement of liver or bone marrow A No symptoms B Unexplained weight loss of 10 of the body weight during the 6 months before staging investigation Unexplained persistent or recurrent fever with temperatures 38 C during the previous month Recurrent drenching night sweats during the previous month E Localized solitary involvement of extralymphatic tissue .
