11-20 L1 clinical approaches to lymphadenopathy

Question 1

Incidence of lymphoma by age

<10 yo

10-25 yo

>25 yo

Answer 1

• >10 = NHL
• 10-25= HD
• >25= NHL

Question 2

Ann arbor staging of lymphoma

define the 4 stages

Answer 2

1. Single lymph node
2. 2 or more regions on same side of diaphragm
3. Both sides of diaphragm or spleen involvement
4. Disseminated involvement of extra lympatic tissue

Question 3

Define B-symptoms in HL

Answer 3

B-symptoms

• recurrent fevers (>38 C)
• Unexplained weight loss (>10%)
• Drenching night sweats

Question 4

Follicular lymphoma

Answer 4

• chrom translocation t(14:18)
  
  • bcl-2 overexpression inhibits programed cell death
• express surface CD20

Question 5

Burkitt lymphoma

B-cell NHL

• Endemic
• Non-endemic

Answer 5

• endemic
  
  • EBV assoc.
  • most common site, H&N
• non-endemic
  
  • DNA translocationinvolving chrom 8
    
    • dereg activation of c-myc and B-cell proliferation
  • fasteste proliferating tumor
  • most common site abdomen

Question 6

TLS

Tumor Lysis Syndrome

Answer 6

• occurs with a high rate of cell turnover, causes renal injury (clogs the kidney) and electrolyte disturbance
• (K, CA, PO4, purine break down )
• LDH (intracellular enzyme) is a marker of cell turnover
• Treatment
  
  • Allopurinol
  • Urate oxidase

Question 7

Superior mediastinal syndrome

Superior vena cava syndrome

Answer 7

• a set of symptoms from compression of the structures in a closed space
• associted with a number of tumors