13 Lymphoma, Myeloma, Leukemia

Question 1

Define malignant lymphoma and discuss general characteristics.

Answer 1

Malignancies of immune system, mostly affecting lymphocytes. Division: Hodgkin’s and non-Hodgkin’s lymphoma. Tend to be multifocal

Question 2

Describe Hodgkin’s disease (lymphoma)

Answer 2

Hodgkins disease (lymphoma). General considerations: Malignang cell “Reid-Sternberg cell (80% have markers for B-cells). Classically presents with lymphadenopathy. 75% cervical or supraclavicular. Predictable spread. Oral involvement rare.

Question 3

Describe non-Hodgkin’s lymphoma

Answer 3

Non-Hodgkins lymphoma. Diverse group immune system malignancies, usually B cell origin with some T cell origin. affect lymphoid tissues/ organs but spread more unpredictably and often affect nonlymphoid tissues i.e. oral present with lymphadenopathy or mass lesion orally, commonly affects palate

Question 4

Discuss characteristics, histologic findings and typical location of Hodgkin’s disease.

Answer 4

Histologic classification: **Reid Sternberg cell. (B-cells. 4 subtypes with distinct prognoses. Oral involvement is rare. 75% is found in the cervical or supraclavicular lymphnodes.

Question 5

Discuss measures used for clinical staging of Hodgkin’s disease.

Answer 5

Clinical staging - Determine anatomic sites involved

PE, chest film, CT, MRI, lymphangiography, laparotomy

Question 6

Ann Arbor system for classification of Hodgkin’s disease (Stage 1)

Answer 6

Stage I: Involvement of a single lymph node region (I) or a single extralymphatic organ or site (IE) /TREATMENT: Radiation therapy. Prognosis: 5 year survival over 90%

Question 7

Ann Arbor system for classification of Hodgkin’s disease (Stage 2)

Answer 7

Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm (II) or one or more lymph node regions with an extralymphatic
site (IIE) /TREATMENT: Radiation therapy. Prognosis: 5 year survival over 90%

Question 8

Ann Arbor system for classification of Hodgkin’s disease (Stage 3)

Answer 8

Stage III: Involvement of lymph node regions on both sides of the diaphragm (III)–possibly with an extralymphatic organ or site (IIIE), the spleen (IIIS), or both IIIES)/ TREATMENT: chemotherapy ± radiation

Question 9

Ann Arbor system for classification of Hodgkin’s disease (Stage 4)

Answer 9

Stage IV: Diffuse or disseminated involvement of one or more extralymphatic organs
(identified by symbols), with or without associated lymph node involvement/ TREATMENT: chemotherapy ± radiation

Question 10

What kind of prognosis would you expect for patients with Hodgkins lymphoma?

Answer 10

Most patients today survive their disease

Stage I and II, 5 year survival is over 90%

Question 11

Discuss some histologic characteristics of non-Hodgkins lympohma

Answer 11

General Characterisitcs: Usually B cell origin (some T-cell). ocassionally histiocytic.

Question 12

What are some areas commonly affected by non-Hodkins lymphoma?

Answer 12

Tend to affect lymphoid tissues/ organs but spread more unpredictably and often affect nonlymphoid tissues (oral present with lymphadenopathy or mass lesion orally), commonly affects palate, it can also affect bone.

Question 13

Describe the histologic classification of Non-Hodgkins lymphoma

Answer 13

Classification: Numerous subtypes. subclassified as: low grade, intermediate grade, high grade

Question 14

Describe the treatment and prognosis of non-Hodgkin’s lymphoma.

Answer 14

Treatment: radioation +/- chemotherapy
Prognosis: highly variable

Question 15

Discuss characteristics, etiology, radiographic and histologic findings of Burkitt’s lymphoma.

Answer 15

Type of non-Hodgkin’s B-Cell lymphoma, 90% contain Epstein-barr virus, 80% show translocation of proto-oncogene from C8 to C14, rapidly growing destructive lucency

Question 16

Discuss typical population and location of Burkitt’s lymphoma.

Answer 16

African jaw lymphoma–>jaws of children

American Burkitt’s - less jaw involvement, older patients. “Starry sky” phagocytic cells histology.

Question 17

What is characteristic treatment and prognosis for Burkitt’s lymphoma?

Answer 17

Tx - aggressive chemotherapy, with cyclophosphamide. Prognosis - highly variable.

Question 18

Identify the specific histologic finding associated with plasma cell dyscrasias.

Answer 18

Group of monoclonal malignant proliferative diseases affecting plasma cells. Light chains - Bence Jones proteinuria

Question 19

Discuss characteristics and typical location of multiple myeloma.

Answer 19

Most common primary malignancy of bone, about 30,000 new cases/yr, multifocal, occasionally soft tissue ↑↑ with age, ↑ males, tend to affect bones with most active marrow, vertebrae, ribs, skull, pelvis, jaws 10%

Question 20

What are some clinical features of multiple myeloma?

Answer 20

Clinical features: bone pain, anemia, infection, renal insufficiency, fatigue

Question 21

Discuss histologic and radiographic findings of multiple myeloma.

Answer 21

Histology: Monoclonal gammopathy, IgA, IgG, IgM, IgE or IgD ± light chains (Kappa or Lambda)
Radiographic features: Orally - destructive lucencies
Skull - punched out lucencies

Question 22

Discuss treatment and prognosis of multiple myeloma.

Answer 22

Treatment: Chemotherapy ± immunomodulating agents ± stem cell or bone marrow transplantation

Prognosis: Poor, overall 5 year survival is about 33%

Question 23

Discuss of solitary myeloma.

Answer 23

Single bone lesion of myeloma many patients will develop multiple myeloma

Question 24

Discuss characteristics of extramedullary plasmacytoma.

Answer 24

Soft tissue lesions

isolated or with multiple myeloma

Question 25

Define leukemia.

Answer 25

Malignancies of bone marrow stem cells which ultimately leave the bone and circulate producing luekocytosis (aids in diagnosis)

Question 26

What are some ways leukemia is classified?

Answer 26

myelocytic, lymphocytic, monocytic or leukocytosis and acute or chronic

Question 27

Describe the primary oral manifestations of leukemia.

Answer 27

Primary - generalized gingival enlargement due to malignant cells radiolucencies.

Question 28

Describe the secondary oral manifestations of leukemia.

Answer 28

Secondary - due to bone marrow panyctopenia (poverty of all normal cell lines) – anemia, thrombocytopenia - bleeding, immunosuppression - infections.