3.2: Lumps and Bumps (Increased Lymph Nodes) Flashcards
Lymphadenopathy (enlarged _______________) may be a result of various causes:
Infections
- Acute infections: bacterial, viral (e.g. HIV, ________________), parasitic (toxoplasmosis)
- Chronic infections (e.g. EBV)
Malignancies: ________________, metastasis from other cancers
Autoimmune: -
Other: Sarcoidosis, ___________ (when lymph nodes drain an area of diseased skin), snake bites
lymph nodes;
infectious mononucleosis;
Primary lymphoid malignancies;
dermatopathic
The clinical presentation of the patient can point to the cause of the lymphadenopathy, or certain investigations to undertake:
- Isolated lymphadenopathy: Tissues draining to that set of lymph nodes must be considered (e.g. ________________ should be considered when looking at cervical nodes)
- Widespread lymphadenopathy (with ____________): Glandular fever (infectious mononucleosis)
If the cause of the lymphadenopathy is not obvious, a ___________ is required (via fine needle aspirate or lymph node biopsy):
• Architecture of the lymph node can be observed on biopsy (important in diagnosis of lymphomas)
throat, chest, ear;
swinging fevers and sore throat;
tissue diagnosis
[Lymphoma]
Lymphomas are cancers beginning in the cells of the ________________ (tumour of lymphoid tissue):
The risk factors for lymphoma include viral infections, family history, radiation, drugs, autoimmune disorders and immunosuppressive therapy:
• Immunocompromised patients have increased likelihood of lymphoma as they are more susceptible to viral infections (linked to lymphoma development) and loss of immune surveillance
• Lymphoid neoplasms also cause secondary disruption of normal functioning immune system, causing some patients with lymphoma to develop immunodeficiency
SIGNS
The typical signs which point towards lymphoma includes:
1. ______________ lymphadenopathy (unexplained)
2. Fevers, ____________ (drenching), weight loss
3. On basis of routine investigations: abnormal CXR (e.g. _________________), FBC (increased ________________ in low grade lymphomas)
immune/lymphoreticular system;
Painless;
night sweats;
hilar lymph nodes/thymic mass;
peripheral blood lymphocytes
Lymphomas are classified into Hodgkin’s lymphoma (20%) and non-Hodgkin’s lymphoma (80%) based on whether the ____________ is present:
• Most cases of non-Hodgkin’s lymphoma are ________________
Hodgkin’s lymphoma: Classical (4 types)
- Mixed cellularity
- Lymphocyte-depleted
- Lymphocyte-rich
- ________________
- Nodular lymphocyte-predominant
Non-Hodgkin’s lymphoma
- B cell: Low grade (e.g. ____________ lymphoma); High grade (e.g. ______________ lymphoma)
- T cell: Precursor T cell neoplasms; _____________ T cell neoplasms
Reed-Sternberg cell;
high grade B cell lymphomas;
Nodular sclerosing;
follicular; diffuse large B cell;
Peripheral
LYMPH NODE ARCHITECTURE
- Germinal centre: B cells, APCs (site of B cell selection and activation)
- _______________: Naïve unstimulated B cells
- Paracortex: T cells, APCs
Different types of cells in the lymph nodes give rise to different malignancies:
- Naïve B cells: ___________________
- GC B cells: _____________, follicular lymphoma, ______________, diffuse large B cell lymphoma (DLBCL)
- Mantle zone B cells: ______________
- Memory B cells: Diffuse large B cell lymphoma (DLBCL)
- Plasma cells: ____________
Mantle zone;
Acute lymphoblastic leukaemia (ALL);
Hodgkin’s lymphoma; Burkitt’s lymphoma;
Mantle cell lymphoma ;
Myeloma
HODGKIN’S LYMPHOMA
Patients with Hodgkin’s lymphoma present with __________, __________ and ____________ pain, and asymmetric lymph nodes in the neck (typically painless, non-tender, rubbery) and splenomegaly upon examination:
• Characterised by the Reed-Sternberg cell (large bi nucleated cell with _________________ nucleoli)
Test results
- FBC: _______________________
- ESR: __________
- LDH: _________
- LFTs: -
- Bone marrow: Infiltration
- CT staging: -
fever; pruritus (itch); alcohol-induced;
prominent eosinophilic inclusion-like;
Neutrophilia and eosinophilia; Raised; Raised
[Ann-Arbor’s Classification]
Staging of the lymphoma in Hodgkin’s disease is important as it tends to start in only one group of lymph nodes before spreading to other nodes:
• Patient with involvement of only one group of lymph nodes is considered to have a less severe case of lymphoma compared to those with multiple groups
- Stage I: Only affects one group of lymph nodes
- Stage II: Affects multiple groups of lymph nodes (confined to one side of the ___________)
- Stage III: Affects multiple groups of lymph nodes on _____________________
- Stage IV: Affects ____________ (e.g. bone marrow, liver)
diaphragm;
both sides of the diaphragm;
extranodal tissues
[Types of Hodgkin’s Lymphoma]
Classical
- Patients are young
- Cellular origin: _____________ cells
- EBV association: ____
- Histology: _____ with mixed cell population (scattered Reed- Sternberg and Hodgkin’s cells with ______)
- Clinical course: moderately aggressive
Nodular lymphocyte- predominant
- patients have _______
- cellular origin: _____ cells
- EBV association: _____
- Histology: ________
- Clinical course: Indolent (but may transform to ______________)
GC/ Post GC B:
present;
sclerosis;
eosinophilia;
isolated lymphadenopathy;
GC B cells;
no;
Distinct B cell rich nodules;
High grade B cell lymphoma
Non-Hodgkin’s lymphoma includes high-grade diffuse large B cell lymphomas (37%) and low-grade follicular lymphomas (29%).
Follicular lymphoma often presents with lymphadenopathy and originates from a _____________ germinal centre cell:
• Median age of presentation is 60 years of age with median survival of 10 years
• Involves a classical __________________ (causing constitutive activation of the bcl-2 gene) → decreased cellular apoptosis
• Clinical course tends to be indolent (causing little/no pain), but may transform to a high-grade B cell lymphoma
• No cure with chemotherapy (only treatment for any complications and symptoms)
Diffuse large B cell lymphoma is a classical high grade non-Hodgkin’s lymphoma presenting with rapidly progressive lymphadenopathy and originates from GC/post-GC B cells:
• Mainly affects the elderly
• Histology reflects the lymphadenopathy as __________________
• Treated with combination chemotherapy and radiotherapy → mixture of rituximab and _____________________
• One third of patients are cured, one third respond to treatment and relapse, and one third do not respond
CD10+ and bcl-6+;
14;18 translocation involving the bcl-2 gene;
sheets of large lymphoid cells;
CHOP (cyclophosphamide, doxorubicin hydrochloride, oncovin, prednisolone)
BURKITT’S LYMPHOMA
Burkitt’s lymphoma is an aggressive tumour with dramatic presentations like an enlarging mass in the ___________________
• Typically affects young children and young adults
• Associated with ___________ and may be divided into 3 subtypes (endemic, sporadic, immunodeficiency) • Shows a characteristic ____________ appearance on histology (with CD10+ and bcl-6+ cells), with _____________________ involved
jaw or abdomen:
EBV infections;
starry-sky;
c-myc oncogene translocation (8;14, 2;8, 8;22)
Some special forms of T cell lymphomas include:
- Adult T cell leukaemia/lymphoma: Common in the _____________ (associated with HTLV-1 infections)
- Enteropathy-associated T cell lymphoma: Occurs in some patients with ____________
- Cutaneous T cell lymphomas: E.g. __________
- Anaplastic large cell lymphoma: Rare type (1% of all lymphomas)
Caribbean and Japan;
longstanding coeliac disease ;
mycosis fungoides
