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Block 5 > 3.2 Lymphoma > Flashcards

3.2 Lymphoma Flashcards

1
Q

What is the common presentation of lymphoma?

A 
Asymptomatic 
Lump: enlarged nodes, extranodal mass 
Organomegaly 
B symptoms: fever, weight loss, night sweats 
Constitutional symptoms 
Unusual sites: lump, CNS, abdominal  
Metabolic complications: hyperclacaemia
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2
Q

What are the methods used for diagnosis in lymphomas?

A

Fine needle aspiartion
Excision biopsy
Routine histology
Ancillary investgations: flow cytometry, immunohistochemistry, cytogenetics, molecular studies

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3
Q

Which leukaemia has bone marrow involvement?

A

Chronic lymphocytic

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4
Q

What is the ann Arbor staging of lymphoma?

A

I: single lymph nod region or single extralymphatic site

II: two or more nodes regions on same side of diaphragm, may include localized extralymphatic involvement on same side

III: lymph node regions on both sides of diaphragm, may include spleen or localized extranodal disease

IV: diffuse extralymphatic disease (liver, bone marrow, lung, skin)

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5
Q

What differentiates CLL from mantle cell lymphoma?

A

CD23

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6
Q

What is the immunophenotype of CLL?

A

CD19, 23, 5 +

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7
Q

Which B cells are CLL thought to arise from?

A

Memory B cells and pre germinal centre naive B cell

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8
Q

What predicts a poor outcome in CLL?

A

Lack of somatic mutations (Ig)

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9
Q

What will you see histologically in CLL?

A

Disrupted tumour cells (SMUDGE CELLS) - little cytoplasm, brittle cells

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10
Q

What is the binet staging of CLL?

A

A: = 3 lymphoid areas
B = > 3
C: anaemia or thrombocytopenia

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11
Q

What is the prognosis of CLL based on?

A

Binet staging, mutated vs unmutated IgVH, cytogenetics

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12
Q

What B cell does follicular lymphoma originate from?

A

Follicular centre B cell

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13
Q

What will you see on flow cytometry for follicular lymphoma?

A

CD10/19, smlg+ (monoclonal)

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14
Q

What genetic mutation occurs in follicular lymphoma?

A

t(14;18) for gene BCL2

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15
Q

What scoring system is used for folicular lymphoma?

A 
FLIPI score 
= 5 nodal sites 
elevated LDH 
Age >60 
Stage 3 or 4 
Hb
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16
Q

What characterises follicular lymphoma?

A

malignant follicles (loss of apoptotic process due to the overexpression of BCL2)

17
Q

What is the usual presentation of follicular lymphoma?

A

asymptomatic for a long time (generalized lymphadenopathy) - usually very progressed at presentation

18
Q

What is the treatment of follicular lymphoma?

A

Only when symptomatic - low dose chemo

19
Q

What is used for the prognosis of DLBCL?

A 
Age (60) 
Stage (I/II vs. III/IV) 
Extranodal (1 vs. >1 site) 
LDH 
ECOG performance (0-1 vs. 2-4)
20
Q

What are the two cells of origin for DLBCL?

A

Germinal centre and post germinal centre B cell

21
Q

What gene is thought to be involved in DLBCL?

A

Bcl6 which is required for the formation of normal germinal centres, growth arrest and apoptosis

22
Q

What are the histologic features of DLBCL?

A

tumour cell shave large nucleus, open chromatin, and prominent nucleoli

23
Q

What is the genetic involvement of Burkitt lymphoma?

A

Translocation of the MYC gene on chromosome 8 leading to overexpression of MYC protein

Usually t(8;14)

24
Q

What infection is associated with Burkitt lymphoma?

A

EBV

25
Q

Why is Burkitt lymphoma so aggressive?

A

The cell shave a 100% proliferation rate

26
Q

What distinguishes Burkitt lymphoma on flow cytometry?

A

Lack of BCL2 (anti apoptotic protein)

27
Q

What is the histologic charaterising feature of Hodgkins lymphoma?

A

Reed Sternberg cells (owl eyes) - multiple nuclei or a single nucleus with multiple nuclear lobes each with a small incision like nucleolus about the size of a small lymphocyte

28
Q

Who normally gets Hodgkins lymphoma?

A

Bimodal - Young and old

29
Q

What is thought to occur in Hodgkins lymphoma?

A

Activation of NF-kB which rescues crippled germinal centre B cells from apoptosis resulting in the acquisition of other unknown mutations that collaborated to produce the Reed Sternberg cells which support the growth of tumour cells

30
Q

What infection if Hodgkins lymphoma associated with?

A

EBV and immunosuppressed patients

31
Q

What is the usual progression of Hodgkins lymphoma?

A

Nodal disease - splenic - hepatic - marrow and other tissues

32
Q

What are the treatment options for lymphomas?

A

Chemoherapy
Monoclonal antibodies (Rituximab - against CD20)
Radiotherapy

Wait and watch for indolent

Anti-emetics
G-CSF antibiotics
Transfusion support

33
Q

What are the markers of B cell differentiation?

A

CD20, CD22, CD19

Block 5 (35 decks)

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