4 Childhood Lymphomas Flashcards

1
Q

Both HL and NHL start in the immune system, but spread differently. Which is generally more aggressive?

A

Hodgkins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which lymphoma is more common:
Less than 10 years old?
Between 15-19?
Males v females?

A

Overall 15% of childhood cancers
For children < 10 years of age, NHL is more common.
For children between the ages of 15-19, HD is almost twice as prevalent as NHL and is also very common in adults.
Male to female ratio
NHL < 15 years of age 3-4 times greater incidence in males compared to females
HD < 8 years of age male to female ratio is 4:1; by age 10 years and older the ration is 3:1 male to female.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Overall survival in HL and NHL?

A

HL - 90%, NLH similar depending on stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

General difference between B and T cells?

A

Both arise in marrow.
B cells become memory cells and regonize specific antigens. they attach and alert when the recognize one.
T cells either become helpers or killers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

6 major places that are lymphoid tissues (other than lymph nodes)

A
  • Tonsils and adenoids
  • Thymus
  • Spleen
  • Small intestine (peyers patches)
  • bone marrow
  • skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which is typically diagnosed with the Reed-Sternberg cell?

A

Hodgkins. gian cell with ‘owls eye’. It can also pop up with mono so its important to note the node it came from and if it is a ‘reactive’ lymph node architecture if it generally diagnostic. This is why a needle biopsy is not the way to go, they need to biopsy the whole thing if HD is suspected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hodgkins is most likely derived from B lymphocytes and commonly stain postiive for what?

A

CD30 and Fascin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hodgkin’s is sometimes associated with what infection?

A

EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hodgkin’s is more prevalent in which gender/age?

A

Rarely less than 5, peaks in adolescents and more common in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 predominant subtypes of HL?

A

1) Classic

2) Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do 80% of HL present with?

A

painless lymphadenopathy. Often supraclavicular or cervical.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In general, if somebody with HL presented with lymphadenopathy in THESE lymph nodes, it would indicate a serious pathologic process

A

epitrochlear (hollow above elbow) or supraclavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In staging HL, what is the difference between A symptoms and B symptoms

A

A is asymptomatic. B symtpoms include unexplained fevers, night sweats and weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you diagnose HL?

A

Biopsy lymph node. Remove the entire node.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which scan is the gold standard for HL?

A

PET.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Would you get a bone scan for HL?

A

only if there is bony involvement.

17
Q

What are the 4 stages of HL based on Ann Arbor Staging Classification

A

Stage I - disease confined to one lymph node or a single extralymphatic organ/site
Stage II - 2 or more lymph node regions on the same side of the diaphragm, or more than one organ/site and one or more lymph node regions on the same side of the diaphragm
Stage III - lymph nodes on both sides on diaphragm, possible involving spleen or organ/site
Stage IV - diffuce involvement of non-lymphoid organs or tissues (marrow, lung, liver, bone, etc)

18
Q

What is favorable risk HL?

A

stage I, IIA, and non-bulky disease (mediastinal mass < 1/3 maximum chest diameter or non-mediastinal mass < 6 cm in diameter.)

19
Q

Which HL treatments will get XRT? When?

A

Favorable patients only get it if they are ‘slow responders’ aka after 2 cycles of chemo have not shrunk initial mass by 80%. They will get more chemo and then low dose radiation therapy.
If unfavorable, 5 chemo cycles followed by either low dose rad therapy (IFRT) or radiotherapy.

20
Q

How long is treatment for HL

A

about 7 months

21
Q

Which medication for HL has food restrictions?

A

procarbazine.

22
Q

What is a popular HL regimen?

A

There are many. ABVD has adria, bleo, vinblastine and dacarbazine

23
Q

In XRT, what is the involved field, mantle field and inverted Y field?

A

Involved- original site
Mantle - neck check axillae
Inverted Y - spleen, para-aortic. common and eternal iliac and inguinal lymph nodes.
(see pic slide 27)

24
Q

What should be considered for females getting pelvic XRT?

A

Oophoropexy, surgical relocation of ovaries to preserve fertility

25
Q

What are risk factors for NHL? (immunodeficincies, either acquired or congenital)

A

-wiscott aldrich (eczema, thrombocytopenia, immune deficiency and bloody diarrhea)
-ataxia telengectasia
-primary immune deficiency
-X linked immune deficiencies
and anything acquired such as HIV, GVH, or a lympoproliferative disorder

26
Q

What is one of the fastest growing human tumors?

A

NHL, many children have life threatening symptoms by the time they reach a diagnosis

27
Q

Which scan is used if a PET is not available

A

Gallium (slide 44)

28
Q

When a presenting patient needs to get a marrow and biopsy what should be considered regarding mediastinal mass?

A

May be contraindicated with general anesthesia depending on how close to airway. If marrow/CSF is positive then you can get away without doing a biopsy

29
Q

What are the stages of the St Jude system for NHL?

A

Stage I - one tumor or single node area (except chest or abdomen)
Stage II - single tumor and regional nodes, greater than 2 nodes on same side of diaphragm or GI tumor
Stage III - 2 tumors on opposite sides of diaphragm, or greater than 2 nodal areas on both sides, primary chest/abdomen, or paraspinal/epidural tumor
Stage IV - any of the above plus CNS/marrow involvement

30
Q

Most common treatment for NHL?

A

Chemo, multiple agents. T-cell lymphoma is alot like ALL treatment.
Radiation is usually not used unless CNS positive T cell, or palliation.
If refractory, transplant.

31
Q

What are the 4 main types of NHL in childhood, and what is the origin?

A

Lymphoblastic lymphoma - t cell, about 30%, usually with mediastinal mass
Burkitt - B cell, often translocation C-MYC, often abdominal, or head/neck, often with abdominal pain or mimics appendicitis. assoc with ebv
Diffuse large B cell - B cell, CD antigens
Anaplastic large cell lymphoma (ALCL) - rare, T cells on CD 30

32
Q

What is Burkitt ‘leukemia’

A

If patients have more than 25% blasts in marrow they technically have leukemia, so a rare subtype of ALL is burkitt leuk(mature B cell) which is meant to distinguish is from other ALL because it should NOT be treated as ALL (poor response) it should be treated like Burkitt lymphoma