Approach to Lymphadenopathy

Question 1

the lymph node at the the left super calvicular area is aka

Answer 1

the virchows node

Question 2

in terms of node consistency:

normal is _____; hard may be ___, rubbery may be ___, fluctuant may be ___

Answer 2

normal is soft; hard may be carcinoma, rubbery may be lymphoma, fluctuant may be infectious

Question 3

if a node is tender, you must consider:

Answer 3

the first thing to think about is infection or inflammation. usually malignant ones are painless but not all the time

Question 4

outline the scheme for the classification and differential diagnosis of localized lymphadenopathy

Answer 4

reactive vs neoplastic

Question 5

outline the scheme for the classification and differential diagnosis for DIFFUSE lymphadenopathy

Answer 5

Question 6

outline the scheme for hematological malignancies

Answer 6

“Lymphoma” is the malignant neoplasm of lymphoid tissue or “monoclonal proliferation of cells of Immune system

Question 7

lymphoma can be ____ or ___ lymphoma

Answer 7

non-hodgkin or hodgkin lymphoma

Question 8

if you do flow cytometry and it revelas that the excess proteins are polyclonal, it indicates ____. If monoclonal, it indicates ____

Answer 8

polyclonal ; indicates reactive

monoclonal; indicates malignant

Question 9

compare and contrast lymphoma and leukemia

Answer 9

Question 10

compare and contrast the incidience of non-hodkin and hodgkin lymphoma

Answer 10

non: more prevalent in older people
hodgkin: common in young people and then old people, with less liklihood aat middle age.

Question 11

what’re the types of non-hodgkin lymphomas?

Answer 11

1. B cell lymphoma (85%)
2. T cell lymphoma (13%)
3. NK cell lymphoma

Question 12

how does B cell lymphoma (non-hodgkin) occur?

Answer 12

lymphoma occurs when enough genetic insults freeze the cells during differentiation.

Question 13

methods of getting a definite diagnosis of lymphoma

Answer 13

1. fine need aspiration
2. needle core biopsy
3. surgical biopsy (best preference)

Question 14

essential information required to start treatment

Answer 14

Question 15

classical hodgkin lymphoma has a ____ age distribution and mostly presents as ___ lymphadenopathy. The lymph nodes tend to be ___ ____ and ___, and spreads in an orderly fashion (nodal). Is it curable?

Answer 15

it is curable. it’s one of the few curable cancers.

classical hodgkin lymphoma has a BIMODAL age distribution and mostly presents as CERVICAL lymphadenopathy. The lymph nodes tend to be NONTENDER, SOFT and MOBILE, and spreads in an orderly fashion (nodal).

Question 16

this is a slide of a lymph node biopsy. what type of lymphoma might this person have?

Answer 16

hodgkins lymphoma. faint hypotrophic lymph nodes indicate a fibrosis.

Question 17

which cells are characteristically seen in a classical hodgkin lymphoma PBS?

Answer 17

reed-sternberd cells that are surrounded by reactive cells like eosinophils, neutrophils, lypmohcytes and plasma cells.

Question 18

what is the circled cells and what disease might this person have

Answer 18

reed-sternberg cells. characteristic of hodgkin lymphoma

Question 19

most common subtypes of non-hodgkin lympoma

Answer 19

1. diffuse large B cell lymphoma
2. follicular lymphoma
3. CLL/SLL
4. T cell and NK cell lymphoma aren’t that common.

Question 20

Follicular lymphoma is a common ____-cell lymphoma in adults. It’s associated with the ___ translocation and has an ____ clincal course except in high grade cases.

Relapse and progression to aggressive disease is common.

Answer 20

common B cell lymphoma.

14;18 translocation

INDOLENT

Question 21

compare and contrast these two lymph node slides

Answer 21

left: follicular lymphoma
right: normal

Question 22

hodgkin lymphoma is associated with the ___ and ___ variant antigens

Answer 22

cd15 and cd30

Question 23

which antigens are follicular lymphomas associated with

Answer 23

cd3 (t)

cd20 (b)

Bcl-2

Question 24

diffuse large B-cell lymphnoma is a common B-cell lymphoma that can present at ____ age. it has an ____ clinical course and usually presents as advance stage. A high percentage of patients can be cured

Answer 24

present at any age. it has an AGGRESSIVE clinical course.

Question 25

rituximab targets the ____ antigen which is why it’s affective at B cell lymphomas like DLBCL and Follicular lymphoma

Answer 25

Cd20 antigen

Question 26

CLL/SLL often presents in ____ ages. it presents as asymptompatic lymphocytosis (gotta look for monoclonal markers in flow cytometry) and has an ___ clincal course. it is impossible to cure.

Answer 26

presents in all ages and has an indolent clinical course

(Aggressive lymphomas are fast-moving and account for about 60 percent of all NHL cases. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive NHL subtype. Indolent lymphomas are slow-moving and tend to grow more slowly and have fewer signs and symptoms when first diagnosed.)

Question 27

Question 28

accourding to CWC, why should we not choose a fine needle aspirate for the evaluation of a suspected lymphoma?

Answer 28

The diagnosis of lymphoma requires specimens with intact
cellular architecture for accurate histopathological and immnophenotypic classification 

An FNA will delay lymphoma diagnosis

 An FNA is only appropriate if lymphoma is not part of the
differential diagnosis of a patient with lymphadenopathy

Question 29

aggressive lymphomas

Answer 29

diffuse larger B-cell lymphoma, Burkitts, T-cell lymphomas.

Question 30

indolent lymphomas

Answer 30

follicular, CLL, marginal zone lymphomas, Waldenstrom’s macroglobulinemia.

Question 31

T/F indolent cancers are slower growing and easier to cure

Answer 31

false. although they are slower growing and repsonsive to treatment, they are harder to cure, Aggressive cancers are easier to cure.

Question 33

outline the ann-arbour staging system for lymphomas

Answer 33

Question 34

A and B symptoms

Answer 34

A= absence of extraneous symptoms

B= fever, night sweats, body weight loss >10%.

Question 35

method of staging.

Answer 35

bone marrow biopsy or CT usually, then classified using ann-arbor

1. one node
2. two lymph nodes on one side detected
3. lymph nodes involved in one side of the diaphragm
4. metastatic disease.

the original lymph node biopsy does not stage– it just diagnosis.

Question 36

PET scans are usually used to ___

Answer 36

confirm remission for lymphomas after treatment, particular for those with residual masses.

Question 37

what is monoclonal antibody therapies

Answer 37

a type of cancer treatment that is a form of immunotherapy. these drugs bind to specific clonal marker antigens (ex. retuximab CD20 binder)

very well tolerated.

Question 38

role of ibrutinib in lymphoma therapy

Answer 38

a novel agent that binds to bruton’s tyrosine kinase.used to treat CLL, mantel cell lymphoma, Waldenstrom’s macrogloulinemia and other lymphomas (more of the indolent lymphomas)

also used to treat chronic GVHD.

Question 39

role of CAR-T cells in lymphoma therapy

Answer 39

Question 40

role of check-point inhibitors in lymphoma therapy

Answer 40

Question 41

role of BCL-2 inhibitors on lymphoma treatment

Answer 41