Approach to Lymphadenopathy Flashcards
the lymph node at the the left super calvicular area is aka
the virchows node
in terms of node consistency:
normal is _____; hard may be ___, rubbery may be ___, fluctuant may be ___
normal is soft; hard may be carcinoma, rubbery may be lymphoma, fluctuant may be infectious
if a node is tender, you must consider:
the first thing to think about is infection or inflammation. usually malignant ones are painless but not all the time
outline the scheme for the classification and differential diagnosis of localized lymphadenopathy
reactive vs neoplastic
outline the scheme for the classification and differential diagnosis for DIFFUSE lymphadenopathy
outline the scheme for hematological malignancies
“Lymphoma” is the malignant neoplasm of lymphoid tissue or “monoclonal proliferation of cells of Immune system
lymphoma can be ____ or ___ lymphoma
non-hodgkin or hodgkin lymphoma
if you do flow cytometry and it revelas that the excess proteins are polyclonal, it indicates ____. If monoclonal, it indicates ____
polyclonal ; indicates reactive
monoclonal; indicates malignant
compare and contrast lymphoma and leukemia
compare and contrast the incidience of non-hodkin and hodgkin lymphoma
non: more prevalent in older people
hodgkin: common in young people and then old people, with less liklihood aat middle age.
what’re the types of non-hodgkin lymphomas?
- B cell lymphoma (85%)
- T cell lymphoma (13%)
- NK cell lymphoma
how does B cell lymphoma (non-hodgkin) occur?
lymphoma occurs when enough genetic insults freeze the cells during differentiation.
methods of getting a definite diagnosis of lymphoma
- fine need aspiration
- needle core biopsy
- surgical biopsy (best preference)
essential information required to start treatment
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?
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).
this is a slide of a lymph node biopsy. what type of lymphoma might this person have?
hodgkins lymphoma. faint hypotrophic lymph nodes indicate a fibrosis.
which cells are characteristically seen in a classical hodgkin lymphoma PBS?
reed-sternberd cells that are surrounded by reactive cells like eosinophils, neutrophils, lypmohcytes and plasma cells.
what is the circled cells and what disease might this person have
reed-sternberg cells. characteristic of hodgkin lymphoma
most common subtypes of non-hodgkin lympoma
- diffuse large B cell lymphoma
- follicular lymphoma
- CLL/SLL
- T cell and NK cell lymphoma aren’t that common.
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.
common B cell lymphoma.
14;18 translocation
INDOLENT
compare and contrast these two lymph node slides
left: follicular lymphoma
right: normal
hodgkin lymphoma is associated with the ___ and ___ variant antigens
cd15 and cd30
which antigens are follicular lymphomas associated with
cd3 (t)
cd20 (b)
Bcl-2
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
present at any age. it has an AGGRESSIVE clinical course.
rituximab targets the ____ antigen which is why it’s affective at B cell lymphomas like DLBCL and Follicular lymphoma
Cd20 antigen
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.
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.)
accourding to CWC, why should we not choose a fine needle aspirate for the evaluation of a suspected lymphoma?
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
aggressive lymphomas
diffuse larger B-cell lymphoma, Burkitts, T-cell lymphomas.
indolent lymphomas
follicular, CLL, marginal zone lymphomas, Waldenstrom’s macroglobulinemia.
T/F indolent cancers are slower growing and easier to cure
false. although they are slower growing and repsonsive to treatment, they are harder to cure, Aggressive cancers are easier to cure.
outline the ann-arbour staging system for lymphomas
A and B symptoms
A= absence of extraneous symptoms
B= fever, night sweats, body weight loss >10%.
method of staging.
bone marrow biopsy or CT usually, then classified using ann-arbor
- one node
- two lymph nodes on one side detected
- lymph nodes involved in one side of the diaphragm
- metastatic disease.
the original lymph node biopsy does not stage– it just diagnosis.
PET scans are usually used to ___
confirm remission for lymphomas after treatment, particular for those with residual masses.
what is monoclonal antibody therapies
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.
role of ibrutinib in lymphoma therapy
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.
role of CAR-T cells in lymphoma therapy
role of check-point inhibitors in lymphoma therapy
role of BCL-2 inhibitors on lymphoma treatment
