Approach to Lymphadenopathy Flashcards
What are the symptoms of lymphadenopthy?
Lump and other associated features = night sweats, weight loss, itch without rash, alcohol induced pain, fatigue
What are the differentials of lymphadenopathy?
Reactive, bacterial infection (regional), viral infection (generalised), metastases, lymphoma
What are the features of lymphadenopathy associated with infection?
Viral = tender, hard, smooth, no inflammation of skin, not tethered Bacterial = tender, hard, smooth, inflamed skin, potentially tethered
What are the features of lymphadenopathy associated with lymphoma and metastases?
Lymphoma = non-tender, rubbery/soft, smooth, no inflammation of skin, not tethered Metastases = non-tender, hard, irregular, no skin inflammation, tethered
How are lymphomas investigated?
Can’t use CT
Biopsy done if lymphoma or other malignancy suspected = FNA or core biopsy often insufficient
What is the purpose of lymph node biopsies?
Helps confirm cancer and exclude other causes
Why is classification of lymphoma useful?
Guides treatment and predicts behaviour of lymphoma
What are the different methods of assessing lymph node pathology?
Histology, immunohistochemistry of solid node, immunophenotyping of blood/marrow, genetic and molecular analysis
What type of lymph node biopsy is best for diagnosing lymphoma?
Whole node biopsy = easier to histologically review sample than if CT guided biopsy was used
What is the purpose of immunohistochemistry?
Confirms lymphoma and helps to subclassify = looks at pattern of proteins on surface of lymphoma cells plus CD numbers
How is immunohistochemistry carried out?
Antibodies against proteins on cell surface are used and enzyme reaction occurs = brown colour is positive result
What type of tissue is used for immunophenotyping?
Cells in the liquid phase rather than a block section of tissue = blood or bone marrow samples
How is immunophenotyping carried out?
Cells are tagged with antibodies attached to a fluorochrome = emits a specific colour of light when a laser is shone on it
What is the use of immunophenotyping?
Determines pattern of CD numbers = very useful in leukaemias and lymphomas involving marrow
Why can lymphomas be cytogenetically analysed?
Certain lymphomas cause specific patterns of chromosome abnormality = can use FISH or G-banding to analyse
What occurs in G-banding?
Aspirate node, grow cells in culture and look at spread of chromosomes
How does FISH work?
Looks for specific abnormalities in chromosomes using probes that emit a specific light colour
What occurs in molecular analysis?
Looks at patterns of gene expression = multiple analyses look at patterns of genes that are switched on or off
What is the purpose of molecular analysis?
Helps to further classify lymphoma and identify subtypes suitable for specific treatment
What does analysis of activated B cell type NHL show?
Overexpression of activation markers = responds well to ibrutinib (cell signalling pathway inhibitor)
What lymphoma are Reed Sternberg cells associated with?
Hodgkin’s disease = very abnormal cells that have lost the normal proteins associated with B cells (e.g CD20)
What are the types of non-Hodgkin’s lymphoma (NHL)?
T cell (10%) and B cell (90%)
What are some types of B cell NHL?
Precursor B-ALL, B-ALL, lymphoblastic NHL, Burkitt’s, DLCL, mediastinal DLCL, primary effusion lymphoma, mantle cell lymphoma, follicular lymphoma, B-CLL, B-PLL, small lymphocytic lymphoma, lymphoplasmacytic lymphoma, marginal cell lymphoma, SLVL, MALToma
What are some types of T cell NHL?
Precursor T-ALL, lymphoblastic lymphoma, T-PLL, T cell LGL, NK cell leukaemia/lymphoma, ATLL (HTLV-1+), CTCL (Sezary/Mycosis fungoides), hepatosplenic gamma/delta lymphoma, enteropathy type T cell NHL, ALCL, peripheral T cell lymphoma, angioimmunoblastic NHL
