Bikman - Lymphoma Flashcards
What is a prominent feature of lymphoma?
Lymphadenopathy
Can also happen with simple infections
What are the two types of lymphomas?
Hodgkin
Non-Hodgkin
What are characteristics of non-Hodgkin?
- Malignant proliferation of lymphoid cells in peripheral lymph nodes
- Skips around
- Extranodal involvement is common
- Many subtypes
- Most are B cell
- > 40yo
What are characteristics of Hodgkin?
- Younger patients
- Good prognosis
- Contiguous spread
- Five subtypes
- Reed-Sternberg cells
What are symptoms of non-Hodgkin lymphoma?
- Painless, firm lymphadenopathy
- Extranodal manifestations, such as gingival and palatal lesions
- “B” symptoms: weight loss, night sweats, fever
In which lymphoma might you find gingival and/or palatal lesions?
non-Hodgkin’s (extranodal manifestations)
What are the two types of non-Hodgkin lymphomas?
Low-Grade
- Older patients
- Indolent (incurable)
- Small, mature cells
- Non-destructive
High-Grade
- Younger patients
- Aggressive (curable?)
- Large, distinct cells
- Destructive
What is the most notable difference between non-Hodgkin and Hodgkin lymphoma?
The Reed-Sternberg cells in Hodgkin lymphoma - these spread in a contiguous manner, so it’s easier to get rid of
What are the 4 different types of low-grade non-Hodgkin lymphomas?
- Small lymphocytic lymphoma
- Malt lymphoma
- Follicular lymphoma
- Mycosis fungoides
What are the 3 different types of high-grade non-Hodgkin lymphomas?
- Large cell lymphoma
- Lymphoblastic lymphoma
- Burkitt lymphoma
What are the features of small lymphocytic lymphoma?
Low-grade non-Hodgkin
- Small, mature lymphocytes
- Same thing as CLL
- CD5+
- Long course; infections are lethal
Expanding in the lymph nodes, rather than the blood
What are the features of malt lymphoma?
Low-grade non-Hodgkin
- Occurs in Mucosa-Associated Lymphoid Tissue
- Associated with H. pylori
- Caught early, can be cured with antibiotics
What are the features of follicular lymphoma?
Low-grade non-Hodgkin
- Follicular pattern (diffuse later)
- Small cleaved cell “centroblast”
- Grade 1-3 (based upon how many centroblasts you see)
Translocation at 14, 18 - bcl2
What are the different stages of follicular lymphoma?
- Single node
- Two or more nodes on the same side of the diaphragm
- Lymph nodes on both sides of diaphragm
- Diffuse extranodal involvement
What is the survival rate in the different stages of follicular lymphoma?
1 & 2 - 90% 5 year survival
3 & 4 - 40% 5 year survival
Follicular lymphoma: A & B?
A = no additional symptoms B = weight loss, night sweats, fever
What lymphoma are centroblasts characteristic of?
Follicular lymphoma (low-grade non-Hodgkin)
What are features of mycosis fungoides/sezary syndrome?
Low-grade non-Hodgkin
- Skin lesions - lymphocytes causing cutaneous tumors
- Blood involvement
- Cerebriform lymphocytes - cleaves in lymphocytes
- T-cell immunophenotype
- *T-cell expansion
What are features of large cell lymphoma?
- Large B cells
- Extranodal involvement
- Grows rapidly
- Bad prognosis (spreads rapidly)
What are features of lymphoblastic lymphoma?
- Typical patient: teenage male with mediastinal mass
- Same as ALL
What are features of Burkitt lymphoma?
High-grade non-Hodgkin
- Children, young adults
- Strong ethnic (African) preference
- Fast-growing, extranodal mass
- Starry sky pattern (same as B-cell ALL)
- Genetics
- – Highly associated with c-myc gene translocation
- – Tumor cells often infected with EBV
Translocation between chromosomes 8, 14
Which lymphoma has a translocation between chromosomes 8, 14?
High grade, non-Hodgkin
Burkitt
What are some features of Hodgkin lymphoma?
- Large lymph nodes
- Younger patients (~30yo)
- Good prognosis
- Contiguous spread (often involves abdominal organs)
- Can be a consequence of EBV
- Reed-Sternberg cells (multi-nucleated giant cells)
- 5 subtypes
What lymphomas can be caused by EBV?
- Hodgkin, as a consequence of EBV
Burkitt’s tumor cells are INFECTED with RBV
What are the different subtypes of Hodgkin lymphoma?
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte rich
- Lymphocyte depleted
- Lymphocyte predominance
Which of the 5 subtypes of Hodgkin lymphomas are classified as classic and why?
1-4 due to morphologic and immunophentotypic similarities
Which of the 5 subtypes of Hodgkin lymphomas are classified as non-classic and why?
5
Which of the 5 subtypes of Hodgkin lymphomas are the most common?
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte predominance
What is nodular sclerosis?
Hodgkin
- One of the most common
- Collagen splitting tumors into distinct nodes; lymph nodes are hardening
- Reed-Sternberg cells are called “lacunar cells”
What is mixed cellularity?
Hodgkin
- One of the most common
- RS cells surrounded by eosinophils, lymphocytes, histiocytes
What is lymphocyte predominance?
Hodgkin
- One of the most common
- Nodules contain predominately small lymphocytes with histiocytes and RS cells
What are features of multiple myeloma?
- Malignant proliferation of plasma cells
- Monoclonal gammopathy
- Decreased normal immunoglobulins
- Osteolytic lesions - bone loss
What are manifestations of multiple myeloma?
- Weakness
- Infections
- Renal failure
- Bone pain
- Hypercalcemia
- Bence-Jones proteins in urine
What is multiple myeloma?
Expansion of plasma cells. Very involved with producing antibodies.
What are features of multiple myeloma?
- Malignant proliferation of plasma cells
- Monoclonal gammopathy
- Decreased normal immunoglobulins
- Osteolytic lesions
What are manifestations of multiple myeloma?
- Weakness
- Infections
- Renal failure (excess Ca2+)
- Bone pain
- Hypercalcemia
- Bence-Jones proteins in urine
In what myeloma might you find Bench-Jones proteins in the urine?
Multiple myeloma
Multiple myeloma acronym?
CRAB
C - Ca2+ elevation
R - Renal failure
A - Anemia
B - Bone lytic lesions
Multiple myeloma treatment?
Chemo and radiation
Bone marrow transplant
20% 5yr survival (with chemo)
Which of the following lymphomas usually involve abdominal organs and is closely linked to the Epstein-Barr virus?
A. Non-Hodgkin lymphoma B. Hodgkin lymphoma C. Mantle Cell lymphoma D. Burkitt's lymphoma E. Follicular lymphoma
B. Hodgkin lymphoma
