Condition- Hodgkin's and Non-Hodgkin's lymphoma

Question 1

Define Hodgkin’s Lymphoma

Answer 1

Malignancy of lymphoid cells in lymphoid tissue characterised by the presence of REED-STERNBERG cells

Question 2

Describe the age distribution of Hodgkin’s lymphoma

Answer 2

20-30yrs and >50yrs

Question 3

Which infectious disease is Hodgkin’s lymphoma associated with?

Answer 3

EBV

Question 4

List the presenting symptoms of Hodgkin’s lymphoma

Answer 4

• LYMPHADNOPATHY
  
  • non-tender, usually cervical, might be groin/axilla
• Mediastinal lymphadenopathy
  
  • SVC obstruction => facial swelling
  • Bronchial obstruction => SOB
• B-symptom: FLAWS

Question 5

State the B symptoms of Hodgkin’s lymphoma

Answer 5

• Pyrexia (might be Pel-Ebstein fever= cyclical >38^oC)
• Weight Loss >10% body weight over 6 months
• Night sweats

Question 6

What makes lymphadenopathy painful in Hodgkin’s lymphoma?

Answer 6

Alcohol

Question 7

List some of the signs of Hodgkin’s examination on physical examination

Answer 7

• Lymphadenopathy: firm, rubbery, non-tender
• SVC Obstruction: facial oedema, raised JVP
• Pyrexia
• Cachexia
• May get splenomegaly
• anaemia (pallor)= ACD

Question 8

Describe the characteristsic of the fever experienced by patients with Hodgkin’s lymphoma

Answer 8

Pel Ebstein Fever= cyclical temperature (over course of weeks)

Question 9

What would you see in the bloods of someone with Hodgkin’s lymphoma?

Answer 9

• HIgh WCC, high eosinophil, high neutrophils
• Low Hb= ACD
• High LDH
• High ESR + CRP

Question 10

Which investigation would you conduct to get a definitive diagosis of Hodgkin’s lymphoma?

Answer 10

Excisional Lymph Node Biopsy

Question 11

What can be seen in this biopsy of the lymph node? Which condition is this seen in?

Answer 11

Rees-Sternberg Cells

Hodgkin’s Lymphoma

Question 12

Which system is used to stage Hodgkins and Non-hodgkins lymphoma?

Answer 12

Ann Arbor staging

Question 13

What are the different stages of the Ann Arbor staging system?

Answer 13

1. Single Lymph node
2. Two or more regions involved on the same side of the diaphragm
3. Involvement of lymph node regions on both sides of the diaphragm
4. Involvement of extra-nodal sites (Gut, liver, spinal cord, bones)

Question 14

Which out of HL and NHL has a worse prognosis? Why?

Answer 14

Non-Hodgkin’s Lymphoma is worse

Non-Hodgkin’s Lymphoma tends spread extra-nodally whereas HL has a ‘contagious’ spread meaning in spreads via lymphatic chains

Question 15

Define Non-Hodgkin’s Lymphoma

Answer 15

A group of malignancies of the lymphoid system

Question 16

List some risk factors NHL

Answer 16

• Oncogenic infections
  
  • EBV and Burkitt’s Lymphoma
  • HBV, HCV
• Immunocompromised- HIV
• Radiotherapy
• SLE, Sjogrens

Question 17

State a dermatological manifestation of NHL

Answer 17

Mycoses Fungoides= cutaneous T cell lymphoma

Question 18

List some of the presenting symptoms of NHL

Answer 18

• Lymphadenopathy: non-tender, usually cervical, can be groin/axilla
• Extra-Nodal Involvement:
  
  • Bone: BM failure (Anaemia, bruising, infections)
  • GIT: Abdo pain, Bowel Obstruction (MALT)
  • Cord compression: loss of sensation etc.
  • CNS: headaches, change in mental state
  • Skin: mycoses fungoides rash
• Systemic Symptoms:
  
  • Fever, weight loss, sweats

Question 19

List some signs of NHL on physical examination

Answer 19

• Lymphadenopathy: rubbery, firm, non-tender
• Extra-nodal signs:
  
  • BM failure: pallor, petechiae
  • Abdo mass
  • Hepatosplenomegaly
  • Mycoses fungoides
• Systemic signs: Pyrexia

Question 20

African boy, lymphadenopathy + jaw enlargement as seen below, also complains of high-grade fevers and sweats. What’s the diagnosis? Which disease is it associated with?

Answer 20

Burkitt’s Lymphoma

EBV infection

Question 21

List some investigations you would conduct on a patient with NHL

Answer 21

• Bloods: FBC, LFTs, LDH
• Excisional Lymph node biopsy
• Skin biopsy (mycoses fungoides)
• CT scan + Ann arbor staging