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SA DX & TX I > Exam 1 - Canine Lymphoma > Flashcards

Exam 1 - Canine Lymphoma Flashcards

1
Q

what is the most common neoplastic disease in canines?

A

lymphoma - 24%

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2
Q

what is the most common lymphoma in dogs?

A

non-hodgkins

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3
Q

what dogs have a decreased risk of developing lymphoma?

A

intact female dogs

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4
Q

T/F: age doesn’t impact the likelihood of developing lymphoma

A

false - increased risk with age

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5
Q

what breeds have an increased risk of getting lymphoma?

A

boxers, st. bernards, bull mastiffs, basset hounds, golden retrievers, scotties, airedales, & bulldogs

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6
Q

the etiology of lymphoma is likely ________

A

multifactorial

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7
Q

what viruses are known to contribute to the etiology of lymphoma in felines, cows, & humans?

A

feline - FeLV
cows - BLV
human - epstein barr, HIV

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8
Q

what are examples of immune mediated diseases related to the etiology of lymphoma?

A

IMTP, IMHA

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9
Q

three categories for lymphoma characterization?

A
  1. anatomic locations
  2. immunophenotypic
  3. histologic criteria
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10
Q

what is the most common anatomic location of lymphoma?

A

multicentric - 85%

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11
Q

other than multicentric, what other anatomic locations are possible for lymphoma?

A

gastrointestinal - 7%
mediastinal - 5%
cutaneous
primary extra-nodal - CNS, bone marrow, bladder, heart, & nose

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12
Q

what are the 3 WHO classifications of lymphoma?

A
  1. low grade/indolent
  2. intermediate
  3. high grade
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13
Q

what is the most common immunophenotypic lymphoma type?

A

diffuse large B cell lymphoma

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14
Q

what is the ratio of occurrence of B/T cell lymphoma?

A

65%/35%

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15
Q

why is it important to evaluate the immunophenotypic lymphoma type?

A

treatment & prognosis are very different

low grade/indolent - ~2yr prognosis vs high grade ~8 to 12 months

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16
Q

what is the breed predilection for boxers?

A

85% of lymphomas will be T cell lymphomas

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17
Q

asian breeds such as sharpeis, shitzu, etc, are predisposed to what type of lymphoma?

A

mostly t cell

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18
Q

mixed breeds have an ____ _______ of immunophenotypic lymphomas

A

equal distribution

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19
Q

what breeds are predisposed to most b cell lymphoma?

A

european breeds - beagles, german shepherds

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20
Q

what immunophenotypic type of lymphoma are golden retrievers predisposed to?

A

50/50

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21
Q

what are the most susceptible breeds to lymphoma!!!

A

boxers, bull mastiffs, st bernards, basset hounds, airedales, scotties, & bull dogs

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22
Q

what is the main clinical presentation of multicentric lymphoma?

A

painless generalized lymphadenopathy - 84% of cases

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23
Q

if lymphatic drainage is compromised in a patient with multicentric lymphoma, what may you see in clinical presentation?

what about non-specific clinical signs?

A

edema & precaval syndrome

GI signs, lethargy, fever, etc

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24
Q

what are the locations of the superficial lymph nodes on the dog?

A

popliteal
superficial inguinal
axillary
pre-scapular
submandibular

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25
Q

what lymph node may be difficult to assess in an overweight dog?

A

superficial inguinal

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26
Q

what superficial lymph node should you not be able to feel in a healthy dog?

A

axillary

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27
Q

if you have multicentric lymphoma with liver & spleen involvement & peripheral lymphadenopathy, what stage lymphoma is it?

A

stage 4

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28
Q

what is hepatosplenic lymphoma?

A

only in the liver & spleen & no peripheral lymphadenopathy present

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29
Q

T/F: peripheral lymphadenopathy isn’t required for lymphoma

A

true

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30
Q

how many stages are there in lymphoma?

A

5

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31
Q

what is the importance of substages in lymphoma?

A

indicates that there are systemic signs present or no systemic signs present

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32
Q

what designates stage 1 lymphoma?

A

involvement of a single node or lymphoid tissue in a single organ

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33
Q

T/F: it is very rare to diagnose lymphoma while it’s at stage 1

A

true - most are diagnosed around stage 3

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34
Q

what designates stage 2 lymphoma?

A

involvement of multiple lymph nodes - on one side of the diaphragm

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35
Q

what designates stage 3 lymphoma?

A

generalized lymph node involvement - both sides of the diaphragm

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36
Q

what is the most common staging presentation of lymphoma?

A

stage 3

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37
Q

what designates stage 4 lymphoma?

A

liver and/or spleen involvement (multicentric lymphoma, peripheral lymphadenopathy, & liver/spleen involvement)

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38
Q

what designates stage 5 lymphoma?

A

involvement of blood & bone marrow and/or any other organ systems

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39
Q

what should be the 5 steps of the diagnostic approach to lymphoma?

A
  1. physical exam
  2. CBC, serum chemistry
  3. abdominal ultrasound
  4. chest rads
  5. +/- bone marrow assessment
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40
Q

why is it important to include an ultrasound when diagnosing lymphoma?

A

assessing liver, spleen, & involvement (if any) of abdominal lymph nodes

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41
Q

why should you take chest rads when doing a lymphoma work up?

A

30% of dogs exhibit lung involvement

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42
Q

before doing a bone marrow biopsy, what should you do?

A

start with an FNA for cytology

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43
Q

when doing an FNA, why should you avoid sampling the submandibular lymph node if possible?

A

mouth is gross & full of nasty bacteria anyways

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44
Q

on your CBC, what is a common lab result finding in a lymphoma patient that indicates a poor prognosis?

A

anemia

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45
Q

other than anemia, what are the three other common lab result findings on a lymphoma patient’s cbc?

A

+/- lymphocytosis
+/- thrombocytopenia
/- leukocytosis

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46
Q

what are the 4 common lab findings on a lymphoma patient’s serum chemistry panel?

A

+/- hypercalcemia
+/- hyperproteinemia
+/- hypoproteinemia (GI-LSA)
+/- elevated liver/renal enzymes

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47
Q

what is the gold standard diagnostic tool for lymphoma? what is the downside to it?

A

tissue biopsy

it’s invasive

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48
Q

what diagnostic test would you use for phenotyping b vs t cell lymphoma?

A

PCR for antigen receptor rearrangement (PARR)

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49
Q

what diagnostic tool can be used for lymphoma prognosis & phenotyping?

A

flow cytometry

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50
Q

because tissue biopsies are invasive, what other test is sufficient for diagnosis?

A

FNA

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51
Q

T/F: flow cytometry does NOT give information on clonality

A

true

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52
Q

why is it important to ship cells in serum overnight for flow cytometry?

A

the cells have to be viable for the test to be run

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53
Q

what do the results of flow cytometry include?

A

cell size
phenotype
prognostic markers
lymphoma vs. leukemia

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54
Q

what are the t-cell markers in flow cytometry?

A

CD3, CD4, CD8

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55
Q

what are the b-cell markers in flow cytometry?

A

CD79a, CD20, & CD21

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56
Q

what does PCR for antigen receptor rearrangement test for?

A

clonal expansion of cells

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57
Q

is cell viability necessary for PARR?

58
Q

what does the PARR test provide information on?

A

clonality & cell phenotype

59
Q

what is the downfall on the PARR test?

A

it is highly sensitive but specificity is relatively low

60
Q

what is the CHOP treatment protocol?

A

week 1 - vincristine 0.5-0.7mg/m2
week 2 - cyclophosphamide 250mg/m2
week 3 - vincristine 0.5-0.7mg/m
week 4 - adriamycin 30mg/m2
week 5 - no treatment

repeat this process 4 times

61
Q

what is the survival time for untreated multicentric lymphoma?

A

typically only 1-2 months

62
Q

what is the survival time for multicentric lymphoma treated with steroids only?

A

1-2 months

63
Q

what is the survival time for multicentric lymphoma treated with chemotherapy?

A

80% or more achieve first remission

64
Q

what is the first time for remission for CHOP therapy for multicentric lymphoma?

65
Q

__% of dogs are still alive at 2 years with chemotherapy treatment for b cell lymphoma

66
Q

survival is ____ months for b cell lymphoma & ____ months for t cell lymphoma

67
Q

why is it important to differentiate between mediastinal lymphoma & thymomas?

A

thymomas carry a better prognosis

68
Q

mediastinal lymphoma is usually what phenotype? most common lab abnormality?

A

t-cell

hypercalcemia

69
Q

what percentage of lymphoma is mediastinal lymphoma?

70
Q

alimentary lymphoma is more common in male or female dogs? is it mostly focal or diffuse?

A

male dogs

can be focal but mostly diffuse

71
Q

what is the clinical presentation of alimentary lymphoma?

A

weight loss, melena, & abdominal mass may be palpated in 20-40% of dogs

72
Q

what is the pathology of alimentary lymphoma?

A

thickening of the intestinal wall, narrowing of the lumen, & ulceration is common

73
Q

what abnormalities may be seen on bloodwork of a patient with alimentary lymphoma?

A

anemia, leukocytosis, hypoproteinemia, & increased BUN

74
Q

what is the typical survival time of canine alimentary lymphoma?

A

60-80 days - it’s very aggressive

75
Q

what is the typical treatment for alimentary lymphoma?

A

chemotherapy - surgery only in cases of perforation

survival times -
10-12 months for B cell & 4-6 months for T cell

76
Q

what is the exception to canine alimentary lymphoma prognosis?

A

disease of the descending colon & rectum - this has a better outcome

77
Q

what is epitheliotropic lymphoma?

A

tumor cells in the epidermis or mucosa

78
Q

what is the primary phenotype of epitheliotropic lymphoma?

A

mostly t-cells - primarily CD8+

79
Q

what is the difference between epitheliotropic & non-epitheliotropic lesions?

A

non-epitheliotropic spare the epidermis & papillary dermis & affect the middle & deep portions of the dermis & subcutis

80
Q

what is sezary syndrome?

A

seen with epitheliotropic lymphoma - cutaneous lesions with systemic disease involvement (malignant circulating cells & lymph nodes)

81
Q

what was the past name of sezary syndrome?

A

mycosis fungoides

82
Q

does epitheliotropic lymphoma respond well to chemotherapy?

83
Q

what may be the most effective drug for treatment of epitheliotropic lymphoma?

84
Q

if sezary syndrome is present in epitheliotropic lymphoma, what is the treatment of choice?

A

CHOP protocol

85
Q

how is low grade lymphoma diagnosed?

A

FNA - cell morphology & flow cytometry

86
Q

what is the treatment of choice for low grade lymphoma?

A

chlorambucil - given orally as daily or once every 2 weeks treatment

87
Q

what is the median survival for low grade lymphoma?

A

more than 2 years

88
Q

what breeds have a higher risk for developing feline lymphoma?

A

siamese/oriental breeds

89
Q

what is the median age of feline lymphoma? what is the exception?

A

11 years

siamese/oriental breeds have predisposition to mediastinal form (not FeLV related) in young cats

90
Q

what viruses are factored into the etiology of feline lymphoma?

A

FeLV & FIV

91
Q

what are examples of extrinsic (exogenous) factors of feline lymphoma? endogenous?

A

tobacco smoke (environmental factors), diet (intestinal form)

immunosuppression - FIV, transplant patients

92
Q

where are the FIV anatomical sites of lymphoma?

A

kidney, liver, & multicentric

93
Q

what is the predominant immunophenotype of FIV associated lymphoma?

94
Q

how does FIV impact risk of lymphoma?

A

increases the risk of it by 5 fold

95
Q

what is the predominant immunophenotype of FeLV related lymphoma?

96
Q

T/F: the alimentary form of lymphoma is not FeLV related

97
Q

what is the impact of FeLV on feline lymphoma?

A

males, younger cats (4-6 years)

mediastinal form & peripheral lymph nodes form

98
Q

what cats are at risk of developing gastrointestinal lymphoma?

A

older aged cats (~13 years) & siamese breeds have an increased risk

99
Q

where does gastrointestinal lymphoma manifest in cats?

A

mostly small intestine

100
Q

is gastrointestinal lymphoma in cats mostly diffuse or nodular in regards to architecture?

A

mostly diffuse

101
Q

what is the most common form of gastrointestinal lymphoma in cats?

A

mucosal low grade t-cell

102
Q

where is the common location of t-cell gastrointestinal lymphoma?

A

mostly in small intestines & rarely in the stomach or large intestine

103
Q

what anatomic locations are impacted by intermediate or high grade b-cells gastrointestinal lymphomas?

A

small intestine & stomach

104
Q

what are the clinical signs seen in feline GI lymphoma?

A

weight loss, vomiting, diarrhea, & anorexia

105
Q

what can be found upon physical exam of a cat with GI lymphoma?

A

palpable mass & thickened intestine

106
Q

how is large cell or LGL (large granular lymphoma) diagnosed in cats?

A

FNA or biopsy of involved organs

107
Q

how is small cell/low grade GI lymphoma diagnosed in cats?

A

full thickness biopsy is needed!!!! PARR & flow cytometry

FNA is not sufficient

108
Q

what is the treatment for feline GI lymphoma (low grade)?

A

low grade - chlorambucil

109
Q

what is the expected survival of low grade GI lymphoma in cats treated with chlorambucil?

110
Q

what is the treatment for high grade GI lymphoma in cats?

111
Q

what is the average survival time for high grade GI lymphoma treated with the CHOP/COP protocol?

112
Q

what age of cats are primarily affected by alimentary large granular lymphoma? FeLV/FIV status?

A

older cats

FeLV/FIV negative

113
Q

what are the typical clinical signs of a cat with alimentary large granular cell lymphoma?

A

anorexia, weight loss, lethargy, & vomiting

114
Q

what is the median survival time of alimentary large granular cell lymphoma?

A

2 months - radiation might improve outcome

115
Q

what is the histology of alimentary large granular cell lymphoma?

A

lymphoblasts, cytotoxic t-cells & nk cells

116
Q

T/F: in alimentary large granular cell lymphoma, tumors are generally transmural

A

true

transmural - existing or occurring across the entire wall of an organ or blood vessel.

117
Q

in alimentary large granular cell lymphoma, about 2/3 of cases have involvement of what organs?

A

liver, spleen, kidney, & bone marrow infiltration is common

118
Q

what physical exam findings may be present in a cat with alimentary large granular cell lymphoma?

A

palpable abdominal mass, enlarged liver, spleen, & kidneys

119
Q

the mediastinal form of lymphoma primarily affects what age of cats?

A

younger - 2 to 4 years old

120
Q

what are the clinical signs of mediastinal lymphoma in a cat?

A

dyspnea, tachypnea, dull heart/lung sounds, pleural effusion is common, horner’s syndrome is rare

121
Q

how is mediastinal lymphoma diagnosed in cats?

A

FNA, CT, & rads

122
Q

what is the prognosis for young cats with mediastinal lymphoma under CHOP/COP therapy taking into consideration their FeLV status?

A

young cats FeLV + = ~2-3 months

young siamese FeLV - = ~9 months

123
Q

what are the clinical signs of nasal lymphoma in cats?

A

nasal discharge, sneezing, stridor, stertor, wheezing, facial deformity, anorexia, & epistaxis

124
Q

how is nasal lymphoma diagnosed in cats?

A

rhinoscopy, CT, & biopsy

125
Q

how is staging of nasal lymphoma done?

A

FNA of lymph nodes & CT

126
Q

what are the treatment protocols for nasal lymphoma in cats?

A

radiation therapy - up to 95% with 1.5-3 years survival

if failure with radiation - 4-5 month survival

CHOP/COP ~2 year survival

127
Q

what is the clinical presentation of nodal hodgkins’s like lymphoma?

A

one enlarged lymph node without systemic signs

128
Q

T/F: nodal hodgkin’s like lymphoma behaves more like an indolent lymphoma

129
Q

what is the spreading of nodal hodgkin’s like lymphoma?

A

trails from one node to the next

130
Q

surgical excision of nodal hodgkin’s like lymphoma provides a remission of about how long?

131
Q

what option is used to provide a prolonged remission after surgical excision for nodal hodgkin’s like lymphoma?

A

chlorambucil & prednisone

132
Q

name the lymphoma

A

nodal hodgkin’s like lymphoma

133
Q

name the lymphoma

A

nasal lymphoma in a cat

134
Q

name the lymphoma

A

mediastinal lymphoma

135
Q

name the lymphoma

A

alimentary - large granular cell lymphoma

136
Q

what is this breed predisposed to?

A

siamese/oriental breeds have a predisposition to mediastinal form (not FeLV related) in young cats

137
Q

name the lymphoma

A

epitheliotropic lymphoma

138
Q

name the lymphoma

A

epitheliotropic lymphoma

139
Q

name the lymphoma & usual immunophenotype

A

canine mediastinal lymphoma - usually t-cell

140
Q

what is the diagnostic test looking for?

A

testing for clonal expansion of cells via PCR

141
Q

this clinical presentation is common in what kind of lymphoma?

A

multicentric lymphoma

SA DX & TX I (59 decks)

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