Exam 1 - Canine Lymphoma Flashcards
1
Q
what is the most common neoplastic disease in canines?
A
lymphoma - 24%
2
Q
what is the most common lymphoma in dogs?
A
non-hodgkins
3
Q
what dogs have a decreased risk of developing lymphoma?
A
intact female dogs
4
Q
T/F: age doesn’t impact the likelihood of developing lymphoma
A
false - increased risk with age
5
Q
what breeds have an increased risk of getting lymphoma?
A
boxers, st. bernards, bull mastiffs, basset hounds, golden retrievers, scotties, airedales, & bulldogs
6
Q
the etiology of lymphoma is likely ________
A
multifactorial
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
8
Q
what are examples of immune mediated diseases related to the etiology of lymphoma?
A
IMTP, IMHA
9
Q
three categories for lymphoma characterization?
A
- anatomic locations
- immunophenotypic
- histologic criteria
10
Q
what is the most common anatomic location of lymphoma?
A
multicentric - 85%
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
12
Q
what are the 3 WHO classifications of lymphoma?
A
- low grade/indolent
- intermediate
- high grade
13
Q
what is the most common immunophenotypic lymphoma type?
A
diffuse large B cell lymphoma
14
Q
what is the ratio of occurrence of B/T cell lymphoma?
A
65%/35%
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
16
Q
what is the breed predilection for boxers?
A
85% of lymphomas will be T cell lymphomas
17
Q
asian breeds such as sharpeis, shitzu, etc, are predisposed to what type of lymphoma?
A
mostly t cell
18
Q
mixed breeds have an ____ _______ of immunophenotypic lymphomas
A
equal distribution
19
Q
what breeds are predisposed to most b cell lymphoma?
A
european breeds - beagles, german shepherds
20
Q
what immunophenotypic type of lymphoma are golden retrievers predisposed to?
A
50/50
21
Q
what are the most susceptible breeds to lymphoma!!!
A
boxers, bull mastiffs, st bernards, basset hounds, airedales, scotties, & bull dogs
22
Q
what is the main clinical presentation of multicentric lymphoma?
A
painless generalized lymphadenopathy - 84% of cases
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
24
Q
what are the locations of the superficial lymph nodes on the dog?
A
popliteal
superficial inguinal
axillary
pre-scapular
submandibular
25
what lymph node may be difficult to assess in an overweight dog?
superficial inguinal
26
what superficial lymph node should you not be able to feel in a healthy dog?
axillary
27
if you have multicentric lymphoma with liver & spleen involvement & peripheral lymphadenopathy, what stage lymphoma is it?
stage 4
28
what is hepatosplenic lymphoma?
only in the liver & spleen & no peripheral lymphadenopathy present
29
T/F: peripheral lymphadenopathy isn't required for lymphoma
true
30
how many stages are there in lymphoma?
5
31
what is the importance of substages in lymphoma?
indicates that there are systemic signs present or no systemic signs present
32
what designates stage 1 lymphoma?
involvement of a single node or lymphoid tissue in a single organ
33
T/F: it is very rare to diagnose lymphoma while it's at stage 1
true - most are diagnosed around stage 3
34
what designates stage 2 lymphoma?
involvement of multiple lymph nodes - on one side of the diaphragm
35
what designates stage 3 lymphoma?
generalized lymph node involvement - both sides of the diaphragm
36
what is the most common staging presentation of lymphoma?
stage 3
37
what designates stage 4 lymphoma?
liver and/or spleen involvement (multicentric lymphoma, peripheral lymphadenopathy, & liver/spleen involvement)
38
what designates stage 5 lymphoma?
involvement of blood & bone marrow and/or any other organ systems
39
what should be the 5 steps of the diagnostic approach to lymphoma?
1. physical exam
2. CBC, serum chemistry
3. abdominal ultrasound
4. chest rads
5. +/- bone marrow assessment
40
why is it important to include an ultrasound when diagnosing lymphoma?
assessing liver, spleen, & involvement (if any) of abdominal lymph nodes
41
why should you take chest rads when doing a lymphoma work up?
30% of dogs exhibit lung involvement
42
before doing a bone marrow biopsy, what should you do?
start with an FNA for cytology
43
when doing an FNA, why should you avoid sampling the submandibular lymph node if possible?
mouth is gross & full of nasty bacteria anyways
44
on your CBC, what is a common lab result finding in a lymphoma patient that indicates a poor prognosis?
anemia
45
other than anemia, what are the three other common lab result findings on a lymphoma patient's cbc?
+/- lymphocytosis
+/- thrombocytopenia
/- leukocytosis
46
what are the 4 common lab findings on a lymphoma patient's serum chemistry panel?
+/- hypercalcemia
+/- hyperproteinemia
+/- hypoproteinemia (GI-LSA)
+/- elevated liver/renal enzymes
47
what is the gold standard diagnostic tool for lymphoma? what is the downside to it?
tissue biopsy
it's invasive
48
what diagnostic test would you use for phenotyping b vs t cell lymphoma?
PCR for antigen receptor rearrangement (PARR)
49
what diagnostic tool can be used for lymphoma prognosis & phenotyping?
flow cytometry
50
because tissue biopsies are invasive, what other test is sufficient for diagnosis?
FNA
51
T/F: flow cytometry does NOT give information on clonality
true
52
why is it important to ship cells in serum overnight for flow cytometry?
the cells have to be viable for the test to be run
53
what do the results of flow cytometry include?
cell size
phenotype
prognostic markers
lymphoma vs. leukemia
54
what are the t-cell markers in flow cytometry?
CD3, CD4, CD8
55
what are the b-cell markers in flow cytometry?
CD79a, CD20, & CD21
56
what does PCR for antigen receptor rearrangement test for?
clonal expansion of cells
57
is cell viability necessary for PARR?
no
58
what does the PARR test provide information on?
clonality & cell phenotype
59
what is the downfall on the PARR test?
it is highly sensitive but specificity is relatively low
60
what is the CHOP treatment protocol?
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
what is the survival time for untreated multicentric lymphoma?
typically only 1-2 months
62
what is the survival time for multicentric lymphoma treated with steroids only?
1-2 months
63
what is the survival time for multicentric lymphoma treated with chemotherapy?
80% or more achieve first remission
64
what is the first time for remission for CHOP therapy for multicentric lymphoma?
189 days
65
__% of dogs are still alive at 2 years with chemotherapy treatment for b cell lymphoma
20%
66
survival is ____ months for b cell lymphoma & ____ months for t cell lymphoma
10-12
4-6
67
why is it important to differentiate between mediastinal lymphoma & thymomas?
thymomas carry a better prognosis
68
mediastinal lymphoma is usually what phenotype? most common lab abnormality?
t-cell
hypercalcemia
69
what percentage of lymphoma is mediastinal lymphoma?
5%
70
alimentary lymphoma is more common in male or female dogs? is it mostly focal or diffuse?
male dogs
can be focal but mostly diffuse
71
what is the clinical presentation of alimentary lymphoma?
weight loss, melena, & abdominal mass may be palpated in 20-40% of dogs
72
what is the pathology of alimentary lymphoma?
thickening of the intestinal wall, narrowing of the lumen, & ulceration is common
73
what abnormalities may be seen on bloodwork of a patient with alimentary lymphoma?
anemia, leukocytosis, hypoproteinemia, & increased BUN
74
what is the typical survival time of canine alimentary lymphoma?
60-80 days - it's very aggressive
75
what is the typical treatment for alimentary lymphoma?
chemotherapy - surgery only in cases of perforation
survival times -
10-12 months for B cell & 4-6 months for T cell
76
what is the exception to canine alimentary lymphoma prognosis?
disease of the descending colon & rectum - this has a better outcome
77
what is epitheliotropic lymphoma?
tumor cells in the epidermis or mucosa
78
what is the primary phenotype of epitheliotropic lymphoma?
mostly t-cells - primarily CD8+
79
what is the difference between epitheliotropic & non-epitheliotropic lesions?
non-epitheliotropic spare the epidermis & papillary dermis & affect the middle & deep portions of the dermis & subcutis
80
what is sezary syndrome?
seen with epitheliotropic lymphoma - cutaneous lesions with systemic disease involvement (malignant circulating cells & lymph nodes)
81
what was the past name of sezary syndrome?
mycosis fungoides
82
does epitheliotropic lymphoma respond well to chemotherapy?
no
83
what may be the most effective drug for treatment of epitheliotropic lymphoma?
lomustine
84
if sezary syndrome is present in epitheliotropic lymphoma, what is the treatment of choice?
CHOP protocol
85
how is low grade lymphoma diagnosed?
FNA - cell morphology & flow cytometry
86
what is the treatment of choice for low grade lymphoma?
chlorambucil - given orally as daily or once every 2 weeks treatment
87
what is the median survival for low grade lymphoma?
more than 2 years
88
what breeds have a higher risk for developing feline lymphoma?
siamese/oriental breeds
89
what is the median age of feline lymphoma? what is the exception?
11 years
siamese/oriental breeds have predisposition to mediastinal form (not FeLV related) in young cats
90
what viruses are factored into the etiology of feline lymphoma?
FeLV & FIV
91
what are examples of extrinsic (exogenous) factors of feline lymphoma? endogenous?
tobacco smoke (environmental factors), diet (intestinal form)
immunosuppression - FIV, transplant patients
92
where are the FIV anatomical sites of lymphoma?
kidney, liver, & multicentric
93
what is the predominant immunophenotype of FIV associated lymphoma?
b cell
94
how does FIV impact risk of lymphoma?
increases the risk of it by 5 fold
95
what is the predominant immunophenotype of FeLV related lymphoma?
t-cell
96
T/F: the alimentary form of lymphoma is not FeLV related
true
97
what is the impact of FeLV on feline lymphoma?
males, younger cats (4-6 years)
mediastinal form & peripheral lymph nodes form
98
what cats are at risk of developing gastrointestinal lymphoma?
older aged cats (~13 years) & siamese breeds have an increased risk
99
where does gastrointestinal lymphoma manifest in cats?
mostly small intestine
100
is gastrointestinal lymphoma in cats mostly diffuse or nodular in regards to architecture?
mostly diffuse
101
what is the most common form of gastrointestinal lymphoma in cats?
mucosal low grade t-cell
102
where is the common location of t-cell gastrointestinal lymphoma?
mostly in small intestines & rarely in the stomach or large intestine
103
what anatomic locations are impacted by intermediate or high grade b-cells gastrointestinal lymphomas?
small intestine & stomach
104
what are the clinical signs seen in feline GI lymphoma?
weight loss, vomiting, diarrhea, & anorexia
105
what can be found upon physical exam of a cat with GI lymphoma?
palpable mass & thickened intestine
106
how is large cell or LGL (large granular lymphoma) diagnosed in cats?
FNA or biopsy of involved organs
107
how is small cell/low grade GI lymphoma diagnosed in cats?
full thickness biopsy is needed!!!! PARR & flow cytometry
FNA is not sufficient
108
what is the treatment for feline GI lymphoma (low grade)?
low grade - chlorambucil
109
what is the expected survival of low grade GI lymphoma in cats treated with chlorambucil?
2-3 years
110
what is the treatment for high grade GI lymphoma in cats?
CHOP/COP
111
what is the average survival time for high grade GI lymphoma treated with the CHOP/COP protocol?
~100 days
112
what age of cats are primarily affected by alimentary large granular lymphoma? FeLV/FIV status?
older cats
FeLV/FIV negative
113
what are the typical clinical signs of a cat with alimentary large granular cell lymphoma?
anorexia, weight loss, lethargy, & vomiting
114
what is the median survival time of alimentary large granular cell lymphoma?
2 months - radiation might improve outcome
115
what is the histology of alimentary large granular cell lymphoma?
lymphoblasts, cytotoxic t-cells & nk cells
116
T/F: in alimentary large granular cell lymphoma, tumors are generally transmural
true
transmural - existing or occurring across the entire wall of an organ or blood vessel.
117
in alimentary large granular cell lymphoma, about 2/3 of cases have involvement of what organs?
liver, spleen, kidney, & bone marrow infiltration is common
118
what physical exam findings may be present in a cat with alimentary large granular cell lymphoma?
palpable abdominal mass, enlarged liver, spleen, & kidneys
119
the mediastinal form of lymphoma primarily affects what age of cats?
younger - 2 to 4 years old
120
what are the clinical signs of mediastinal lymphoma in a cat?
dyspnea, tachypnea, dull heart/lung sounds, pleural effusion is common, horner's syndrome is rare
121
how is mediastinal lymphoma diagnosed in cats?
FNA, CT, & rads
122
what is the prognosis for young cats with mediastinal lymphoma under CHOP/COP therapy taking into consideration their FeLV status?
young cats FeLV + = ~2-3 months
young siamese FeLV - = ~9 months
123
what are the clinical signs of nasal lymphoma in cats?
nasal discharge, sneezing, stridor, stertor, wheezing, facial deformity, anorexia, & epistaxis
124
how is nasal lymphoma diagnosed in cats?
rhinoscopy, CT, & biopsy
125
how is staging of nasal lymphoma done?
FNA of lymph nodes & CT
126
what are the treatment protocols for nasal lymphoma in cats?
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
what is the clinical presentation of nodal hodgkins's like lymphoma?
one enlarged lymph node without systemic signs
128
T/F: nodal hodgkin's like lymphoma behaves more like an indolent lymphoma
true
129
what is the spreading of nodal hodgkin's like lymphoma?
trails from one node to the next
130
surgical excision of nodal hodgkin's like lymphoma provides a remission of about how long?
1 year
131
what option is used to provide a prolonged remission after surgical excision for nodal hodgkin's like lymphoma?
chlorambucil & prednisone
132
name the lymphoma
nodal hodgkin's like lymphoma
133
name the lymphoma
nasal lymphoma in a cat
134
name the lymphoma
mediastinal lymphoma
135
name the lymphoma
alimentary - large granular cell lymphoma
136
what is this breed predisposed to?
siamese/oriental breeds have a predisposition to mediastinal form (not FeLV related) in young cats
137
name the lymphoma
epitheliotropic lymphoma
138
name the lymphoma
epitheliotropic lymphoma
139
name the lymphoma & usual immunophenotype
canine mediastinal lymphoma - usually t-cell
140
what is the diagnostic test looking for?
testing for clonal expansion of cells via PCR
141
this clinical presentation is common in what kind of lymphoma?
multicentric lymphoma
