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ENT H&N > H&N Lymphomas of the head and neck > Flashcards

H&N Lymphomas of the head and neck Flashcards

1
Q

Where are the most common location for extranodal lymphoma in the head and neck?

A

Waldeyer ring. Nasopharynx > tonsil > tongue base

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2
Q

What structures in the head and neck can be

involved with lymphoma?

A

Essentially any; paranasal sinuses, salivary glands, thyroid,
lymph nodes, Waldeyer ring, larynx, and the orbit are all
possible sites.

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3
Q

In addition to the lymph nodes, what anatomical
sites should be considered for involvement in a
patient with extranodal tonsillar non-Hodgkin
lymphoma?

A

About 20% of patients with tonsillar non-Hodgkin lympho-

ma have gastrointestinal tract involvement.

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4
Q

What percentage of patients with extranodal

lymphoma will have associated nodal disease?

A

50%

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5
Q

Between Hodgkin lymphoma and non-Hodgkin lymphoma, which is more likely to involve extra-
nodal disease at diagnosis?

A

Non-Hodgkin lymphoma (30% extranodal presentation)

more than Hodgkin lymphoma (5%)

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6
Q

What is the primary risk factor for parotid mucosa-

associated lymphoid tissue (MALT) lymphoma?

A

Sjögren syndrome

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7
Q

What is the primary risk factor for thyroid MALT

lymphoma?

A

Hashimoto thyroiditis

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8
Q

What is the second most common malignancy in

the head and neck?

A

Lymphoma; it makes up 15 to 20% of all head and neck

cancers.

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9
Q

What are the indolent non-Hodgkin lymphomas?

A

Follicular, B-cell chronic lymphocytic lymphoma, marginal B-cell, lymphoplasmacytic (Waldenstrom macroglobuline-
mia)

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10
Q

What are the aggressive non-Hodgkin lymphomas?

A

Diffuse large B-cell, peripheral T-cell, mantle cell

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11
Q

What are the highly aggressive non-Hodgkin

lymphomas?

A

Burkitt, precursor T- and B-cell lymphoblastic

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12
Q

Describe the endemic form of Burkitt lymphoma.

A

A form of non-Hodgkin lymphoma that arises from EBV genomic integration and t(8;14) translocation that constitutively activates c-myc, causing mandible tumors among children of central Africa.

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13
Q

What are common markers for B-cell lymphoma?

A

CD20, CD22, and CD79a are strongly positive in most B-cell lymphomas.

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14
Q

What is the typical histopathology of Hodgkin

disease?

A

Reed-Sternberg cells, which contain two large nuclear lobes

with pale chromatin and distinct eosinophilic nucleoli

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15
Q

Describe tumor lysis syndrome.

A

The development of hypocalcemia, hyperkalemia, hyperuricemia, hyperphosphatemia, and acute renal failure in the days after initiation of chemotherapy for aggressive
lymphoma. Death from cardiac arrhythmias can result.

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16
Q

What are B-symptoms as they pertain to lymphoma?

A

Fever > 38°C, > 10% weight loss in 6 months, night sweats

17
Q

Are B-symptoms more common with Hodgkin

lymphoma or non-Hodgkin lymphoma?

A

Hodgkin lymphoma

18
Q

How common are B-symptoms in patients with

extranodal non-Hodgkin lymphoma?

A

Approximately 20% of patients with extranodal non-

Hodgkin lymphoma have B symptoms.

19
Q

What are the findings for lymphoma on T1- and
T2-weighted MRI with and without gadolinium
enhancement?

A

T1-low signal intensity and T2-low to high signal intensity.
Gadolinium uptake is variable but usually demonstrates low
enhancement.

20
Q

How is FNA limited in diagnosing lymphoma?

A

FNA results yield cytology, which does not provide infor-

mation on nodal architecture (follicular vs. diffuse).

21
Q

Describe the Ann Arbor staging system for

lymphoma.

A

● Stage I: single lymph node region or single extralym-
phatic organ
● Stage II: Two or more lymph node regions or extra-
lymphatic organs on one side of the diaphragm
● Stage III: Involvement on both sides of the diaphragm
● Stage IV: Diffuse or disseminated involvement of 1 or
more extralymphatic organs with or without node
involvement

22
Q

What is the mechanism of action of rituximab?

A

A monoclonal antibody against CD20, which is a B-cell marker.

23
Q

What agents are included in CHOP therapy?

A

● Cyclophosphamide (Cytoxan)
● Hydroxydaunorubicin (doxorubicin)
● Oncovin (vincristine)
● Prednisone

24
Q

What is the primary treatment modality for localized (stage I or II) low-grade lymphoma?

A

Radiation therapy, to which chemotherapy is often added in

more advanced disease.

25
Q

What is the primary role of surgery for head and

neck non-Hodgkin lymphoma?

A

Surgery is useful for establishing diagnosis. Further treatment is better served with radiation and chemotherapy.

ENT H&N (24 decks)

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