H&N Lymphomas of the head and neck Flashcards
Where are the most common location for extranodal lymphoma in the head and neck?
Waldeyer ring. Nasopharynx > tonsil > tongue base
What structures in the head and neck can be
involved with lymphoma?
Essentially any; paranasal sinuses, salivary glands, thyroid,
lymph nodes, Waldeyer ring, larynx, and the orbit are all
possible sites.
In addition to the lymph nodes, what anatomical
sites should be considered for involvement in a
patient with extranodal tonsillar non-Hodgkin
lymphoma?
About 20% of patients with tonsillar non-Hodgkin lympho-
ma have gastrointestinal tract involvement.
What percentage of patients with extranodal
lymphoma will have associated nodal disease?
50%
Between Hodgkin lymphoma and non-Hodgkin lymphoma, which is more likely to involve extra-
nodal disease at diagnosis?
Non-Hodgkin lymphoma (30% extranodal presentation)
more than Hodgkin lymphoma (5%)
What is the primary risk factor for parotid mucosa-
associated lymphoid tissue (MALT) lymphoma?
Sjögren syndrome
What is the primary risk factor for thyroid MALT
lymphoma?
Hashimoto thyroiditis
What is the second most common malignancy in
the head and neck?
Lymphoma; it makes up 15 to 20% of all head and neck
cancers.
What are the indolent non-Hodgkin lymphomas?
Follicular, B-cell chronic lymphocytic lymphoma, marginal B-cell, lymphoplasmacytic (Waldenstrom macroglobuline-
mia)
What are the aggressive non-Hodgkin lymphomas?
Diffuse large B-cell, peripheral T-cell, mantle cell
What are the highly aggressive non-Hodgkin
lymphomas?
Burkitt, precursor T- and B-cell lymphoblastic
Describe the endemic form of Burkitt lymphoma.
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.
What are common markers for B-cell lymphoma?
CD20, CD22, and CD79a are strongly positive in most B-cell lymphomas.
What is the typical histopathology of Hodgkin
disease?
Reed-Sternberg cells, which contain two large nuclear lobes
with pale chromatin and distinct eosinophilic nucleoli
Describe tumor lysis syndrome.
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.
What are B-symptoms as they pertain to lymphoma?
Fever > 38°C, > 10% weight loss in 6 months, night sweats
Are B-symptoms more common with Hodgkin
lymphoma or non-Hodgkin lymphoma?
Hodgkin lymphoma
How common are B-symptoms in patients with
extranodal non-Hodgkin lymphoma?
Approximately 20% of patients with extranodal non-
Hodgkin lymphoma have B symptoms.
What are the findings for lymphoma on T1- and
T2-weighted MRI with and without gadolinium
enhancement?
T1-low signal intensity and T2-low to high signal intensity.
Gadolinium uptake is variable but usually demonstrates low
enhancement.
How is FNA limited in diagnosing lymphoma?
FNA results yield cytology, which does not provide infor-
mation on nodal architecture (follicular vs. diffuse).
Describe the Ann Arbor staging system for
lymphoma.
● 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
What is the mechanism of action of rituximab?
A monoclonal antibody against CD20, which is a B-cell marker.
What agents are included in CHOP therapy?
● Cyclophosphamide (Cytoxan)
● Hydroxydaunorubicin (doxorubicin)
● Oncovin (vincristine)
● Prednisone
What is the primary treatment modality for localized (stage I or II) low-grade lymphoma?
Radiation therapy, to which chemotherapy is often added in
more advanced disease.
What is the primary role of surgery for head and
neck non-Hodgkin lymphoma?
Surgery is useful for establishing diagnosis. Further treatment is better served with radiation and chemotherapy.
