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Ha - Lymphoma / CLL Flashcards

1
Q

Why are there so many diff subtypes of lymphoma

A

can arise from cells at many diff stages of lymphoid maturation

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2
Q

Why are lymphocytes prone to lymphoma -give 3 reasons

A

1) Rapid proliferation in infection
2) VDJ recombination
3) Highly dependent on apoptotic process (so if this goes wrong…there is prolif of abnormal cells)

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3
Q

examples of oncogenes in lymphoma

A

c-myc, cyclin D1, bcl2, bcl6

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4
Q

Diff in presentation of CLL and lymphoma?

A
  • CLL = symmetrical
  • Lymphoma = asymmetrical painless lymphadenopathy
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5
Q

causes of lymphoma

A

Sporadic mutations is biggest cause
Infections: HTLV1 or EBV
Immunodeficiency eg HIV can allow EBV infection / AIDs
Constant antigenic stimulation eg H. Pylori

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6
Q

Hodgkin’s lymphoma - where do the cells tend to arise from

A

Germinal centre

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7
Q

Smear cells

A

CLL

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8
Q

Presentation of hodgkin’s lymphoma

A

Asymmetrical, painless lymphadenopathy

B - Sx: Drenching night sweats/fever/10% wt loss in 6 months

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9
Q

B symptoms of Hodgkin’s lymphoma

A
  • Drenching night sweats
  • Fever
  • 10% wt loss in 6 months
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10
Q

Most common subtype of Hodgkin’s lymphoma

A

Nodular sclerosing

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11
Q

Staging of Hodgkin’s lymphoma

A

1: one group of LNs

2: more than 1 group of LNs on 1 side of diaphragm

3: both sides of diaphragm involved

4: extra nodal sites

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12
Q

What is stained for in ?Hodgkin’s lymphoma

A

CD15 and CD30

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13
Q

2 useful investigations for staging Hodgkins?

A

CT/PET
Lymph node biopsy

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14
Q

Treatment of Hodgkin’s lymphoma

A

COMBINATION CHEMOTHERAPY FOR ALL
Adriamycin, Bleomycin, Vinblastin, Dacarbazine

+/-radiotherapy

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15
Q

Common dilemma in the management of hodgkin’s lymphoma?

A

Do we use radiotherapy?

Radiotherapy would cure the lymphoma, but increases risk of malignancy later in life

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16
Q

Mx of relapse of Hodgkin’s lymphoma

A

Intensive chemo + autologous SCT

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17
Q

what is autologous SCT

A

PATIENT’S OWN SCs are harvested + frozen

  • enables high dose radio/chemo to eradicate malignant cells
  • no GvHD
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18
Q

3 high grade NHLs

A

Burkitt’s
Diffuse large b-cell
Mantle cell

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19
Q

3 low grade NHLs

A

Follicular
Small Lymphocytic
Marginal zone

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20
Q

starry sky appearance
high mitosis and proliferation
CD20, BCL6

A

Burkitt’s

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21
Q

Burkitt’s lymphoma
- translocation?
-oncogene?

A

t(8;14)
c-myc

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22
Q

Treatment of Burkitt’s lymphoma

A

Rituximab

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23
Q

t(11;14), abhorent CD5+ and cyclin D1

A

Mantle cell lymphoma

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24
Q

Mantle cell lymphoma
- translocation?
- which oncogene is upregulated?

A

t(11;14)
Cyclin D1

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25
Q

t(14;18) with CD20+ and CD10+, BCL2 expression by neoplastic B cells. Dx?

A

Follicular B-cell lymphoma

26
Q

HTLV1 infection predisposes to which malignancy?

A

Adult T-cell lymphoma

27
Q

Coeliac disease is associated with which lymphoma?

A

Enteropathy associated T-cell lymphoma (EATL)

28
Q

Mycosis fungoides is associated with which lymphoma?

A

Cutaneous T Cell lymphoma

29
Q

t(2;5)

A

Anaplastic large cell lymphoma (T- cells)

30
Q

Large epithelioid lymphocytes in sheets

A

Anaplastic large cell lymphoma (T-cells)

31
Q

T-cell lymphoma which affects younger patients

A

Anaplastic large cell lymphoma

32
Q

4 chemo drugs used to treat hodgkin’s lymphoma

A

ABVD
Adriamycin
Bleomycin
Vinblastin
Dacarbazine

33
Q

define lymphoma

A

neoplastic tumour of lymphoid cells forming discrete masses

34
Q

what kind of lymphoma does H Pylori cause

A

B cell lymphoma

35
Q

what kind of lymphoma does coealiacs cause?

A

enteropathy T cell lymphoma

36
Q

nodular architecure on histology indicates what type of lymphoma?

A

follicular

37
Q

diffuse architecure on histology indicates what type of lymphoma?

38
Q

small round cells on histology indicates what type of lymphoma?

A

CLL / mantle

39
Q

small cleaved cells on histology indicates what type of lymphoma?

A

follicular

40
Q

large cells on histology indicates what type of lymphoma?

A

high grade

41
Q

marker for T cells?

42
Q

marker for B cells?

43
Q

diffuse small uniform nuclei, CD23+

A

CLL / small lymphocytic

44
Q

What is Richter transformation?

A

Small lymphocytic –> high grade lymphoma

45
Q

features of MALT lymphoma

A

Extranodal sites eg lung / stomach
Post germinal centre memory B cells
Small, pale cytoplasm

46
Q

what stain is used to show proliferation?

47
Q

larger nuclei with prominent nucleoli, variable and pleomorphoc nuclei. CD20+. Sheets of large cells. Dx?

A

Diffuse large B cell

48
Q

what protein expression betters the prognosis of anaplastic large cell lymphoma?

49
Q

Histological features of Hodgkins
Inc CD staining

A

Sclerosis, reactive cells, Reed Sternberg (large nucleoli multi nucleation - Owl’s Eye)
CD30+, CD15+, CD20-

50
Q

Tx of NHL

A

MALT - ABx
Others: chemo R-CHOP (inc rituximab) x6 cycles

51
Q

Give %s of NHL

A

Diffuse Large B Cell 40%
Follicular 35%
Extra Nodal Marginal Zone 8%

52
Q

Describe Tx of diffuse large B cell with prognosis

A

R-CHOP
50% curative, 25% further salvaged

53
Q

Factors influencing prognosis of diffuse large B cell

A

Stage, LDH, age, extra nodal, performance status

54
Q

Prognosis of follicular

A

12-15 years survival but incurable

55
Q

Ix for CLL with results

A

FBC, WCC - raised, anaemia
Blood film - smudge cells with mature lymphocytes

56
Q

Markers of CLL?

A

CD5+, CD19+

57
Q

Give rules of 1/3rds for CLL

A

1/3 never progress to blast phase
1/3 progress then respond to Tx
1/3 progress then die of CLL

58
Q

Prognosis of CLL with contributing factors

A

5-10 years good health, decline to 2-3 years terminal
Better prognosis if IgHV mutated and no P53 expression

59
Q

Tx for CLL

A

Initially supportive: ABx and vaccination
Targeted Tx - BCR kinase or BCL2 inhibitors
NOT CHEMO
Ventoclax - new Tx

60
Q

Side effect of ventolax

A

Tumour lysis syndrome

Pathology (87 decks)

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