Haem: Lymphoma MDT Pt.2

Question 1

Give an example of a chromosomal translocation that is diagnostic of lymphoma.

Answer 1

11;14 = Mantle Cell Lymphoma

Question 2

Give an example of a chromosomal translocation that is prognostic in lymphoma.

Answer 2

2;5 = anaplastic large cell lymphoma

Question 3

List some types of low grade lymphoma.

Answer 3

• Follicular lymphoma
• Small lymphocytic lymphoma (CLL)
• Marginal zone lymphoma

Question 4

Name 3 types of high grade lymphoma.

Answer 4

• Diffuse large B cell lymphoma
• Burkitt’s lymphoma
• Mantle cell lymphoma

Question 5

How does follicular lymphoma typically present?

Answer 5

Lymphadenopathy in middle-aged or elderly patients

NOTE: it is usually indolent but can transform into a high-grade lymphoma

Question 6

Describe the histological features of follilcular lymphoma.

Answer 6

• Follicular pattern - the follicles are neoplastic and spread from the node into adjacent tissues
• Cells have a germinal centre cell origin (positive staining for CD10 and Bcl2)

Question 7

Which molecular feature is associated with follicular lymphoma?

Answer 7

14;18 translocation involving Bcl2 gene

Question 8

Describe the typical presentation of small lymphocytic lymphoma.

Answer 8

Lymphadenopathy or high blood lymphocyte count in middle-aged or elderly patients

Question 9

Outline the histological features of small lymphocyte lymphoma.

Answer 9

• Small lymphocytes
• Arise from naïve B cells or post-germinal centre memory B cells
• Cells are CD5 and CD23 positivie
• They replace the entire lymph node so that you can no longer identify follicles or T cell areas

Question 10

What is the term used to describe the transformation of small lymphocytic lymphoma into a higher grade lymphoma/leukaemia?

Answer 10

Richter transformation

Question 11

What is marginal zone lymphoma?

Answer 11

• Arise mainly in extra-nodal sites (e.g. gut, spleen)
• Thought to arise due to chronic antigenic stimulation
• Arise from post-germinal centre memory B cells
• Low-grade disease can be treated by non-chemotherapeutic methods (e.g. H. pylori eradication)

Question 12

Outline the typical presentation of mantle cell lymphoma.

Answer 12

• Typically affects middle-aged males
• Affects lymph nodes and the GI tract (diarrhoea, abdominal pain)
• Often present with disseminated disease

NOTE: median survival = 3-5 years

Question 13

Outline the key histological features of mantle cell lymphoma.

Answer 13

• Located in the mantle zone of the lymph node
• Arise from pre-germinal centre cells
• Show aberrant expression of cyclin D1 and CD5
• ‘anglular / clefted nuclei’

Question 14

Which molecular features are characteristic of mantle cell lymphoma?

Answer 14

• 11;14 translocation
• Cyclin D1 overexpression

Question 15

Outline the typical presentation of Burkitt’s lymphoma.

Answer 15

• Jaw or abdominal mass in children and young adults
• Associated with EBV

NOTE: this is very agressive

Question 16

Outline the histological features of Burkitt’s lymphoma.

Answer 16

• Arises from germinal centre cells
• Starry sky appearance

Question 17

Which molecular feature is associated with Burkitt’s lymphoma.

Answer 17

• c-Myc translocation (8;14, 2;8 or 8;22)

Question 18

Outline the typical presentation of diffuse large B cell lymphoma.

Answer 18

Middle-aged and elderly patients with lymphadenopathy

Question 19

Outline the histological features of diffuse large B cell lymphoma.

Answer 19

• Arise from germinal centre or pre-germinal centre B cells
• Large lymphoid cells
• Lymph node is effaced so follicles and germinal centres cannot be identified

Question 20

List some prognostic association of diffuse large B cell lymphoma.

Answer 20

Good prognosis - germinal centre phenotype

Poor prognosis - p53-positive and high proliferation fraction

Question 21

Outline the typical presentation of T cell lymphomas.

Answer 21

Middle-aged and elderly patients with lymphadenopathy

NOTE: these are aggressive

Question 22

Outline some key histological features of T cell lymphomas.

Answer 22

• Large T lymphocytes
• Associated reactive cell population (especially eosinophils)