Haem: Lymphoma MDT Pt.3

Question 1

List some types of T cell lymphoma and their associations.

Answer 1

• Adult T cell leukaemia/lymphoma - HTLV1
• Enteropathy-associated T cell lymphoma - Coeliac disease
• Cutaneous T cell lymphoma (mycosis fungoides)
• Anaplastic large cell lymphoma

Question 2

Outline the typical presentation of anaplastic large cell lymphoma.

Answer 2

Children and young adults with lymphadenopathy

NOTE: this is aggressive

Question 3

Outline the key histological features of anaplastic large cell lymphoma.

Answer 3

• Large epithelioid lymphocytes
• T cell or null phenotype (anaplastic)

Question 4

Which molecular features are associated with anaplastic large cell lymphoma?

Answer 4

• 2;5 translocation
• Alk-1 protein expression - BETTER prognosis

Question 5

List some key differences between Hodgkin and Non-Hodgkin Lymphoma.

Answer 5

• Hodgkin is more localised (usually one nodal site)
• Hodgkin spreads contiguously to adjacent to adjacent lymph nodes

NOTE: NHL tends to involve multiple lymph node sites and spread discontinuously

Question 6

Outline the typical presentation of classical Hodgkin lymphoma.

Answer 6

• Young and middle-aged patients with only a single group of lymph nodes involved
• Associated with EBV

Question 7

Name 3 subtypes of classical Hodgkin’s lymphoma

Answer 7

• Nodular sclerosing
• Mixed cellularity
• Lymphocyte rich and lymphocyte depleted

Question 8

Which type of Hodgkin’s lymphoma is related to NHL

Answer 8

Lymphocyte predominant Hodgkins

Question 9

What is the difference between a Hodgkin cell and a Reed-Sternberg cells

Answer 9

Hodgkin cell: mononucleated abnormal lymphocyte

Reed-Sternberg cell: bi- or multinucleated abnormal lymphocyte

Question 10

Outline some histological features of classical Hodgkin lymphoma.

Answer 10

• Nodular sclerosis
• Mixed cell population of Reed-Sternberg cells and Hodgkin cells
• Lymphoma cells are few in number and are scattered around
• Eosinophils present
• Arise from germinal centre or post-germinal centre cells

Question 11

What are the diagnostic markers for classic Hodgkin lymphoma?

Answer 11

• CD15
• CD30

(CD20 negative)

Question 12

Describe the typical presentation of nodular lymphocyte predominant Hodgkin lymphoma.

Answer 12

• Isolated lymphadenopathy
• NO association with EBV

Question 13

Outline the key histological features of lymphocyte predominant Hodgkin lymphoma.

Answer 13

• B cell rich nodules with scattered around L&H cells
• Arise from germinal centres
• Reactive population in the background consisting of small lymphocytes
• NO eosinophils and macrophages

Question 14

Which markers are key in the diagnosis of lymphocyte predominant Hodgkin lymphoma?

Answer 14

• Positive = CD20
• Negative = CD15, CD30 (unlike classical Hodgkin lymphoma)

Question 15

What constitutional symptoms may be present in a patient with lymphoma?

Answer 15

B symptoms - fever, night sweats, weight loss

Pruritis

Question 16

What are the stages of lymphoma?

Answer 16

1 = 1 group of nodes

2 = > 1 group of nodes on the same side of the diaphragm

3 = > 1 group of nodes above and below the diaphragm

4 = extranodal spread

Suffic ‘B’ if B symptoms are present

Question 17

Which type of scan is often used to stage lymphoma?

Answer 17

FDG-PET/CT

Question 18

Which treatment modalities are used in Hodgkin lymphoma?

Answer 18

• All patients receive chemotherapy
• Radiotherapy is often used because Hodgkin lymphoma is very responsive
• Referred to as ‘combined modality’ if both are used

Question 19

Which chemotherapy regimen is usually used for Hodgkin lymphoma?

Answer 19

ABVD: Adriamycin, Bleomycin, Vinblastine, Dacarbazine

NOTE: this is usually given at 4-weekly intervals for 2-6 cycles

Question 20

What are some possible long-term consequences of chemotherapy for Hodgkin lymphoma?

Answer 20

Pulmonary fibrosis

Cardiomyopathy

Question 21

How might a relapse of Hodgkin lymphoma be treated?

Answer 21

High-dose chemotherapy with autologous stem cell transplant

NOTE: intensifying chemotherapy will lead to an increased cure rate but it will also lead to an increase in secondary cancers

Question 22

Describe the curability of Hodgkin lymphoma.

Answer 22

Stage I and II: >80%

Stage IV: 50%