Haematological: Lymphoma (brief) Flashcards

1
Q

what is lymphoma?

A

Lymphoma is a cancer that develops in the lymphatic system. Lymphomas are caused by malignant proliferation of lymphocytes – T and B cells (More common in B cells).

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2
Q

what are the two types of lymphoma?

A
  1. Non-Hodgkin lymphoma

2. Hodgkin lymphoma

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3
Q

what is the most common type of lymphoma?

A

Non-Hodgkin lymphoma

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4
Q

what are the two most common types of Non-Hodgkin lymphoma?

A
  1. Diffuse large B cell lymphoma (aggressive)

2. follicular lymphomas (non-aggressive)

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5
Q

which type of lymphoma has Reed–Sternberg cells present?

A

Non-Hodgkin lymphoma

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6
Q

which type of lymphoma does not have Reed–Sternberg cells present?

A

Hodgkin lymphoma

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7
Q

what are the two types of Hodgkin lymphoma?

A

Classical Hodgkin’s Lymphoma (95%) + Nodular lymphocyte-predominant Hodgkin’s lymphoma (5%).

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8
Q

what are lacunar histiocytes also known as?

A

Reed–Sternberg cells

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9
Q

what are Reed–Sternberg cells?

A

distinctive, giant cells found with light microscopy in biopsies from individuals with Hodgkin lymphoma

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10
Q

what are some risk factors for a lymphoma?

A
Age >50.
Male sex. 
Immunocompromised host. 
Epstein-Barr virus (EBV); EBV antigens are found in 20% to 40% of Reed-Sternberg cells.
Human T-lymphocytotrophic virus-1 (HTLV-1).
Human herpes virus-8. 
Helicobacter pylori.
HIV.
Hepatitis C virus. 
Sjogren’s syndrome. 
Wiskott-aldrich syndrome. 
Ataxia-telangiectasia. 
Family history.
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11
Q

how does Hodgkin lymphoma present?

A
  • Painless Lymphadenopathy (most common symptom) – Lower neck/supraclavicular region
  • Mediastinal masses
  • Chest discomfort – Cough, dyspnoea
  • Systemic symptoms (B symptoms) – Night sweats, fever (>38 degrees), weight loss (>10% over six months).
  • Alcohol-induced pain at sites of nodal disease
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12
Q

how does Non-Hodgkin lymphoma present?

A
  • Painless lymphadenopathy
  • Splenomegaly
  • Fever
  • Night sweats
  • Weight loss
  • Extra-nodal involvement – Bowel obstruction, fatigue, easy bruising, recurrent infections, weakness + loss of sensation in the legs.
  • Low-grade lymphoma – Slowly progressive lymphadenopathy (most common clinical presentation), spontaneous regression of enlarged lymph nodes
  • Intermediate-grade lymphoma – Rapidly growing and bulky lymphadenopathy, systemic symptoms + extra nodal involvement
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13
Q

which conditions may present in a similar way to a lymphoma?

A
  • Infectious mononucleosis
  • AIDS
  • Hodgkin’s lymphoma/non-Hodgkin’s lymphoma
  • TB
  • Leukaemia
  • Sarcoidosis
  • Myeloma
  • Toxoplasmosis
  • Cytomegalovirus infection
  • Tularaemia
  • Malignant metastatic disease
  • Lymphadenopathy – secondary to other disease
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14
Q

what investigations would you conduct to confirm a diagnosis of lymphoma?

A

FBC

Result: NHL - thrombocytopenia, pancytopenia, lymphocytosis. HL - low Hb and platelets; WBC count may be high or low.

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15
Q

How is a lymphoma staged?

A

Stage 1 – Involvement of one lymph-node region or lymphoid structure (spleen, thymus, Waldeyer’s ring).
Stage 2 – Two or more lymph nodes regions on the same side of the diaphragm.
Stage 3 – Lymph nodes on both sides of the diaphragm.
Stage 4 – Involvement of extra nodal sites.

A – No symptoms.
B – Fever, drenching night sweats, weight loss greater than 10% in six months.
X – Bulky disease: Greater than a third widening of mediastinum or greater than 10cm maximum diameter of nodal mass.
E – Involvement of single, contiguous or proximal extra nodal site .

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