Haematological: Lymphoma (brief)

Question 1

what is lymphoma?

Answer 1

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).

Question 2

what are the two types of lymphoma?

Answer 2

1. Non-Hodgkin lymphoma

2. Hodgkin lymphoma

Question 3

what is the most common type of lymphoma?

Answer 3

Non-Hodgkin lymphoma

Question 4

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

Answer 4

1. Diffuse large B cell lymphoma (aggressive)

2. follicular lymphomas (non-aggressive)

Question 5

which type of lymphoma has Reed–Sternberg cells present?

Answer 5

Non-Hodgkin lymphoma

Question 6

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

Answer 6

Hodgkin lymphoma

Question 7

what are the two types of Hodgkin lymphoma?

Answer 7

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

Question 8

what are lacunar histiocytes also known as?

Answer 8

Reed–Sternberg cells

Question 9

what are Reed–Sternberg cells?

Answer 9

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

Question 10

what are some risk factors for a lymphoma?

Answer 10

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.

Question 11

how does Hodgkin lymphoma present?

Answer 11

• 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

Question 12

how does Non-Hodgkin lymphoma present?

Answer 12

• 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

Question 13

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

Answer 13

• 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

Question 14

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

Answer 14

FBC

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

Question 15

How is a lymphoma staged?

Answer 15

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 .