Haematological: Lymphoma (brief) Flashcards
what is lymphoma?
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).
what are the two types of lymphoma?
- Non-Hodgkin lymphoma
2. Hodgkin lymphoma
what is the most common type of lymphoma?
Non-Hodgkin lymphoma
what are the two most common types of Non-Hodgkin lymphoma?
- Diffuse large B cell lymphoma (aggressive)
2. follicular lymphomas (non-aggressive)
which type of lymphoma has Reed–Sternberg cells present?
Non-Hodgkin lymphoma
which type of lymphoma does not have Reed–Sternberg cells present?
Hodgkin lymphoma
what are the two types of Hodgkin lymphoma?
Classical Hodgkin’s Lymphoma (95%) + Nodular lymphocyte-predominant Hodgkin’s lymphoma (5%).
what are lacunar histiocytes also known as?
Reed–Sternberg cells
what are Reed–Sternberg cells?
distinctive, giant cells found with light microscopy in biopsies from individuals with Hodgkin lymphoma
what are some risk factors for a lymphoma?
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.
how does Hodgkin lymphoma present?
- 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
how does Non-Hodgkin lymphoma present?
- 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
which conditions may present in a similar way to a lymphoma?
- 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
what investigations would you conduct to confirm a diagnosis of lymphoma?
FBC
Result: NHL - thrombocytopenia, pancytopenia, lymphocytosis. HL - low Hb and platelets; WBC count may be high or low.
How is a lymphoma staged?
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 .