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Haematology > Haematology 10 - Lymphoma 1: multidisciplinary > Flashcards

Haematology 10 - Lymphoma 1: multidisciplinary Flashcards

1
Q

What is multiple myeloma a malignancy of?

A

Plasma cells

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2
Q

Why do bacterial infections and autoimmune disorders increase lymphoma risk?

A

Constant antigenic stimulation

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3
Q

Why do viral infections increase lymphoma risk?

A

Direct viral integration of lymphocytes

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4
Q

Which lymphoma does Sjorgen’s syndrome increase risk of?

A

Marginal zone lymphoma of the parotid

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5
Q

Which lymphoma does Hashimoto’s syndrome increase risk of?

A

Marginal zone lymphoma of the thyroid

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6
Q

How is HTLV1 transmitted, and which cancer does it increase risk of?

A

A retrovirus that is transmitted at birth, and increases risk of adult T cell leukaemia lymphoma (an aggressive subtype of T cell NHL)

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7
Q

Which type of cells are infected by EBV?

A

B cells

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8
Q

How are EBV-expressing B cells usually eliminated? What lymphoma does EBV predispose to and how?

A

Cytotoxic T cell function

B cell NHL

Mechanism:

  • if you’re previously infected with EBV and then it becomes latent
  • then when you’re immunosuppressed eg on chemo or during old age, and you get reactivation of the virus, T cells are suppressed so normal cytotoxic T cell killing doesn’t occur –> lymphoma

____

can also precipitate classical Hodkin’s lymphoma….

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9
Q

What type of lymphoma does h pylori infection predispose to?

A

Gastric MALT

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10
Q

Which oncoportein is overexpressed in Burkitt’s lymphoma?

A

c-myc

Because of t(8.14)

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11
Q

What are the 2 broad subtypes of Non-Hodgkins lymphoma?

A

B and T cell type

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12
Q

What are the subtypes of B cell NHL?

A

Low grade: follicular, small lymphocytic, marginal zone
High grade: diffuse large cell, Burkitt’s
Aggressive: mantle cell

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13
Q

What test can prove germinal centre origin of a lymphoma?

For diffuse large b cell lymphoma, which subtype has better prognosis: germinal centre or post germinal centre?

A

Positive staining for CD10 and bcl6

GERMINAL CENTRE origin has better prognosis

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14
Q

What is the classification of Burkitt’s lymphoma

A

High grade peripheral B cell lymphoma

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15
Q

What gene mutation is associated with follicular lymphoma?

A

t(14;18) - it causes overexpression of the bcl-2 gene

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16
Q

Which lymphoma typically has a ‘starry sky appearance’ on histology?

A

Burkitt’s lymohoma

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17
Q

Where does TCR gene recombination occur?

A

Bone marrow

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18
Q

What are the key enzymes involved in VDJ (TCR gene) recombination?

A

RAG1 and RAG2

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19
Q

What are the 2 methods of gene recombination in B cells?

A

Class switching
Somatic hypermutation

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20
Q

What is the key enzyme involved in B cell class switching?

A

Adenosine-induced deaminase

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21
Q

Which lymphoma are coeliac’s predisposed to?

A

EATL (enteropathy-associated t cell lymphoma)

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22
Q

What can PCR be used for in lymphoma diagnosis?

A

Identifying:

  1. Translocations
  2. TCR rearrangement
  3. IG gene rearrangement
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23
Q

What is the translocation t(11;14) diagnostic of?

A

Mantle cell lymphoma

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24
Q

What is the translocation of t(2;5) associated with?

A

A better prognosis for aplastic large cell lymphoma (T cell)

**t for T cell; t for two**

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25
Q

Which lymphoma shows aberrant CD5 and cyclin D1 expression?

A

Mantle cell lymphoma

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26
Q

Which type of lymphoma can cause either a jaw or abdominal mass?

A

Burkitt’s lymphoma

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27
Q

Recall one good and one bad prognostic indicator in diffuse large b cell lymphoma?

A

Good: germinal centre phenotype
Bad: p53 mutation

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28
Q

What is the grade of peripheral T cell lymphomas?

A

V aggressive

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29
Q

Which lymphoma is particularly common in Japan and the Caribbean?

A

Adult T cell leukaemia lymphoma

**caused by HTLV-1 which is becoming more common in these areas

30
Q

What is cutaneous T cell lymphoma known as?

A

Mycosis fungoides

31
Q

Which age group tends to be affected by anaplastic large cell lymphoma?

A

Young adults

32
Q

What is the t(2;5) translocation associated with?

A

Anaplastic large cell lymphoma- T cell lymphoma

if you have this translocation it is good prognosis

33
Q

Which type of lymphoma is associated with ALK-1 expression?

A

Anaplastic large cell lymphoma

this is associated with good prognosis

34
Q

Which type of lymphoma is most likely to involve just one lymph node group?

A

Hodgkin’s

35
Q

Which type of granulocyte will be present within a classical Hodgkin’s lymphoma?

A

Eosinophil

other reactive cells: marophages and plasma cells

**in nodular - no reactive cells

36
Q

Which type of lymphoma is associated with an isolated lymphadenopathy?

A

Nodular Lymphocyte predominant Hodgkin’s lymphoma

37
Q

Recall the subtypes of classical Hodgkin’s lymphoma

A

Nodular sclerosing - most common, more common in females
Mixed cellularity
Lymphocyte rich/ depleted - worst prognosis

38
Q

Which type of Hodgkin’s lymphoma would show B cell rich nodules?

A

Nodular lymphocyte-predominant lymphoma (i.e. not classical hodgkin’s lymphoma)

39
Q

Which type of lymphoma stains positively for CD15 and CD30?

A

CLASSICAL HODGKIN’S LYMPHOMA

40
Q

What is the biggest risk of radiotherapy in hodgkin’s lymphoma for women?

A

Breast Ca

** chemotherapy is mainstay; radiotherapy is in case of relapse but it carries risk of secondary malignancies

41
Q

What is the translocation t(8;14) associated with?

A

Burkitt’s lymphoma

42
Q

What is the best chemotherapy for Burkitt’s lymphoma?

A

Rituximab

43
Q

What is the histological finding of “angular nuclei” pathognemonic for?

A

Mantle cell lymphoma

44
Q

The Durie-Salmon staging system is used for which type of malignancy?

A

Multiple myeloma

45
Q

Where are lymphomas found?

A

Can arise in any lymphoid tissue

a) generative
b) reactive
c) acquired

46
Q

Are lymphomas usually disseminated or localised in disease?

A

Usually disseminated as lymphomas circulate in the blood

Except Hodkin’s lymphoma- tends to affect specific lymph node groups

And also early NHL tends to be localised in presentation

47
Q

CLassification of lymphoid malignancies

A
48
Q

What is the difference between lymphoma and lymphoid leukaeimia?

A

Lymphoma: predominantly affects lymph nodes with possible LATER involvement of blood/bone marrow

Lymphoid leukaemia: predominantly affects bone marrow and blood with moderate involvement of lymph nodes

49
Q

What are the precursor lymphoid neoplasms?

A

B cell: precursor B cell lymphoblastic leukaemia

T cell: precursor T cell lymphoblastic leukaemia

50
Q

What malignancy do naive B cells give rise to?

A

Chronic lymphocytic leukaemia

51
Q

What malignancy do plasma cells give rise to/

A

Multiple myeloma

52
Q

What malignancy do mantle cells give rise to?

A

Mantle cell lymphoma

53
Q

What malignancy do follicular lymphocytes give rise to?

A

Follicular lymphoma

Follicular lymphocytes- found in germinal centre

54
Q

Which mutations give rise to lymphoma? Inherited or somatic?

A

Mostly somatic!!

Altho there may be genetic predisposition to mutations, the actual mutation that causes cancer arises from a somatic mutatoin

55
Q

What lymphoma is prediposed to by HIV?

A

B cell NHL

eg diffuse large b cell and burkitts

**Bc HIV also leads to loss of T cell function - less cytotoxic killing

56
Q

Broad risk factors for lymphoma development

A
  • most cases are sporadic
  • some specific risk factors- constant antigenic stimulation, viral integration into lymphocytes, loss of T cell function
  • inherited disorders- genomic instability
  • iatrogenic- chemo and radio
  • immunosuppression
57
Q

In certain NHL subtypes you get chromosomal trnaslocations involving the promoter region: what is it? And what is the proto-oncogene?

A

IgH: immunoglobulin H

proto-oncogenes e.g. c-myc, BCL-2, BCL-6, cyclin-D1

58
Q

Which type of hodkin’s lymphoma is associated with EBV?

A

Classical- nodular sclerosing

**nb: nodular lymphocyte predominant is NOT associated with EBV

59
Q

How does HL spread?

A

contiguously, often involves a single lymph node group

60
Q

What type of fever do you get with HL?

A

Pel ebstein fever- cyclical fever

61
Q

Markers of classical vs non classical HL

A
62
Q

Hodgkin cells vs reed sternberg cells

A

hodgkin’s cells: mononuclear versions of reed sternberg cells

reed strnberg cells: multinucleate giant cells with reactive cells like eosinophils

63
Q

Treatment of hodkin’s lymphoma

A
64
Q

Allogenic vs autologous stem cell transplant

A

basc: allogeniec only preferred in leukaemia because of graft vs tumour effect which can be taken advantage of

65
Q

3 types of burkitt’s lymphoma

A
66
Q
A
67
Q

Tx of burkitt’s

A

rituximab

68
Q

mantle cell lymphoma treatment

A

R-CHOP

Auto-sct for relapse

69
Q

Tx of follicular lymphoa

A

watch and wait

rituximab

or obintuxumab+cvp

70
Q

what tx can be used for t cell NHL?

A

alemtuzumab- anti CD52

CD52 is the T cell receptor

71
Q

what is bcl2 inhibitor?

A

used in cll - it promotes apoptosis of cells

Haematology (16 decks)

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