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Lymphoreticular > Haematopoetic Neoplasia 1 (Annaleise Stell) > Flashcards

Haematopoetic Neoplasia 1 (Annaleise Stell) Flashcards

1
Q

Where does lymphoma orginiate?

A
  • LNs, spleen, lymphoid tissue anywhere in body
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2
Q

What is the most common canine and feline malignant tumours?

A

Lymphome for both

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3
Q

What signalment is pdf lymphoma in dogs?

A
  • middle aged/older BUT can be any age (reported
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4
Q

Aetiology of lymphoma in dogs?

A
  • unknown
  • ?genetic factors
  • chromosomal abnormalities and mutations in tumour suppressors genes eg. p53
  • environmental factors (herbicides, magnetic fields, industrial areas)
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5
Q

Signalment pdf lymphoma in cats?

A
  • ~10yo @ onset (previously younger cats more common but v incidence as FeLV numbers v)
  • siamese/oriental cats pdf mediastinal lymphoma
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6
Q

Aetiology of lymphoma in cats?

A
  • FeLV+ ^ risk d/t retrovirus recombination encouraging malignant transformation and immunosuppressive role (vax has v no.s lymphoma d/t FeLV, though some cases testing -ve may still be d/t FeLV infection in the past which has been cleared)
  • FIV+ ^ risk, mechanism unknown (?Immunosuppression)
  • Genetic factors
  • Environmental tobacco smoke
  • Sites of chronic inflammation (eg. IBD)
  • immunosuppression eg. cyclosporine post renal-transplant int he USA
  • spontaneous (Aetiology not fully understood)
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7
Q

Most common presentation of lymphoma in dogs?

A

> multicentric 85% dog lymphomas
- peripheral lymphadenomegaly (painless, movable, multiple LNs)
- otherwise asymptomatic or nonspecific signs (malaise, lethargy, wt loss, anorexia, pyrexia, PUPD if hyperCa)
± liver/spleen enlargement

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8
Q

Which LNs are easiest to assess on PE?

A
  • submand
  • prescap
  • popliteal
    ±axillary
    ±superficial inguinal
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9
Q

Does FeLV affect old cats?

A

No young

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10
Q

Ddx for multicentric lymphoma in dogs?

A
  • disseminate infection -> lymphadenitis (bacteria/virus/rickettsial/protozoal/parasitic/fungal)
  • immune mediated dz
  • other haem tumours (leukaemia, myeloma)
  • mets/disseminate neoplasia eg. histiocytic sarcoma, MCT
  • generalised skin dz
  • sterile granulomatous lymphadenitis (rare)
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11
Q

What is the 2nd most common presentation of lymphoma in dogs?

A

> GI/alimentary lymphoma 7% cases

  • wt loss, anorexia, VD+, ± jaundice if concurrent liver involvement
  • localised mass/multifocal diffuse thickened loops of intestine ± mesenteric LN enlargement
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12
Q

Ddx for GI lymphoma in the dog?

A
  • IBD (especially if difuse)
  • other GI tumours (adenocarcinoma, leimyoma, leiomyosarcoma, gastrointestinal stromal tumours (GISTs)
  • FB/intusseseption
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13
Q

Which forms of lymphoma are less commonly seen in dogs?

A

> mediastinal 3% cases
- cranial mediastinal mass ± pleural fluid
- cough, regurge, dyspnoea/tachypnoea, v heart sounds or caudal displacmeent of heart, loss of compressability, caval syndrome (impedence of venous return from head -> oedema) Horners syndrome
- often T cell phenotypes
± hyperCa (rare in cats) -> PUPD, dehydration, malaise, V+, bradycardia, constipation, mm tremors
cutaneous (solitary/generalised)
- epitheliotropic (in epidermis, “mycoides fungoides”, chronic dz, assoc with T cells, casues 3 stage scaling, alopecia, pruritis -> erythematous, thickened, ulcerated and exudatice -> proliferative plaques and nodules, may involve oral mucosa/mucocutaneous junction)
- non-epitheliotropic form (deeper, can be T or B cell, causes nodules rather than scaling)

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14
Q

Ddx for mediastinal lymphoma in the dog?

A
  • other neoplasia (thymoma, ectopic thyroid tumour, thymic carcinoma, chemodectoma, mets)
  • non-neoplastic mass lesions (abscess, granuloma, cyst)
  • other casues of effusion (pyothorax, chylothorax, heart failure, haemothorax)
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15
Q

Ddx cutaneous lymphoma

A
  • infectious deramatitis
  • immune mediated dermatitis
  • histiocytic skin dz
  • other cutaneous neoplasia (eg. MCT, mets)
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16
Q

Which extranodal forms of lymphoma occour very rarely in dogs?

A
  • hepatic
  • spenic
  • ocular (can be seen alone or with generalised disease, signs of uveitis, blepharospasm , infiltration, haemorrhage, retinal detachment)
  • renal lymphoma
  • CNS/spinal lymphoma
  • nasal/nasopharyngeal/laryngeal/tracheal
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17
Q

Most common presentation of feline lymphoma?

A

> GIT >50% cases (very rare to see generalised lymphadenopathy)
- wt loss, anorexia, VD+ ±jaundice if concurrent liver invovlemnet
~ High grade form (mass lesions GI or mesenteric LNs, acute onset, signs of obstruction, commonly ~10yo)
~ Low grade form (may be diffuse thickening of intestinal loops/mild lymphadenomegaly, chronic hx, commonly ~13yo)

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18
Q

Ddx for feline GI lymphoma?

A
  • IBD
  • other Gi neoplasia (Adenocarcinoma, leimyoma, leiomyosarcoma, GI stronal tumours (GISTs) intestinal MCT
  • FB,/intusseseption
  • r/o other dz of old cats -> wt loss eg. hyperthyroidism , renal failure, DM
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19
Q

2nd most common form of lymphoma in cats?

A

> mediastinal 20% cases

  • cranial mediastinal mass ± pleural fluid ± other sites affected concurrently
  • esp younger cats
  • often T cell phenotype
  • HyperCa RARE in cats cf. dogs
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20
Q

Ddx mediastinal lymphoma in cats?

A
  • other neoplasia (thymoma, ectopic thyroid tumour, thymic carcinoma, chemodectoma, mets)
  • non-neoplastic mass lesions (abscess, granuloma, cyst)
  • other casues of effusion (pyothorax, chylothorax, heart failure, haemothorax, FIP)
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21
Q

Which forms of lymphoma are seen in ~5-10% lymphoma cases in cats?

A
  • nodal
  • renal
  • hepatic/splenic
  • nasal/nasopharyngeal
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22
Q

Outline clinical picture with nodal lymphoma in cats

A
  • rare alone but more common as a component of disease
  • in pure node forms, single/regional elargement more common than generalised lymphadenomegaly.
  • uncommon distinct form HODGKINS-LIKE LYMPHOMA (T cell rich B cell lymphoma) only affects head or neck
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23
Q

How may Hodgkins-like lymphome be treated in cats?

A

May be amenable to surgery as localised

24
Q

Ddx nodal lymphoma cats

A

=== dogs

- benign hyperplastic LN syndromes unique to cats

25
Q

Outline clinical picture with renal lymphoma in cats

A
  • large irregular kidneys, often bilateral
  • signs of kidney dz (PUPD, anorexia, weight loss)
  • ~9yo
  • can be concurrent with lymphoma elsehere
  • 50% cats also develop CNS lymphoma (link unknown)
  • often intermediate - high grade
26
Q

Ddx for renal lymphoma in cats

A
  • polycystic kidney disease
  • pyelonephritis
  • FIP
  • acute renal failure
  • hydronephrosis
  • perinephric pseudocyst
  • other renal tumours eg carcinoma (can also be bilateral) HS
27
Q

Outline clinical picture with hepatic/splenic lymphoma in cats

A
  • malaise ± jaundice if liver invovled

- may be concurrent with GI lymphoma

28
Q

Ddx hepatic/splenic lymphoma?

A
  • other splenic masses (feline MCT, HSA)

- other causes of hepatic enlargement/jaundice (cholangiohepatitis, other neoplasia)

29
Q

Outline clinical picture with nasal/nasopharyngeal lymphoma in cats

A
  • older cats ~10yo
  • mostly B cell
  • often localised, can spread to local LNs or appear elsewhere later on!
  • intermediate - high grade
  • clinical signs: sneezing, chronic nasal discharge (serosanguinous to mucopurulent), epistaxis, stertor, anorexia, facial deformity, exopthalmus, epiphora
30
Q

Ddx for nasal lymphoma in cats

A
  • cat flu
  • neoplasia (carcinoma)
  • fungal ( cryptococcus)
  • lymphocytic rhinitis
  • dental dz
31
Q

Clinical picture with laryngeal/tracheal lymphoma?

A
  • older cats ~9yo
  • URT obstruction
  • dyspnoea
  • can be localised/multiple sites
32
Q

Which forms of lymphoma rarely affects cats?

A

> CNS/spinal lymphoma
- BUT one of the most common CNS tumours in cats
- spinal or intracranial often multiple regions affected (intra or extradural)
- >80% mixed site involvement esp renal and BM
- clinical presentation: insidious/rapidly progressive neurological signs depending on lesion localisation
cutaneous lymphoma
- very rare in cats

33
Q

Ddx for CNS/spinal lymphoma in cats

A
  • other CNS tumours eg. Meningioma
  • trauma, intervertebral disc prolapse/herniation
  • infection: FIP, mycotic infection
  • aortic thrombus/embolism
  • discospondylitis
  • FeLV association non-neoplastic myelopathy
34
Q

Which paraneoplastic syndromes are seen wi lymphoma?

A
  • hypercalcaemia
  • hypergammaglobulinaemia
  • rarely immune mediated disease
35
Q

Clinical signs associated with hypercalcaemia

A
  • 10-40% dogs with lymphoma (usually T cells) rare in cats
  • PUPD D/t nephrogenic diabetes insipidus (Ca interferes with action of ADH in the kidney) stops concentration of urine
  • dehydration, depression, lethargy, weakness, V+, constipation , bradycardia/bradydysrhythmias, muscle tremors
  • renal failure may occour if left untreated d/t v renal blood flow and /or nephrocalcinosis
36
Q

What causes hypercalcaemia with lymphoma?

A

Production of PTH-rp acting on PTH-Rs stimulating release of Ca from stores and ^ absorption from gut

37
Q

How does hypergammaglobulinaemia occour with lymphoma

A

Monoclonal gammopathy d/t abhorrent AB production. Can cause hyperviscosity if extreme.
-> retinal detachment and neurological signs can occour

38
Q

How is immune mediated disease linked to lymphoma?

A

Aberrant AB response triggering IMHA/IMT (if older animal develops these suspect neoplasia)

39
Q

How can lymphoma be diagnosed?

A

> Hx and OE
- LN (Including rectal exam)
- mucous membranes
- abdominal palpation (mass lesions, organomegaly liver and spleen esp.) peritoneal fluid?)
- thoracic auscultation, percussion and compression in cats ?fluid)
LN / tissue aspirates or biopsy
- 23G needle multiple sites
- >50% immature lymphocytes suspect neoplasia
- ultrasound guided aspirates of deep LNs
ultrasound
- esp. Cats GI lymphoma
- high grade (loss of normal layering, mass lesions, +- mesenteric LN enlarged) FNA mass lesions/LNs useful.
- low grade (muscularis propria thickened, Ddx IBD) may need full thickness biopsies
if FNA not possible
- surgical biopsies (whole LNs or full thickness GIT)
- Tru cut (LNs, harder to interpret architecture, masses, liver)
- endoscopic (GIT)
- punch biopsy (skin)
cytology of abdominal/pleural fluid/CSF
- lymphoma sheds readily into effusions

40
Q

Are there subtypes of lymphoma?

A

Yes lots! Current area of research - different subtypes require different tx and px.

41
Q

Commonest subtype of lymphoma in dogs?

A

Diffuse large B cell lymphoma

42
Q

How is lymphoma graded and what grade is most common?

A
  • in dogs most intermediate to high grade (low rare, usually in spleen)
  • cell size and morphology important regarding type of lymphoma (small cell suggests low grade lymphoma, large cells/blasts suggests high grade)
43
Q

What is immunophenotyping useful for?

A

Affects prognoses in canine lymphoma
- intermediate to high grade lymphoma in dogs (majority) B cell = Better, T cell worse. BUT SOME LOW GRADE T CELL LYMPHOMA BETTER PROG. EG. T-zone lymphoma
> unknown if B/T affects px in cats

44
Q

What samples need to be taken for immunophenotyping

A

LN aspirate in “cytocheck medium” sample should appear cloudy

45
Q

What markers show B and T cell phenotypes?

A

B cell (majority of dog lymphoma)
- CD79a, CD21
T cell (majority of mediastinal form)
- CD3, CD4, CD8

46
Q

How may immunophenotyping affect tx?

A
  • dogs intermediate to high grade T cell respond well to alkylating agents (eg. Lomustine)
    > @RVC
  • B cells COP and CHOP
  • T cells modified LOPP (lomustine, vincristine, procarbazine, prednisolone)
47
Q

What is immunohistochemistry useful for?

A

B or T cells labelled, In lymphoma one will predominate whereas in inflammation it will be a mixed population

48
Q

What is PARR?

A
  • PCR for Antigen Receptor Rearragnement
    > lymphoma
    Monoclonal population of cells present with the same antigen receptor region (single band)
    > inflam or non-neoplastic
    Polyclonal gives multiple bands/smear
49
Q

After diagnosis of lymphoma has been made, what diagnostics can be used for further diagnostics and why?

A

> haematology
- general health, check cytopenias or abnormal cells
- baseline before starting chemo
- anaemia (mild normochromic, normocytic, non-regenerative)
- cytopenias (if multiple cell lines affected suspect BM infiltration (myelophthisis))
- atypical circulating lymphocytes/lymphocytosis (suspect BM involvement)
Biochemistry
- assess organ invovlemnt and function pre-chemo
- paraneoplastic effects
- liver enzymes
- azotaemia (renal infiltration, hypercalcaemia nephropathy, pre-renal)
- hypercalcaemia
- hyperglobulinaemia
- hypoproteinaemia (with GI loss)
Urinalysis
- esp pre- cyclophosphamide (haemorrhagic cystitis dogs)
serum B12
- GI lymphoma levels often low, need supplements

50
Q

Does staging affect tx plan?

A

Not always , gives info about prognosis

51
Q

Who stages, who grades?

A

Pathologist grades, clinician stages

52
Q

Outline WHO staging system for lymphoma

A

I: solitary node or lymphoid tissue single organ
II: multiple LNs one side of diaphragm
III: generalised LN involvement (both sides of diaphragm)
IV: Liver/spleen involvement
V: BM +- other organs
> substage a: no systemic signs, b: systemic signs
> good for dogs, not really good for cats but can be used

53
Q

Any ideas for prognosis with lymphoma?

A
  • some studies stage I and II better prog, V worse
  • but not always end of the road because stage V!
  • substage b worse prog
54
Q

What imaging modalities may be useful for lymphoma?

A 
> rads
> ultrasound
- esp cats low v high grade GI lymphoma 
> CT/MRI 
- esp for nasal/CNS
55
Q

How can involvement of organs be confirmed ?

A

sampling and cytology

- BM aspirate may be needed for full staging but rarely done clinically

56
Q

Minimum database prior to starting chemo?

A
  • haem
  • biochem
  • urinalysis

Lymphoreticular (31 decks)

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