Haematopoetic Neoplasia Flashcards
(90 cards)
1
Q
Define lymphoma
A
Diverse group of malignant neoplasms that originate from lymph nodes, spleen or lymphoid tissue anywhere in the body
2
Q
Outline the signalment for canine lymphoma…
A
6-9ys
Breeds - boxers, bull mastifs
F=M
3
Q
What causes canine lymphoma?
A
Chromosomal abnormalities
Mutations in tumour suppessor genes
Environmental factors
4
Q
What are the types of canine lymphoma in order of most to least common?
A
- Multicentric
- GIT
- Mediastinal
- Cutaneous
- Hepatic, hepatosplenic, renal, CNS
5
Q
What are the symptoms of multicentric lymphoma?
A
Asymptomatic Malasie, lethargy Anorexia Pyrexia PU/PD (hyperca) Hepatosplenomegaly
6
Q
Which lymph nodes are palpable on small animals?
A
Submandibular Prescapular Axillary Superficial inguinal Popliteal
7
Q
What are DDx for generalised lymphadenomegaly?
A
Lymphoma Disseminated infection Immune-mediate disease Metastatic neoplasia Other haematopoietic neoplasia Skin disease Sterile granulomatous lymphadenitis
8
Q
What are the clinical signs for canine GIT lymphoma?
A
Weight loss
D+ V+
Anorexia
9
Q
What are the DDx for canine GIT lymphoma?
A
IBD
Gut tumours
FB, intussussception
10
Q
What are the clinical signs of mediastinal lymphoma?
A
Dyspnoea, tachypneoa Cough Weight loss Regurgitation Displaced heart sounds Reduced lung sounds Loss og compressibility Signs of hyperca
11
Q
What phenotype are medialstinal lymphomas usually? What does this tend to lead to?
A
T Cell
hyperCa
12
Q
What are the clinical signs of Hyperca?
A
PUPD
Dehydration
V+
13
Q
How can mediastinal lymphoma cause Horner’s syndrome?
A
Compression of the vagosympthetic trunk within the thorax
14
Q
How can mediastinal lymphoma cause swelling of the head?
A
Compression of the superior vena cava
15
Q
What are the DDx for mediastinal lymphoma?
A
Thyoma
Pulmonary neoplasia
Chest wall mass
Transudate, pyo/haemothorax, air
16
Q
Name the two types of cutaneous lymphoma. How do they differ?
A
Epitheliotropic - involved v superficial layers of skin
Non-epitheliotropic - involved layers of dermis
17
Q
Does hyperCa tend to occur more in dogs or cats?
A
Dogs (rare in cats)
18
Q
Are epitheliotropic and non-epitheliotropic cutaneous lymphomas more likely to be B or T cell phenotype?
A
E - T cell
N-E - B or T
19
Q
What are the clinical signs of epitheliotrophic cutaneous lymphoma?
A
Scaling
Pruritus
Plaques and nodules
20
Q
What are DDx for cutaneous lymphoma?
A
Dermatitis
Immune-mediated dermatitis
Histiocytic skin disease
Other cutaneous neoplasia
21
Q
How can lymphoma cause hyperCa?
A
T cells produce PTH-rp which mimics PTH causing calcium release from stores
22
Q
What can occur due to paraneoplatic syndrome of lymphomas?
A
HyperCa
Hypergammaglobulinaemia
Immune-mediated disease
23
Q
What should be included in a PE when diagnosing lymphoma?
A
LN palpation
MM - pallor petechiae
Chest auscultation
Abdominal palpation
24
Q
Which LN shouldn’t be used for a FNA diagnosis of lymphoma and why?
A
Submandibular
Can be affected by dental disease => confused diagnosis
25
What can be done in a lymphoma cases when FNA/cytology isn't feasible?
Biopsy - removal of entire LN
26
What test are used when diagnosing lymphoma is tricky?
IHC - B or T cell dominates with lymphoma
PARR - single band with lymphoma, multiple bands with inflammation
27
Outline the PARR test...
PCR for antigen receptor rearrangement
28
What is the most common subtype of lymphoma in dogs?
Diffuse large B cell lymphoma
29
How common are low, intermediate and high grade lymphomas in dogs? Is this significant?
Low - uncommon
I and H - common
Yes - treatment and prognosis differs
30
Is the phenotype of lymphoma significant? How is it found?
Yes - B cell lymphoma - better prognosis
- Flow cytometry
- IMH
- PARR
31
How are intermediate-high T cell lymphomas treated?
Alkylating agents e.g. lomustine
32
One the diagnosis of lymphoma has been made, what work up should be done?
Haem - Health status, anaemia, cytopenias, atypical cells
Biochemistry - organ function, paraneoplatic effects, hyperCA
Urinalysis - baseline info, USG, esp if starting cyclophophamide
Serum B12 - GIT lymphoma only, may need supplementation
33
Is finance is a restrain, what can be done once diagnosed lymphoma?
Skip staging and go straight to treatment
34
Outline the stages of canine lymphoma...
```
I - Single LN
II - Multiple LN in one region
III - Generalised LN involv
IV - Liver +/- spleen involv
V - Bone marrow involv
```
35
How are canine lymphomas stages?
Radiographys - thoracic, abdominal, affected areas
US of abdomen
CT/MRI - CNS and nasal
Aspirate/cytology
Bone marrow aspirate/biopsy
36
What abnormalities on abdominal US are used to stage canine lymphoma?
```
Changes in echogenicity
Enlarged organs
Lymphadenopathy
Masses
Thickening of gut wall, loss of layering
```
37
What is the most effective treatment of canine lymphoma? What other treatment can be used and when?
Combination chemo
- Surgery - solitary lesion, obstructive GI
- Radiation - nasal, oral or solitary lesion, prolong remission
38
What is trying to be achieved with chemo for lymphoma?
Palliation - NOT curative
| Maintain QOL
39
What treatment protocols are used for B and T cells lymphomas in dogs?
B - CHOP, COP
| L - LOPP
40
What drugs are used in COP/CHOP chemo protocols?
COP
- Cyclophosphamide
- Vincristine
- Prednisolone
CHOP
- Above + doxyrubicin
41
How is the chemo protocol chosen?
Cost
Adverse effects
First remission duration
Median survival
42
What drugs are used in LOPP protocol?
Lomustine
Vincritine
Prendisolone
Procarbazine
43
What is rescue therapy?
Relapse of lymphoma when having no treatment => restart chemo
Relapse of lymphoma during treatment => try different drugs
44
How should lymphoma chemo patients be monitored during their treatment?
```
PE or LN, weight loss, clinical signs
Imaging of internal lesions
FNA of liver/spleen
Haem - neutrophils, platelets
Biochemistry
Serum B12 in GIT
```
45
What specific drug toxicities can occur with chemo drugs?
Loumustine - hepatic disease
Doxorubicin - cardiac disease
Cyclophosphamide - haemorrhagic cystitits
46
How should adverse effects of chemo be managed?
GI protectants/anti-emtics
Antibiotics if myelosuppressed
Antihistamines/dex is allergic
Specalist care
47
What are the prognosis for B and T cell lymphomas treated with chemo?
B - 1year
T - 6m
4-6W with no treatment
48
What are the negative prognostic indicators for canine lymphoma?
```
T cell
Systemic signs
HyperCa
Prolonged pre-treatment steroids
Stage III-V
Fail to achieve complete remission
Primary site in the GIT
```
49
Outline the signalment for feline lymphoma...
9-11y
Siamese/oriental
F=M
50
What greatly increases the risk of developing feline lymphoma?
FeLV +ve
51
What causes feline lymphoma?
```
FeLV, FIV
Breed disposition
Smoking in environment
Chronic inflammation
Immunosuppresion
Spontaneous
```
52
How has the FeLV vacc changed the signalment for feline lymphoma?
Usually used to affect 4-6yo cats but now 9-11
53
What are the types of feline lymphoma in order of most to least common?
1. GIT
2. Mediastinal
3. Renal, heptaic, splenic, nasopharyngeal
4. Nodal
5. Laryngeal/tracheal/CNS/spinal
6. Cutaneous (rare)
54
What are the clinical signs of feline GIT lymphoma?
Weight loss
V+ D+
Anorexia
55
What are DDx of feline GIT lymphoma?
IBD
Other GIT tumours
FB, intussusception
Other causes of weight loss in elderly cats
56
What are the DDx for feline nodal lymphoma?
Infectious
| Benign hyperplasia
57
What type of nodal lymphoma can occur in cats and has a good prognosis? Which LNs are affected?
Hodgkin's-like lymphoma variant
Head and neck LNs
58
What are the clinical signs of renal lymhpoma in cats?
PUPD
Anorexia
Weight loss
Renomegaly
59
What secondary lymphoma is likely to develop after feline renal lymphoma?
CNS lymphoma
60
What are the DDx for feline renal lymphoma?
```
Polycystic kidney disease
FIP
Acute renal failure
Hydronephrosis
Perinephric pseudocyts
Other renal tumours
```
61
What are clinical signs of feline hepatic/splenic lymphoma?
Malaise
Organomegaly
Icterus
62
What are the clinical signs of feline nasal/nasopharyngeal lymphoma?
Nasal discharge
Epistaxis
Facial pain, distortion
Loss of airflow
63
What are the DDx for feline nasal/nasopharyngeal lymphoma?
```
Cat flu
Other neoplasia
Fungal infection
Lymphocytic rhinitis
Dental disease
```
64
What are the clinical signs of feline CNS and ocular lymhpoma?
CNS - neuro deficits, paresis/paralysis
O - Infiltrates, uveitis, glaucoma
65
What are the DDx for feline CNS lymphoma?
```
Meningioma
Trauma
Disc herniation
FIP
Aortic thromboembolism
Discospondylitis
FeLV myelopathy
```
66
How is feline GI lymphoma diagnosed?
US
Cytology
Endoscopy
Laparotomy
67
What are the signs of high grade and low grade feline GI lymphomas on US?
```
H:
Mass lesions in gut
Loss of layering
Mesenteric lymphadenopathy
Effusion
```
L:
Difffuse thickening of gut
LN enlargement
68
What is a sign of feline GI lymphoma on cytology?
Monomorphic large lymphoid cells
69
Why might endoscopy not be useful for biopsy of a feline GI lymphoma?
Can only get a superficial biopsy and may not extract enough tissue to differentiate lymphoma from IBD
70
Are grade and phenotype of feline GI lymphoma important?
Yes - grade affects treatment and prognosis
| Low grade GI lymphomas are usually T cell
71
How are intermediate-high grade feline lymphomas treated?
COP protocol
72
How are low grade feline lymphomas treated?
Chlorambucil and preds
73
Do cats or dogs have a better response rate to lymphoma treatment?
Dogs
74
What is the prognosis for feline GI lymphoma?
H-I - 6-10m
| L - >2y
75
What are positive prognostic factors of feline lymphoma?
Achieving complete remission
Low grade
Hodgkin's subtype
Nasal lymphoma
76
What are negative prognostic factors for feline lymphoma?
FeLV +ve
High grade
Large granular lymphocyte subtype
77
Which feline lymphoma has a v poor prognosis?
LGL subtype
78
Define leukaemia. What are the two types?
Malignant neoplasias originating from haematopoietic precursors in the bone marrow or spleen
1. Lymphoid
2. Myeloid
79
What are the clinical signs of leukaemia?
```
Lethargy, weakness, anorexia
Pyrexia
Pallor, petechiae
Mild generalised lymphadenopathy
Hepatospenomegaly
```
80
How is leukaemia diagnosed?
Haemo - cytopenia in >1 cell line, abnormal circulating cells
Bone marrow aspirate/core and flow cytometry
81
How are acute lymphoid and myeloid leukaemia treated?
L - L-asparaginase/preds/cytarabine, COP/CHOP
M - cytarabine
82
How are chronic lymphoid and myeloid leukaemia treated?
L - Chlorambucil/preds
M - Hydroxycarbamide
83
How do you differentiate stage V lymphoma from acute lymphoblastic leukaemia?
```
Stage V lymphoma:
Often well
LNs often enlarged
Cytopenias tend to be mild
CD34 -ve on flow
```
```
ALL:
Often sick
LNs mildly enlarged
Cytopenias tend to be marked
CD34 +ve on flow
```
84
What cells do myelomas originate from?
Plasma cells within the bone marrow
85
What are the clinical signs of myeloma?
```
Pyrexia
Lethargy
Pallor
Lymphadenopathy
Hepatosplenomegaly
Neuro signs/bleeding due to hyper viscosity
Bone pain
```
86
How do myelomas appear on radiographs?
Diffuse ostepenia
| Punched out osteolytic lesions
87
What haem, biochemistry and UA results indicate myeloma?
H - cytopenias
B - Increased globulins, hyperca
UA - Bence-Jones proteinuria
88
What test and results is characteristic of myeloma?
Electrophoresis of serum/urine show Ig light chains (Bence-Jones proteins)
89
How is myeloma diagnosed? How is it treated in dogs and cats?
Bone marrow aspiration/biopsy
D - Melphalan and preds
C - Chlorambucil and preds
90
What is the mean survival time for dogs treated for myeloma?
12-18m
