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Lymphoreticular and Haemopoietic > Haematopoetic Neoplasia > Flashcards

Haematopoetic Neoplasia Flashcards

1
Q

Define lymphoma

A

Diverse group of malignant neoplasms that originate from lymph nodes, spleen or lymphoid tissue anywhere in the body

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2
Q

Outline the signalment for canine lymphoma…

A

6-9ys
Breeds - boxers, bull mastifs
F=M

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3
Q

What causes canine lymphoma?

A

Chromosomal abnormalities
Mutations in tumour suppessor genes
Environmental factors

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4
Q

What are the types of canine lymphoma in order of most to least common?

A
  1. Multicentric
  2. GIT
  3. Mediastinal
  4. Cutaneous
  5. Hepatic, hepatosplenic, renal, CNS
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5
Q

What are the symptoms of multicentric lymphoma?

A 
Asymptomatic
Malasie, lethargy
Anorexia
Pyrexia
PU/PD (hyperca)
Hepatosplenomegaly
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6
Q

Which lymph nodes are palpable on small animals?

A 
Submandibular
Prescapular
Axillary
Superficial inguinal
Popliteal
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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
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8
Q

What are the clinical signs for canine GIT lymphoma?

A

Weight loss
D+ V+
Anorexia

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9
Q

What are the DDx for canine GIT lymphoma?

A

IBD
Gut tumours
FB, intussussception

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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
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11
Q

What phenotype are medialstinal lymphomas usually? What does this tend to lead to?

A

T Cell

hyperCa

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12
Q

What are the clinical signs of Hyperca?

A

PUPD
Dehydration
V+

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13
Q

How can mediastinal lymphoma cause Horner’s syndrome?

A

Compression of the vagosympthetic trunk within the thorax

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14
Q

How can mediastinal lymphoma cause swelling of the head?

A

Compression of the superior vena cava

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15
Q

What are the DDx for mediastinal lymphoma?

A

Thyoma
Pulmonary neoplasia
Chest wall mass
Transudate, pyo/haemothorax, air

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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

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17
Q

Does hyperCa tend to occur more in dogs or cats?

A

Dogs (rare in cats)

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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

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19
Q

What are the clinical signs of epitheliotrophic cutaneous lymphoma?

A

Scaling
Pruritus
Plaques and nodules

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20
Q

What are DDx for cutaneous lymphoma?

A

Dermatitis
Immune-mediated dermatitis
Histiocytic skin disease
Other cutaneous neoplasia

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21
Q

How can lymphoma cause hyperCa?

A

T cells produce PTH-rp which mimics PTH causing calcium release from stores

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22
Q

What can occur due to paraneoplatic syndrome of lymphomas?

A

HyperCa
Hypergammaglobulinaemia
Immune-mediated disease

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23
Q

What should be included in a PE when diagnosing lymphoma?

A

LN palpation
MM - pallor petechiae
Chest auscultation
Abdominal palpation

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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

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25
Q

What can be done in a lymphoma cases when FNA/cytology isn’t feasible?

A

Biopsy - removal of entire LN

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26
Q

What test are used when diagnosing lymphoma is tricky?

A

IHC - B or T cell dominates with lymphoma

PARR - single band with lymphoma, multiple bands with inflammation

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27
Q

Outline the PARR test…

A

PCR for antigen receptor rearrangement

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28
Q

What is the most common subtype of lymphoma in dogs?

A

Diffuse large B cell lymphoma

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29
Q

How common are low, intermediate and high grade lymphomas in dogs? Is this significant?

A

Low - uncommon
I and H - common
Yes - treatment and prognosis differs

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30
Q

Is the phenotype of lymphoma significant? How is it found?

A

Yes - B cell lymphoma - better prognosis

  • Flow cytometry
  • IMH
  • PARR
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31
Q

How are intermediate-high T cell lymphomas treated?

A

Alkylating agents e.g. lomustine

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32
Q

One the diagnosis of lymphoma has been made, what work up should be done?

A

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

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33
Q

Is finance is a restrain, what can be done once diagnosed lymphoma?

A

Skip staging and go straight to treatment

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34
Q

Outline the stages of canine lymphoma…

A 
I - Single LN
II - Multiple LN in one region
III - Generalised LN involv
IV - Liver +/- spleen involv
V - Bone marrow involv
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35
Q

How are canine lymphomas stages?

A

Radiographys - thoracic, abdominal, affected areas

US of abdomen

CT/MRI - CNS and nasal

Aspirate/cytology

Bone marrow aspirate/biopsy

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36
Q

What abnormalities on abdominal US are used to stage canine lymphoma?

A 
Changes in echogenicity
Enlarged organs
Lymphadenopathy
Masses
Thickening of gut wall, loss of layering
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37
Q

What is the most effective treatment of canine lymphoma? What other treatment can be used and when?

A

Combination chemo
- Surgery - solitary lesion, obstructive GI

  • Radiation - nasal, oral or solitary lesion, prolong remission
38
Q

What is trying to be achieved with chemo for lymphoma?

A

Palliation - NOT curative

Maintain QOL

39
Q

What treatment protocols are used for B and T cells lymphomas in dogs?

A

B - CHOP, COP

L - LOPP

40
Q

What drugs are used in COP/CHOP chemo protocols?

A

COP

  • Cyclophosphamide
  • Vincristine
  • Prednisolone

CHOP
- Above + doxyrubicin

41
Q

How is the chemo protocol chosen?

A

Cost
Adverse effects
First remission duration
Median survival

42
Q

What drugs are used in LOPP protocol?

A

Lomustine
Vincritine
Prendisolone
Procarbazine

43
Q

What is rescue therapy?

A

Relapse of lymphoma when having no treatment => restart chemo

Relapse of lymphoma during treatment => try different drugs

44
Q

How should lymphoma chemo patients be monitored during their treatment?

A 
PE or LN, weight loss, clinical signs
Imaging of internal lesions
FNA of liver/spleen
Haem - neutrophils, platelets
Biochemistry
Serum B12 in GIT
45
Q

What specific drug toxicities can occur with chemo drugs?

A

Loumustine - hepatic disease
Doxorubicin - cardiac disease
Cyclophosphamide - haemorrhagic cystitits

46
Q

How should adverse effects of chemo be managed?

A

GI protectants/anti-emtics
Antibiotics if myelosuppressed
Antihistamines/dex is allergic
Specalist care

47
Q

What are the prognosis for B and T cell lymphomas treated with chemo?

A

B - 1year
T - 6m
4-6W with no treatment

48
Q

What are the negative prognostic indicators for canine lymphoma?

A 
T cell
Systemic signs
HyperCa
Prolonged pre-treatment steroids
Stage III-V
Fail to achieve complete remission
Primary site in the GIT
49
Q

Outline the signalment for feline lymphoma…

A

9-11y
Siamese/oriental
F=M

50
Q

What greatly increases the risk of developing feline lymphoma?

A

FeLV +ve

51
Q

What causes feline lymphoma?

A 
FeLV, FIV
Breed disposition
Smoking in environment
Chronic inflammation
Immunosuppresion
Spontaneous
52
Q

How has the FeLV vacc changed the signalment for feline lymphoma?

A

Usually used to affect 4-6yo cats but now 9-11

53
Q

What are the types of feline lymphoma in order of most to least common?

A
  1. GIT
  2. Mediastinal
  3. Renal, heptaic, splenic, nasopharyngeal
  4. Nodal
  5. Laryngeal/tracheal/CNS/spinal
  6. Cutaneous (rare)
54
Q

What are the clinical signs of feline GIT lymphoma?

A

Weight loss
V+ D+
Anorexia

55
Q

What are DDx of feline GIT lymphoma?

A

IBD
Other GIT tumours
FB, intussusception
Other causes of weight loss in elderly cats

56
Q

What are the DDx for feline nodal lymphoma?

A

Infectious

Benign hyperplasia

57
Q

What type of nodal lymphoma can occur in cats and has a good prognosis? Which LNs are affected?

A

Hodgkin’s-like lymphoma variant

Head and neck LNs

58
Q

What are the clinical signs of renal lymhpoma in cats?

A

PUPD
Anorexia
Weight loss
Renomegaly

59
Q

What secondary lymphoma is likely to develop after feline renal lymphoma?

A

CNS lymphoma

60
Q

What are the DDx for feline renal lymphoma?

A 
Polycystic kidney disease
FIP
Acute renal failure
Hydronephrosis
Perinephric pseudocyts
Other renal tumours
61
Q

What are clinical signs of feline hepatic/splenic lymphoma?

A

Malaise
Organomegaly
Icterus

62
Q

What are the clinical signs of feline nasal/nasopharyngeal lymphoma?

A

Nasal discharge
Epistaxis
Facial pain, distortion
Loss of airflow

63
Q

What are the DDx for feline nasal/nasopharyngeal lymphoma?

A 
Cat flu
Other neoplasia
Fungal infection
Lymphocytic rhinitis
Dental disease
64
Q

What are the clinical signs of feline CNS and ocular lymhpoma?

A

CNS - neuro deficits, paresis/paralysis

O - Infiltrates, uveitis, glaucoma

65
Q

What are the DDx for feline CNS lymphoma?

A 
Meningioma
Trauma
Disc herniation
FIP
Aortic thromboembolism
Discospondylitis
FeLV myelopathy
66
Q

How is feline GI lymphoma diagnosed?

A

US
Cytology
Endoscopy
Laparotomy

67
Q

What are the signs of high grade and low grade feline GI lymphomas on US?

A 
H:
Mass lesions in gut
Loss of layering
Mesenteric lymphadenopathy
Effusion

L:
Difffuse thickening of gut
LN enlargement

68
Q

What is a sign of feline GI lymphoma on cytology?

A

Monomorphic large lymphoid cells

69
Q

Why might endoscopy not be useful for biopsy of a feline GI lymphoma?

A

Can only get a superficial biopsy and may not extract enough tissue to differentiate lymphoma from IBD

70
Q

Are grade and phenotype of feline GI lymphoma important?

A

Yes - grade affects treatment and prognosis

Low grade GI lymphomas are usually T cell

71
Q

How are intermediate-high grade feline lymphomas treated?

A

COP protocol

72
Q

How are low grade feline lymphomas treated?

A

Chlorambucil and preds

73
Q

Do cats or dogs have a better response rate to lymphoma treatment?

A

Dogs

74
Q

What is the prognosis for feline GI lymphoma?

A

H-I - 6-10m

L - >2y

75
Q

What are positive prognostic factors of feline lymphoma?

A

Achieving complete remission
Low grade
Hodgkin’s subtype
Nasal lymphoma

76
Q

What are negative prognostic factors for feline lymphoma?

A

FeLV +ve
High grade
Large granular lymphocyte subtype

77
Q

Which feline lymphoma has a v poor prognosis?

A

LGL subtype

78
Q

Define leukaemia. What are the two types?

A

Malignant neoplasias originating from haematopoietic precursors in the bone marrow or spleen

  1. Lymphoid
  2. Myeloid
79
Q

What are the clinical signs of leukaemia?

A 
Lethargy, weakness, anorexia
Pyrexia
Pallor, petechiae
Mild generalised lymphadenopathy
Hepatospenomegaly
80
Q

How is leukaemia diagnosed?

A

Haemo - cytopenia in >1 cell line, abnormal circulating cells

Bone marrow aspirate/core and flow cytometry

81
Q

How are acute lymphoid and myeloid leukaemia treated?

A

L - L-asparaginase/preds/cytarabine, COP/CHOP

M - cytarabine

82
Q

How are chronic lymphoid and myeloid leukaemia treated?

A

L - Chlorambucil/preds

M - Hydroxycarbamide

83
Q

How do you differentiate stage V lymphoma from acute lymphoblastic leukaemia?

A 
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
Q

What cells do myelomas originate from?

A

Plasma cells within the bone marrow

85
Q

What are the clinical signs of myeloma?

A 
Pyrexia
Lethargy
Pallor
Lymphadenopathy
Hepatosplenomegaly
Neuro signs/bleeding due to hyper viscosity 
Bone pain
86
Q

How do myelomas appear on radiographs?

A

Diffuse ostepenia

Punched out osteolytic lesions

87
Q

What haem, biochemistry and UA results indicate myeloma?

A

H - cytopenias
B - Increased globulins, hyperca
UA - Bence-Jones proteinuria

88
Q

What test and results is characteristic of myeloma?

A

Electrophoresis of serum/urine show Ig light chains (Bence-Jones proteins)

89
Q

How is myeloma diagnosed? How is it treated in dogs and cats?

A

Bone marrow aspiration/biopsy
D - Melphalan and preds
C - Chlorambucil and preds

90
Q

What is the mean survival time for dogs treated for myeloma?

A

12-18m

Lymphoreticular and Haemopoietic (14 decks)

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