HL

Question 1

ped vs AYA lymphoma

Answer 1

child: HL, EBV, larger families, mixed cellularity

AYA: NHL, not EBV, smaller families, nodular sclerosing

Question 2

HL age distribution

Answer 2

AYA, 6-8th decades

Question 3

HL RF

Answer 3

F
FHx
childhood: large families, low SES, EBV

Question 4

Classic HL subtypes

Answer 4

Nodular sclerosis (70%): localized, better px
Mixed cellularity (20%): developing countries, EBV
Lymphocyte rich (5%): better px
lymphocyte deplete (1-2%): worse px, EBV

Question 5

HL biopsy type and reason

Answer 5

excisional
RS cells are few, in inflammatory background

Question 6

CD30 L+L

Answer 6

HL
PMNHL
ALCL (CD15 neg)
minority of DLBCL

Question 7

RS cell altered pathway

Answer 7

NFkB
JAK/STAT

Question 8

cHL vs NLPHL IHC

Answer 8

cHL: CD30 and 15 ; CD45 neg
NLPHL: CD45 ; neg CD 15 and 30

Question 9

HL presentation

Answer 9

80% lymphadenopathy: painless, rubbery, firm
2/3 mediastinal mass
1/3 B symptoms

Question 10

define B symptoms

Answer 10

10% weight loss over 6 mo
fever >38C x 3d
drenching night sweats

Question 11

HL ix

Answer 11

CT neck-pelvis
PET
baseline: PFT, echo, fertility

Question 12

Ann Arbor staging system

Answer 12

I: single nodal region or extralymphatic site
II: 2+ nodal regions on same side of diagphragm or localized extralymphatic and 1+ LN
III: both sides of diaphragm
IV: diffuse/disseminated; liver, lung, BM

A: absence of B symptoms
B: B symptoms
E: extranodal
X: bulky mediastinal
S: splenic

Question 13

HL px factors

Answer 13

type
stage
B symptoms
bulk
slow/incomplete response

Question 14

HL bulk disease

Answer 14

mediastinal mass > 1/3 thoracic diameter
nodal aggregate >6cm
macroscopic splenic nodules

Question 15

HL COG risk stratification

Answer 15

LR: I/IIA
IR: I/IIA w bulk, I/IIAE, IIIA, IB, IIB no bulk
HR: IVA/B, IIB w bulk, IIIB

Question 16

HL SMN risk

Answer 16

19% at 30y

Question 17

HL treatment by risk stratification

Answer 17

LR: ABVD +-IFRT
IR: ABVE-PC x4 +- IFRT (SER post cycle 2)
HR: BvACVE-PC x5 +- IFRT (SER post cycle 2)

Question 18

NLPHL tx

Answer 18

resection only
ritux
AVPC x3 +- IFRT (if no CR)

Question 19

relapse HL px factors

Answer 19

time to relapse: <3mo worse, >12mo best
stage
response to reinduction
histology
B symptoms
refractory

Question 20

What is PTGC and what does it predispose

Answer 20

progressive transformation of germinal centre
benign
non-clonal
proliferation of large follicles with expanded mantle

ALPS, SLE, Castleman

Question 21

describe Reed Sternberg cell

Answer 21

large binucleated cells with abundant basophilic cytoplasm and large red nucleoli with characteristic clearing around nucleoli

germinal centre B cell origin
~1% of total cells

Question 22

Reed Sternberg IHC

Answer 22

CD30
CD15
PAX5
MUM1

Negative CD45, CD19, CD20, EMA

Question 23

Results of AHOD1331

Answer 23

HR HL
BvAVE-PC x5 superior to ABVE-PC

Question 24

Deauville 1-5

Answer 24

1: no uptake above background
2: update <= mediastinum
3: upatake > mediastinum but <=liver
4: uptake moderately > liver
5: uptake markedly > liver

1-3 is complete metabolic response (CMR)

Question 25

NLPHL path/IHC

Answer 25

popcorn cells
CD19, 20, 45, 79A, PAX5

Negative CD10, 15, 30