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House Hemat > Hodgkin’s Lymphoma > Flashcards

Hodgkin’s Lymphoma Flashcards

1
Q

Lymphomas are broadly divided into _____ and ______

A

Hodgkin and Non hodgkin

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2
Q

• Hodgkin lymphoma is a incurable lymphoma with distinct histology, biologic behavior, and clinical characteristics.

T/F

A

F

potentially curable lymphoma

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3
Q

Thomas Hodgkin first described the disorder in 1832 in his paper titled “ ________________________ ”

A

some morbid appearances of the absorbent glands and spleen

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4
Q

Hodgkin lymphoma:

a (benign or malignant?) lymphoid neoplasm characterised by the presence of neoplastic _________ cells or its variants ( _____________ ) in a background of _________ ————— cell infilterates comprising lymphocytes, eosinophils, histiocytes, plasma cells and neutrophils

A

Malignant

Reed-sternberg

Hodgkin cell

non-neoplastic inflammatory

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5
Q

REED-STERNBERG CELL

• Neoplastic giant cells derived from ______ centre or _______ centre ___ cells.

A

germinal

post germinal

B

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6
Q

REED-STERNBERG CELL

___lobed nucleus with prominent ______ nucleoli separated by a _______

A

Bi

eosinophilic

clear space.

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7
Q

REED-STERNBERG CELL

Account of ___-___% of cell population

A

1-2

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8
Q

HODGKIN CELLS

_____nuclear variants: ______nucleus with (small or large?) nucleolus.

A

Mono

single

Large

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9
Q

HODGKIN CELLS

Lacunar cells : folded _____lobed nuclei with (scanty or abundant?) cytoplasm.

A

multilobed

Abundant

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10
Q

HODGKIN CELLS

_________ variant(L&H cells or _______ cells): _________nuclei,( conspicuous or inconspicuous?) nucleoli and (mild or moderately?) abundant cytoplasm.

A

Lymphohistocytic

popcorn

polypoid

inconspicuous

moderately

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11
Q

HODGKIN CELLS

•__________ variants
•___________ cells
•___________ variant or ______ cells

A

Mononuclear variants

Lacunar cells

Lymphohistocytic

popcorn

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12
Q

AETIOLOGY of Hodgkin’s lymphoma

Main
• Largely (known or unknown?)
• Strong association with the ________ VIRUS

A

Unknown

EPSTEIN BARR

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13
Q

AETIOLOGY of Hodgkin’s lymphoma

Other risk factors
• (Low or High?) socio economic status particularly in the young adults.
• Family history of ________ disease.
•_________
• ____
• Infectious ___________

A

High

autoimmune

Identical twin

HIV

mononucleosis

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14
Q

HISTOLOGIC CLASSIFICATION

Hodgkin lymphoma is classified into 2 main types:

1)___________ HODGKIN LYMPHOMA
2) _______________ HODGKIN LYMPHOMA.

A

CLASSICAL

NODULAR LYMPHOCYTE PREDOMINANT

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15
Q

CLASSICAL HODGKIN LYMPHOMA

• Characterised by large ____________ cells or ____________ cells.

• The cells are CD___+,CD___+,CD20-,CD45-,CD____+,CD79a-,PAX5+

A

mononuclear hodgkin

binucleate reed- sternberg

30, 15; 75

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16
Q

CLASSICAL HODGKIN LYMPHOMA

• Comprises of 4 subtypes.

• __________
•___________
•____________
• ____________

A

NODULAR SCLEROSIS

MIXED CELLULARITY

LYMPHOCYTE DEPLETED

LYMPHOCYTE RICH

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17
Q

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• A unique subtype constitutes _____% of cases.

• Reed-sternberg cells are (frequent or infrequent?) or (absent or present?) .

A

5-10

infrequent

absent

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18
Q

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• _____________________ cells are seen in a background of _______ ————— cells.

A

Lymphocytic and histiocytic cells or popcorn

benign inflammatory

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19
Q

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

It is associated with EBV infection

T/F

A

F

not

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20
Q

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• Unlike reed-sternberg cells they are positive for B cell antigen such as CD__,CD___,CD___,CD___,CD79a,BCL-6 and negative for CD____,CD__,CD__

A

19; 20; 45; 75;

30;15

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21
Q

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• majority of patients are young adult (male or female?) (4;1) with _______ or _________

• Prognosis is (good or bad?).

A

Male

cervical or axillary lymphadenopathy.

Good

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22
Q

CLINICAL FEATURES of HL

• Presentation commonly with (painful or painless?) ‘_______ ’ ____________ lymph node enlargement: frequently ____ gland(s).

• Initial mode of spread occurs predictably to ___________. Often involves _______ and ________ glands and other sites.

A

painless;rubbery

supradiaphragmatic; cervical

contiguous nodal chains

supraclavicular and axillary

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23
Q

CLINICAL FEATURES

•_____________ involvement is rare and suggests a diagnosis of _______.

•______________ in HL may wax and wane during observation.

A

Waldeyer’s ring; NHL

Lymphadenopathy

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24
Q

CLINICAL FEATURES

• Abdominal lymphadenopathy may occur with ______ involvement.

A

splenic

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25
Q

CLINICAL FEATURES of HL

• Bulky ________ and _______ lymphadenopathy may produce local symptoms(e.g. _____ or ______ ) or direct extension (e.g. to _____,_____,______, or _______ ).

A

mediastinal and hilar

bronchial or SVC compression

lung, pericardium, pleura or rib

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26
Q

CLINICAL FEATURES of HL

• Extranodal spread may also occur via ______ (e.g. to _____,_______, or _______ ).

Presence of disseminated extranodal disease is generally accompanied by _________________.

A

bloodstream

bone marrow, lung or liver

generalised lymphadenopathy

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27
Q

CLINICAL FEATURES of HL

• ~33% patients have ≥1 associated constitutional __________ at presentation:

•weight loss >____% body weight during the previous ________

•unexplained ________ or ____________.

•_______,__________, and __________ -induced lymph node pain.

A

‘B’ symptoms

10; 6 months

fever or drenching night sweats

‘B’ symptoms, pruritus and alcohol

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28
Q

CLINICAL FEATURES of HL

• A defect in ______ immunity has been documented in patients with HL rendering them more susceptible to TB, fungal, protozoal and viral infections including Pneumocystis carinii and HZV.

A

cellular

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29
Q

CLINICAL FEATURES of HL

•___________ fever

A

Pel-ebstein

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30
Q

DIAGNOSTIC WORK UP to be done to check for HL

•_______
•_______
•_________

A

Blood studies

Biopsy

Imaging

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31
Q

Blood studies of HL

• FBC: may show _____chromic _____cytic anaemia, reactive leuco____ and/or a reactive mild thrombo_______.

• ESR is (elevated or depressed?)

• LDH is (elevated or depressed?)

A

normo; normo

cytosis; cytosis

Elevated

Elevated

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32
Q

Blood studies of HL

• elevated ESR may (help or worsen?) prognosis.

• elevated LDH is correlating with ________

A

Worsen

bulk of disease

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33
Q

Blood studies of HL

•Elevations of ESR and LDH are seen in ____,_____.

• ____glycemia due to _________

•_____ screening.

A

CRP, ALP

Hypo

insulin auto antibodies

HIV

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34
Q

BIOPSY of HL

• Bone marrow biopsy especially in the (youth or elderly?) ,(early or advanced?) stage disease, (local or systemic?) symptoms as well as ____ involvement.

A

Elderly ; advanced; systemic; liver

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35
Q

BIOPSY in HL

• Sampling of pleural fluid by _______

• CNS evaluation by _________

A

thoracocentesis

lumbar puncture

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36
Q

A histologic diagnosis is always required with excisional lymph node biopsy.

T/F

A

T

37
Q

MRI is done for HL if __________________

A

rare CNS symptoms are present.

38
Q

IMAGING in HL

• AP and LATERAL CXR to assess _________
• CT scan of _____,_______, and ________

A

bulk of mediastinal mass.

chest,abdomen,pelvis

39
Q

IMAGING in HL

•________________(PET) scan now considered essential in the ________ of hodgkin lymphoma as well as in _______

A

Positron emission tomography

initial staging

assessing treatment.

40
Q

STAGING OF HODGKIN LYMPHOMA
• ____ stage __________ classification is used.

• It is a _______ and ______ staging system.

A

4 stage ann-arbour

clinical and pathological

41
Q

STAGING OF HODGKIN LYMPHOMA
• It is a clinical and pathological staging system.

• The clinical stage is the result of _____,_______,________, and ________

• Pathological staging refers to the use of ________ or __________

A

history, physical examination,imaging and laboratory investigation.

biopsy procedures or staging laparotomies.

42
Q

STAGING OF HODGKIN LYMPHOMA

Presence or absence of ______________ further modifies the staging system.

A

constitutional symptoms

43
Q

ANN ARBOUR STAGING SYSTEM

Stage 1: Involvement of _________ region(I) or __________________

A

single lymph node

a single extralymphatic organ or site(Ie)

44
Q

ANN ARBOUR STAGING SYSTEM

STAGE II: Involvement of ________________ regions on ______________ or with involvement of ______________________(IIe)

A

two or more lymph node

the same side of the diaphragm alone(II)

limited contiguos extralymphatic organ or tissue

45
Q

ANN ARBOUR STAGING SYSTEM

STAGE III: Involvement of ________________ ,which may include the ________ or limited _____________ or _______

A

lymph node regions on both side of the diaphragm III

spleen IIIs

contiguos extralymphatic organ or site IIIe or both IIIes.

46
Q

ANN ARBOUR STAGING SYSTEM

STAGE IV: _______________ of involvement of _____________________ with ___________________

A

Multiple or disseminated foci

one or more extralymphatic organ or tissues

or without associated lymph node involvement.

47
Q

Modifying features in HL

• A. ____________
• B. ____________

• X. ________:mass>___cm,.__:__mediastinal:mass ratio

• E.Involvement of a ________,______ or ________

• Spread is via __________,________, or ___________

A

ASYMPTOMATIC

B symptoms

Bulky disease; 10; 1:3

single,contiguos or proximal extranodal site

lymphatics,hematogenous or direct extension.

48
Q

PROGNOSTIC FACTORS(EORTC)
Favourable

• Clinical stage ________
• Maximum of _____ nodal areas involved
• Age < ___ years
• ESR < ____mm/hour without ———— or ESR < ____mm/hour with __________
• Mediastinal/thoracic ratio < ____

A

I and II

three

50

50 ; ‘ B ’ symptoms

30 ; ‘ B ’ symptoms

0.35

49
Q

UNFAVOURABLE PROGNOSTIC FACTORS

• ________ disease

• An ESR of _____ mm/h or higher, if the patient is otherwise asymptomatic

• More than ___ sites of disease involvement

A

Bulky

50

3

50
Q

UNFAVOURABLE PROGNOSTIC FACTORS

• The presence of _____ symptoms
• The presence of ______ disease

A

B; extranodal

51
Q

Bulky disease is defined as a ________ mass >___rd of the intrathoracic diameter on a chest radiograph or greater than ____% of the thoracic diameter at vertebral level ____-____

A

mediastinal

1/3

33

T5-6.

52
Q

UNFAVOURABLE FACTORS:ADVANCED DISEASE

• Serum albumin less than ___g/dL
• Hemoglobin less than ______ g/dL
• (Male or female ?) sex

A

4

10.5

Male

53
Q

UNFAVOURABLE FACTORS:ADVANCED DISEASE

• Stage —— disease
• Age ____ years or older
• White blood cell (WBC) count greater than _______/μL

A

IV

45

15,000

54
Q

UNFAVOURABLE FACTORS:ADVANCED DISEASE

• Lymphocyte count less than _____/μL or less than ___% of the total WBC count

A

600

8

55
Q

Advanced disease refers to stage ___/___ disease or early stage disease with ______ or ______

A

iii/iv

systemic symptoms or bulky disease.

56
Q

• Treatment of Hodgkin lymphoma is tailored to disease type, disease stage, and an assessment of the risk of resistant disease.

T/F

A

T

57
Q

TREATMENT of HL

• It is potentially curable but significant ___________ can arise from therapy.

A

long term toxicity

58
Q

TREATMENT of HL

•____________ therapy (______ therapy and _________ ) is frequently the preferred approach.

A

Combined-modality

radiation

chemotherapy

59
Q

TREATMENT of HL

• In patients with advanced Hodgkin lymphoma, involved-field radiotherapy can be used for sites of persistent disease following chemotherapy(Stanford V)

A
60
Q

TREATMENT of HL

• In patients with advanced Hodgkin lymphoma, _________ ———-therapy can be used for sites of persistent disease following ———therapy(Stanford V)

A

involved-field radio

chemo

61
Q

TREATMENT of HL

many cases of Hodgkin lymphoma do not relapse

T/F

A

F

Despite the high rate of cure for this disease, many cases Hodgkin lymphoma do relapse.

62
Q

TREATMENT of HL

• In most of these relapse cases, _____ chemotherapy followed by _______ chemotherapy (HDC) with _______________ support is indicated.

A

salvage

high-dose

autologous hematopoietic stem cell

63
Q

GOAL OF THERAPY

The primary goal of therapy is to induce __________, which is defined as the _____________, as evaluated by ______ scanning, physical examination, and _______ examination.

A

a complete remission (CR)

disappearance of all evidence of disease

PET/CT

bone marrow

64
Q

GOAL OF THERAPY

• A partial remission (PR) is defined as “ __________________________ “ of disease.

A

regression of measurable disease and no new sites

65
Q

For treatment of classic Hodgkin lymphoma, ______ therapy is generally administered in combination with ______therapy

A

radiation

chemo

66
Q

RADIATION THERAPY

• Radiation fields and doses are selected to minimize _____________, and maximize ________________

A

the potential side effects of therapy

the potential for long-term disease- free survival.

67
Q

RADIATION THERAPY

• Involved-field therapy encompasses __________________.

• Regional-field therapy ______________________________

A

only the areas of observed disease

extends the involved field to include adjacent lymph regions

68
Q

RADIATION THERAPY

Other fields that have been used historically and may be used in exceptional clinical circumstances include:

the _______ field
__________ field
____________ irradiation

A

mantle

inverted Y

Subtotal nodal

69
Q

Radiation therapy

1)the mantle field, covering the ____,______ and ,_________ nodes and avoiding the _________

A

mediastinal, cervical, and axillary

heart and lungs

70
Q

Radiation therapy

•inverted Y field, covering the _____,______. And _____ nodes

•Subtotal nodal irradiation involves the ________ plus _________

A

para-aortic, pelvic, and inguinal

mantle field

the para-aortic nodes.

71
Q

In Radiation therapy

Careful avoidance of the ________ can reduce the risk of _______.

A

spinal cord

myelitis

72
Q

In radiation therapy,

__________________________________________________ are important during the reproductive years

A

Shielding the testes and oophoropexy (temporary surgical suspension of the ovaries [eg, outside of a radiation field])

73
Q

In radiation therapy ,

Doses used in combined modality therapy are 30-36 Gy for _________ sites and 20-30 Gy for ______ sites.

A

bulky disease

nonbulky disease

74
Q

In radiation therapy,

When radiation therapy is used alone, doses may range from ___-___ Gy.

A

30-44

75
Q

INDUCTION CHEMOTHERAPY REGIMEN

____________ was the first effective combination chemotherapy for Hodgkin
lymphoma.

A

MOPP (mechlorethamine, vincristine, procarbazine, prednisolone)

76
Q

INDUCTION CHEMOTHERAPY REGIMEN
• 1)MOPP

• It is a ____-drug regimen developed by ___________ and colleagues at the National Cancer Institute in the mid _____s and is primarily of historical importance.

• It has a high incidence of _________ and ____________

A

4; Vincent DeVita

1960

sterility and secondary leukaemia.

77
Q

INDUCTION CHEMOTHERAPY REGIMEN

___________ combination has now become the standard chemotherapy regimen for Hodgkin lymphoma.

A

ABVD regimen

78
Q

MOPP (______,________,________,_______)

A

mechlorethamine, vincristine, procarbazine, prednisolone

79
Q

ABVD (_______,________,_________,__________)

A

Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine

80
Q

ABVD

The ABVD regimen was designed in Italy by ______________ and his colleagues in the early _____s.

A

Gianni Bonadonna

1970

81
Q

OTHER INDUCTION CHEMOTHERAPY REGIMENS

•_____________
•_____________

A

Stanford V

BEACOPP

82
Q

SALVAGE CHEMOTHERAPY

• When _______ chemotherapy fails, or patients experience _______, salvage chemotherapy is generally given.

A

induction

relapse

83
Q

SALVAGE CHEMOTHERAPY

• Salvage regimens incorporate drugs that are _______________________________________.

A

complementary to those that failed during induction therapy

84
Q

SALVAGE CHEMOTHERAPY

Some salvage protocols include
• -____
• -______
• -_______- regimen

A

ICE

DHAP

EPOCH

85
Q

RESPONSE ASSESSMENT

• Assessment of disease response requires _________ and, if infiltrated on staging investigations, repeat __________

• The utility of _____ is increasingly well understood.

A

repeat imaging

bone marrow biopsy.

PET

86
Q

RESPONSE ASSESSMENT
PET can help differentiate between _______ and ________

A

active disease and fibrotic material.

87
Q

Response to treatment has been graded as follows.

• Complete remission CR: ———————

• PARTIAL REMISSION PR: ___________________ and ________________

A

DISSAPEARANCE OF ALL EVIDENCE OF
DISEASE

REGRESSION OF MEASURABLE DISEASE AND NO NEW SITES.

88
Q

Response to treatment has been graded as follows.

• STABLE DISEASE SD: ___________________

• RELAPSED DISEASE OR PROGRESSIVE DISEASE PD: ________ OR ______________

A

FAILURE TO ATTAIN CR/PR OR PD

ANY NEW LESION

INCREASE BY >50% OF PREVIOUSLY INVOLVED SITES.

89
Q

Response to treatment has been graded as follows.
• Complete remission CR: DISSAPEARANCE OF ALL EVIDENCE OF
DISEASE
• PARTIAL REMISSION PR:REGRESSION OF MEASURABLE DISEASE AND NO NEW SITES.
• STABLE DISEASE SD:FAILURE TO ATTAIN CR/PR OR PD
• RELAPSED DISEASE OR PROGRESSIVE DISEASE PD:ANY NEW LESION OR INCREASE BY >50% OF PREVIOUSLY INVOLVED SITES.

A

House Hemat (29 decks)

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