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Clinical Haematology > Hodgkin's Lymphoma > Flashcards

Hodgkin's Lymphoma Flashcards

1
Q

The presence of which cell indicates a Hodgkin Lymphoma?

A

Reed Sternberg Cells

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2
Q

True or False? “The Reed Sternberg cell is of B-lymphoid lineage and that it is often derived from a B cell with a ‘crippled’ immunoglobulin gene caused by the acquisition of mutations that prevent synthesis of full-length immunoglobulin.”

A

TRUE!!

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3
Q

Which virus genome has been detected in almost 50% of cases of Hodgkin Tissue?

A

Ebstein- Barr Virus ( EBV)

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4
Q

True or False? “B-lymphoid lineage and that it is often derived from a B cell with a ‘crippled’ immunoglobulin gene caused by the acquisition of mutations that prevent synthesis of full-length immunoglobulin.”

A

TRUE!!

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5
Q

At what age is the Peak Incidence for Hodgkin Lymphoma?

A

Young Adults

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6
Q

True or False? There is a Female predominance in Hodgkin Lymphoma.

A

FALSE!! There is a MALE predominance ( 2:1 ratio)

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7
Q

What are the Clinical Features of Hodgkin Lymphoma?

A
  1. PAINLESS, asymmetrical, firm and discrete enlargement of superficial lymph nodes.
  2. Modest splenomegaly
  3. Mediastinal involvement ( Feature of Nodular sclerosing type )
  4. Associated pleural effusions & Superior vena cava obstruction.
  5. Cutaneous Hodgkin lymphoma occurs as a late complication in approximately 10% of patient.
  6. Constitutional symptoms - Fever, weight loss, Pruuritus , Alcohol-induced pain , profuse sweating (especially at night), weakness, fatigue, anorexia and cachexia
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8
Q

What are the laboratory findings associated with Hodgkin Lymphoma?

A
  1. Normochromic normocytic anaemia
  2. 1/3 of patients have Neutrophilia , Eosinophlila may be present .
  3. Advanced disease is associated with lymphopenia and loss of cell-mediated immunity.
  4. Platelet count is normal or Increased in early disease then reduced in later stages
  5. ESR and C- Reactive Protein is increased
  6. Serum LDH is raised initially
  7. HIV status should be confirmed.
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9
Q

What are the percentages of lymph nodes involvement ?

A
  • Cervical lymph node - 60-70 %
  • Axillary nodes in approximately 10–15%
  • Inguinal nodes in 6–12%
  • Retroperitoneal nodes ( determined by CT)
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10
Q

How Is the diagnosis of Hodgkin Lymphoma determined?

A

The diagnosis is made by histological examination of an excised lymph node.

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11
Q

What are the biomarkers for Reed- Sternberg Cells?

A

CD30 and CD15 Positive

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12
Q

True or False? “Reed Sternberg Cells are normally NEGATIVE for B-cell antigen expression such as CD10, CD19 or CD20.”

A

TRUE!!

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13
Q

What is the biomarker for Infiltrating macrophages?

A

CD68

  • “CD68 detects infiltrating macrophages and if this is strongly positive it is an unfavourable feature.”
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14
Q

Which type of Hodgkin Lymphoma has a particularly strong association with EBV infection and malnutrition?

A

Lymphocyte depleted

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15
Q

In which countries is Nodular Sclerosis Type of Hodgkin Lymphoma, the most common?

A

Europe and USA

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16
Q

Which type of Hodgkin Lymphoma DOES NOT have the presence of Reed- Sternberg Cells?

A

Nodular lymphocyte PREDOMINANT (LP) Hodgkin lymphoma

17
Q

What type of cells are found in Nodular lymphocyte PREDOMINANT (LP) Hodgkin lymphoma?

A

Popcorn ‘ B- Cells”

18
Q

What are the different charachteristics of Reed- Sternberg Cells?

A
  1. Multinucleated
  2. ’ Owl’s Eye ‘ appearance
19
Q

What are the characteristics of Nodular Sclerosis Hodgkin Lymphoma?

A
  • Collagen bands extend from the node capsule to encircle nodules of abnormal tissue.
  • A characteristic lacunar cell variant of the Reed–Sternberg cell is OFTEN found.
  • The cellular infiltrate may be of the lymphocyte-predominant, mixed cellularity or lymphocyte-depleted type; eosinophilia is FREQUENT .
20
Q

Which type of Hodgkin lymphoma is characterised by Reed–Sternberg cells which are numerous and lymphocyte numbers are intermediate?

A

Mixed cellularity Hodgkin Lymphoma

21
Q

Which Hodgkin lymphoma can be characterized as having scanty Reed–Sternberg cells; multiple small lymphocytes with few eosinophils and plasma cells; nodular and diffuse types?

A

Lymphocyte Rich Hodgkin lymphoma

22
Q

How is Lymphocyte depleted Hodgkin lymphoma charctaerized?

A
  • There is either a reticular pattern with dominance of Reed–Sternberg cells and sparse numbers of lymphocytes
  • A diffuse fibrosis pattern where the lymph node is replaced by disordered connective tissue containing few lymphocytes. Reed–Sternberg cells may also be infrequent in this latter subtype
23
Q

Which type of Hodgkin Lymphoma arises in lymphoid follicles and there is a vaguely nodular appearance?

A

Nodular lymphocyte-PREDOMINANT Hodgkin Lymphoma

24
Q

What are the biomarkers for Nodular lymphocyte-PREDOMINANT Hodgkin Lymphoma?

A

B- Cell markers - CD 10, CD19 , CD20 Positive
B cell transcription factor antibody OCT2.

25
Q

How is clinical staging of Hodgkin Lymphoma done?

A

Staging is performed by clinical examination together with combined positron emission tomography (PET) and CT scans

’ clinical exam + PET & CT scan’

26
Q

What does Stage I of Hodgkin lymphoma resembles?

A

Stage I indicates node involvement in one lymph node area

27
Q

Fill in the blanks. “ ___________ of Hodgkin Lymphoma indicates disease involving two or more lymph nodal areas confined to one side of the diaphragm.”

A

Stage II

28
Q

What does Stage III of Hodgkin lymphoma resembles?

A

Stage III indicates disease involving lymph nodes above and below the diaphragm. Splenic disease is included in stage III

29
Q

What does Stage IV of Hodgkin lymphoma resembles?

A

Stage IV indicates involvement outside the lymph node areas and refers to diffuse or disseminated disease in the bone marrow, liver and other extranodal sites

30
Q

What are the different Scores of Deauville 5-point criteria?

A

■ Score 1 no abnormal uptake.
■ Score 2 nodal uptake present but ≤ mediastinum uptake.
■ Score 3 nodal uptake > mediastinum but ≤ liver.
■ Score 4 moderately increased nodal uptake > liver.
■ Score 5 markedly increased nodal uptake > liver.

31
Q

What advice is given to males and females before Treatment of Non- Hodgkin’s lymphoma begins?

A

Semen storage for males, if appropriate, should be carried out before therapy is begun. For females it is advisable that fertility advice is sought from a specialist.

32
Q

What is the generalised treatment for Hodgkin Lymphoma?

A

Treatment is either with chemotherapy alone or a combination of chemotherapy with radiotherapy.

33
Q

What is the most widely used treatment for Early- Stage Hodgkin Lymphoma?

A

2 Courses -
A (Adriamycin = Doxorubicin)
B (Bleomycin)
V (Vinblastine)
D (Dacarbazine) (ABVD) chemotherapy

  • followed by 20Gy radiotherapy to the involved field.
34
Q

What is the treatment for Early- stage , Unfavourable diseases (1B or 2B) ?

A

This could be treated with four to six courses of ABVD followed by 30Gy radiotherapy for bulky disease.

35
Q

What is the adverse effect of Bleomycin?

A

Pulmonary toxicity

35
Q

What is an alternative more intensive chemotherapy that can be used in the treatment of Hodgkin Lymphoma?

A

BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine = Oncovin, Procarbazine and Prednisolone).

36
Q

What is the name of an Anti- CD 30 antibody?

A

Brentuximab Vedotin

37
Q

What is the side effect of Vinblastine?

A

Permanent Neuropathy

38
Q
A

Clinical Haematology (26 decks)

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