Hodgkin's Lymphoma Flashcards
The presence of which cell indicates a Hodgkin Lymphoma?
Reed Sternberg Cells
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.”
TRUE!!
Which virus genome has been detected in almost 50% of cases of Hodgkin Tissue?
Ebstein- Barr Virus ( EBV)
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.”
TRUE!!
At what age is the Peak Incidence for Hodgkin Lymphoma?
Young Adults
True or False? There is a Female predominance in Hodgkin Lymphoma.
FALSE!! There is a MALE predominance ( 2:1 ratio)
What are the Clinical Features of Hodgkin Lymphoma?
- PAINLESS, asymmetrical, firm and discrete enlargement of superficial lymph nodes.
- Modest splenomegaly
- Mediastinal involvement ( Feature of Nodular sclerosing type )
- Associated pleural effusions & Superior vena cava obstruction.
- Cutaneous Hodgkin lymphoma occurs as a late complication in approximately 10% of patient.
- Constitutional symptoms - Fever, weight loss, Pruuritus , Alcohol-induced pain , profuse sweating (especially at night), weakness, fatigue, anorexia and cachexia
What are the laboratory findings associated with Hodgkin Lymphoma?
- Normochromic normocytic anaemia
- 1/3 of patients have Neutrophilia , Eosinophlila may be present .
- Advanced disease is associated with lymphopenia and loss of cell-mediated immunity.
- Platelet count is normal or Increased in early disease then reduced in later stages
- ESR and C- Reactive Protein is increased
- Serum LDH is raised initially
- HIV status should be confirmed.
What are the percentages of lymph nodes involvement ?
- Cervical lymph node - 60-70 %
- Axillary nodes in approximately 10–15%
- Inguinal nodes in 6–12%
- Retroperitoneal nodes ( determined by CT)
How Is the diagnosis of Hodgkin Lymphoma determined?
The diagnosis is made by histological examination of an excised lymph node.
What are the biomarkers for Reed- Sternberg Cells?
CD30 and CD15 Positive
True or False? “Reed Sternberg Cells are normally NEGATIVE for B-cell antigen expression such as CD10, CD19 or CD20.”
TRUE!!
What is the biomarker for Infiltrating macrophages?
CD68
- “CD68 detects infiltrating macrophages and if this is strongly positive it is an unfavourable feature.”
Which type of Hodgkin Lymphoma has a particularly strong association with EBV infection and malnutrition?
Lymphocyte depleted
In which countries is Nodular Sclerosis Type of Hodgkin Lymphoma, the most common?
Europe and USA
Which type of Hodgkin Lymphoma DOES NOT have the presence of Reed- Sternberg Cells?
Nodular lymphocyte PREDOMINANT (LP) Hodgkin lymphoma
What type of cells are found in Nodular lymphocyte PREDOMINANT (LP) Hodgkin lymphoma?
Popcorn ‘ B- Cells”
What are the different charachteristics of Reed- Sternberg Cells?
- Multinucleated
- ’ Owl’s Eye ‘ appearance
What are the characteristics of Nodular Sclerosis Hodgkin Lymphoma?
- 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 .
Which type of Hodgkin lymphoma is characterised by Reed–Sternberg cells which are numerous and lymphocyte numbers are intermediate?
Mixed cellularity Hodgkin Lymphoma
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?
Lymphocyte Rich Hodgkin lymphoma
How is Lymphocyte depleted Hodgkin lymphoma charctaerized?
- 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
Which type of Hodgkin Lymphoma arises in lymphoid follicles and there is a vaguely nodular appearance?
Nodular lymphocyte-PREDOMINANT Hodgkin Lymphoma
What are the biomarkers for Nodular lymphocyte-PREDOMINANT Hodgkin Lymphoma?
B- Cell markers - CD 10, CD19 , CD20 Positive
B cell transcription factor antibody OCT2.
How is clinical staging of Hodgkin Lymphoma done?
Staging is performed by clinical examination together with combined positron emission tomography (PET) and CT scans
’ clinical exam + PET & CT scan’
What does Stage I of Hodgkin lymphoma resembles?
Stage I indicates node involvement in one lymph node area
Fill in the blanks. “ ___________ of Hodgkin Lymphoma indicates disease involving two or more lymph nodal areas confined to one side of the diaphragm.”
Stage II
What does Stage III of Hodgkin lymphoma resembles?
Stage III indicates disease involving lymph nodes above and below the diaphragm. Splenic disease is included in stage III
What does Stage IV of Hodgkin lymphoma resembles?
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
What are the different Scores of Deauville 5-point criteria?
■ 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.
What advice is given to males and females before Treatment of Non- Hodgkin’s lymphoma begins?
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.
What is the generalised treatment for Hodgkin Lymphoma?
Treatment is either with chemotherapy alone or a combination of chemotherapy with radiotherapy.
What is the most widely used treatment for Early- Stage Hodgkin Lymphoma?
2 Courses -
A (Adriamycin = Doxorubicin)
B (Bleomycin)
V (Vinblastine)
D (Dacarbazine) (ABVD) chemotherapy
- followed by 20Gy radiotherapy to the involved field.
What is the treatment for Early- stage , Unfavourable diseases (1B or 2B) ?
This could be treated with four to six courses of ABVD followed by 30Gy radiotherapy for bulky disease.
What is the adverse effect of Bleomycin?
Pulmonary toxicity
What is an alternative more intensive chemotherapy that can be used in the treatment of Hodgkin Lymphoma?
BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine = Oncovin, Procarbazine and Prednisolone).
What is the name of an Anti- CD 30 antibody?
Brentuximab Vedotin
What is the side effect of Vinblastine?
Permanent Neuropathy
