Hodgkin's Lymphoma Flashcards
What is the difference between lymphomas and leukamias?
Lymphomas are disorders with malignant proliferation within the lymphatic system as opposed to leukemias which are in the BM
Lymphoma is classified as hodgkin’s and non-hodgkin’s lymphoma. There are 2 types of Hodgkin’s lymphoma.
Define Hodgkin’s lymphoma
What are the 2 types?
What % of lymphomas are Hodgkin’s lymphoma?
Haematological malignancy characterised by abnormal B cell proliferation in the lymphatic system
10% of lymphomas are Hodgkin’s
Also M>F like everything else in this chapter (other than anaemia lol)
2 types: Classical (95%) and Nodular HL (NHL) (5%)
Abnormal B cell proliferation is characteristic of Hodgkin’s lymphoma. What are these abnormal B cells called?
Are they present in both HL and NHL?
Reed Sternberg cells
No, in NHL there is an atypical variant of the Reed Sternberg cell which is a lymphocyte with a popcorn appearance on histology
Is Hodgkin’s lymphoma only a B cell disease?
Yes
The pattern of NHL is nodular, what about classical HL?
Classical is Diffuse, interfollicular
What cells are involved in Classical HL. Which of those are also seen in NHL
Lymphocytes (also NHL)
histiocytes (also NHL)
Eosinophils
Plasma cells
What are background lymphocytes?
In terms of background lymphocytes is B or T cell lymphoma more common?
Background lymphocytes are the reactive cells that are found in the tumour environment surrounding the malignant cell (in this case Reed Sternberg B-Cells). These immune cells are recruited and influenced by the B cell (malignant cell) to create a niche
HL - T>B
NHL - B>T
Remember the disease is just B cells.
What CD markers are associated with classical HL? How about NHL?
HL - CD 15 and 30
NHL - CD 20 and 45
Is fibrosis common in both HL and NHL?
No only HL, rare in NHL
What is the primary pathogen that is a major RF for Hodgkin’s lymphoma?
Does that apply to NHL or only HL?
Only HL and EBV (50% associated)
NHL is almost always -ve for EBV
Which major organ is part of the lymphatic system?
Spleen
What is the relation between alcohol and HL
Alcohol ingestion leads to bony pain (at sites of bony involvement)
State the symptoms of HL that you would like to elicit in a hx
+ always ask about CNS complications
How would you describe LN in HL?
What LN are most likely affected?
Non-tender, firm, rubbery.
Cervical and Supraclavicular (80%)
Axillary LN (5%)
Groin (<5%)
State the signs associated with HL
Common:
Splenomegaly
Lymphadenopathy
Pemberton’s sign
Excoriations (2 to pruritis)
Uncommon:
Pallor
Jaundice
Ascites
Bony tenderness
When I say someone is immunodeficient, what are the possible causes?
What are the RF of HL?
What is the diagnostic investigation for HL?
what findings would you expect for
LN biopsy examined with light microscopy and immunohistochemistry
HL - Reed Sternberg cells
NHL - Atypical variant of the Reed Sternberg cell which is a lymphocyte with a popcorn appearance on histology
Is FDG PET CT used in both NHL and HL or no?
when is it done?
Only HL because FDG activity is poor in NHL.
Done pre-chemo and Ann Arbour staging
go through the investigations for Hodgkin’s Lymphoma
If a patient presents with CNS symptoms what additional tests will you perform?
LP for CSF cytology
CT/MRI brain
What grading scale is used in HL?
What investigation(s) is/are used to determine the classification?
Go through it
Ann-Arbor System based on PET CT FDG
+ Suffixes are given
A = asymptomatic
B = B symptoms present
e.g. Stage 3B is LN on both sides AND
N = Nodal
E = Extranodal
X = Bulky disease
What is the management of HL?
What is the main specific complication of the ABVD regimen for HL?
Temporary oligospermia and irregular menses for 1-2 years after tx
What are the Side effects of radiotherapy?
Hypothyroidism (if over thyroid gand)
Infertility, amenorrhoea, premature menopause (if over gonadal tissue)
In general: IHD, Lung fibrosis
a good way to look at it is dysfunction of an organ
e.g. over salivary gland, decreased salivation => increased dental carries
What are the complications of HL (disease only)
what about the treatments?
Treatments:
Radiotherapy:
Hypothyroidism (if over thyroid gand)
Infertility, amenorrhoea, premature menopause (if over gonadal tissue)
In general: IHD, Lung fibrosis
ABVD: Temporary oligospermia and irregular menses for 1-2 years after tx
Chemotherapy:
Febrile neutropenia
Tumour lysis syndrome
Alopecia
Cardiotoxicity
Infertility
Risk for secondary malignancy (e.g. melanoma, breast, thyroid)
Endocrinopathies (impaired glucose and insulin metabolism, thyroid dysfunction
