Intro to Lymphoma Flashcards
3 places where
1. B cells
2. NK cells
are often found
- Lymph nodes, spleen, MALT
2. Skin, liver, spleen, GI tract
What is a lymphoid neoplasm?
Lymphoproliferation due to uncontrolled accumulation of lymphocytes
Malignant accumulation of neoplastic lymphocytes
Lymphoma definition
Collection of malignant lymphocytes that form a mass
What does the
1. t(14;18)
2. t(8;14)
translocation lead to?
- Loss of apoptosis
2. Uncontrolled cellular proliferation
t(14;18)
Chromosome 14 has an Ig heavy chain gene that is constitutively expressed
Chromosome 18 has the BCL-2 gene that is anti-apoptosis
When they are fused there is constitutive expression of the BCL2 gene and over expression of anti-apoptosis protein BCL2
t(8;14)
Chromosome 14 has an Ig heavy chain gene that is constitutively expressed
Chromosome 8 has the MYC gene that promotes cellular proliferation
When they are fused there is constitutive expression of the MYC gene and over expression of cell proliferation promoter MYC protein
5 oncogenic viruses
EBV HIV Hep C Human T-lymphotropic virus 1 (HTLV-1) Human herpes virus 8 (HHV-8)
How does Epstein Barr Virus lead to lymphoma?
Infects B cells and incorporates DNA into host genome
These cells can get genetic transformations that lead to lymphoma
4 ways to get genetic transformation that can lead to lymphoma
Random genetic alteration
Oncogenic virus
Antigen over stimulation
Immunosuppression
2 common causes of antigen over-stimulation
Microorganisms
Autoimmune diseases
Historial convention
- Hodgkin lymphoma
- Non-hodgkin lymphoma
- Tumor consists mostly of reactive inflammatory cells with only rare Reed-Sternberg cell lymphocytes
- All the cells in the tumor are malignant lymphocytes
Indolent/low grade lymphoma
Tumour grows slowly over the course of years
Lymphocyte accumulation due to defective apoptosis
Malignant lymphocytes are usually small
Treatment often not required at time of diagnosis
Incurable
Aggressive/high grade lymphoma
Tumour grows rapidly over the course of hours, days or weeks
Lymphocyte accumulation due to uncontrolled cellular proliferation
Malignant lymphocytes are usually large
Treatment required at the time of diagnosis
Potentially curable
Lymphoma is more common in…. (age group, sex, race, cell type, location)
Adults and elderly (30+) Males Caucasians B cell origin Lymph nodes
Low grade lymphoma on history and physical exam
Slow growing painless mass
Sometimes multiple masses at multiple sites
Constitutional symptoms usually ABSENT
Appears well
+/- hepatosplenomegaly
If bone marrow is involved, can see pallor, bruising, signs of infection
High grade lymphoma on history and physical exam
Rapidly growing mass Often localized Constitutional B symptoms (weight loss, fever, night sweats) Appear unwell Febrile Non-tender lymphadenopathy \+/- hepatosplenomegaly Abdominal mass If bone marrow is involved, can see pallor, bruising, signs of infection
3 types of biopsy you can do to diagnose lymphoma
Fine needle aspiration
Needle core biopsy (sample of node is taken)
Excisional biopsy (remove entire lymph node)
Treatment of lymphoma depends on
Diagnosis and classification of the lymphoma
Low stage vs high stage disease
Low (stage 1/2): disease localized to one or a few lymph node groups or organs, good prognosis
High (stage 3/4): disease spread throughout the body, involves lymph nodes and extra nodal sites, poor prognosis
4 ways lymphoma can be treated
Conservative management (watch and wait)
Chemo (mainstay)
Immunotherapy
Radiation
4 main lymphomas
Classical hodgkin lymphoma
Follicular lymphoma
Diffuse large B-cell lymphoma
Burkitt lymphoma
Classical Hodgkin Lymphoma (what is it, clinical features, treatment)
Reed-Sternberg cell in a background of mixed inflammatory cells
Clinical features: lymphadenopathy, B symptoms common, pruritis, lymph node pain after alcohol consumption
Treat with chemo
Follicular lymphoma
Middle age to elderly adults, rare in children
Clinical features: predominantly involves lymph nodes, B symptoms less common
Associated with t(14;18)
Low grade, small B cell lymphoma, follicular growth pattern
Incurable
Conservative management or immunochemo
Diffuse Large B cell lymphoma
Most common lymphoma, most frequently in elderly, males
Clinical features: affects lymph nodes and extra-nodal sites equally, rapidly enlarging mass at single or multiple sites, often otherwise asymptomatic
High grade B cell lymphoma (large cells), diffuse growth pattern
Treat with immunochemo
Aggressive
Can be curable
