Introduction To Lymphomas And Myelomas Flashcards

1
Q

Define lymphoma

A

cancer of white blood cells (lymphoctes)

- affects mature blood cells mostly B and T lymphocytes

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2
Q

What genetic sturcure is associated to lymphoma?

A

Many specific genetic mutations and chromosomal translocations

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3
Q

What is the main functions of lymphatic system? (4)

A

1) blood filtration / purification
2) removal of excess fluids from tissues
3) absorption and transport of lipids
4) immune system activation

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4
Q

What are primary lymph nodes? + examples

A

Sites where stem cells divide and become imunocompetent

- bone marrow and thymus

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5
Q

What happens in seconary lymph nodes + examples

A

Sites where most of immune responses occurs

- spleen, peyer’s patches, lymph nodes, tonsils

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6
Q

How do lymphomas develop stage wise?

A

Lymphocytes affected in diff maturation states due to genetic alteration

Uncontrolled division of the lymphocytes

Orga size increases e.g. splenomegaly(spleen), adenopathy (lymph node)

Spreads to other tissues through lymphatic system

Infiltrate into bone marrow - detectable in blood and/or other organs

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7
Q

What is the classification of lymphomas?

A

Non hodgkin lymphoma - most common - separates into either diffuse or follicular
Hodgkin lymphoma

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8
Q

Presentation of lymphoma

A
Enlarged lymph nodes, normally painless
Excessive night sweats
Unintended weightloss
Itching
Constant tiredness
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9
Q

How do you diagnose lymphoma?

A

Lymph node biopsy - flow cytometry, FISH, NGS and immunophenotyping

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10
Q

How do you diagnose stage of lymphoma after diagnosing lymphoma?

A

PET scan (positon emission tomography)

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11
Q

What are the 4 stages of lymphoma?

A

Stage 1 - localise - single lymph node / organ
Stage 2 - 2 or more lymph nodes but on same side of diaphragm
Stage 3 - 2 or more lymph nodes but on diff sides of diaphragm
Stage 4 - widespread, multiple organs with or without lymph node involvement (liver and bone marrow)

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12
Q

What causes lymphoma?

A

Multifactorial - malfunction to body’s immune system and exposure to certain infections

usually B cell develops a mutation in its DNA

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13
Q

Risk factors of hodgkin lymphoma

A

Epstein barr virus
Familt history
HIV/AIDS

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14
Q

How does Hodkin lymphoma present?

A

Non painful enlarged lymph nodes

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15
Q

How do you diagnose hodkin lymphma?

A

Excisional lymph node biopsy

- look for reed - sternberg cells (hodgkin cell only in hodgkin lymphoma)

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16
Q

What are reed sternberg cells?

A

Hodgkin cells

Multinucleated red stem cells in lymph nodes - only in Hodgkin not non hodgkin lymphoma

17
Q

What is the treatment for hodgkin lymphoma?

A

Chemotherapy and sometimes radiotherpay too.

Stem cell transplant

18
Q

What is non-hodgkin lymphoma?

A

all lymphomas apart from hodgkin lymphomas

19
Q

How does non hodgkin lymphoma present?

A

Enlarged lymph nodes + general symtoms including night swears, fever and weight loss)

20
Q

What is the cause of non hodgkin lymphoma?

A

Chromosomal translocation

esp involving Ig heavy chain or light chain loci on chromosome 14
- each Ig gene has powerful tissue specific enhancer

21
Q

What are risk factors of non hodgkin lymphomas?

A
virus infections (EBV) driven lymphomas in immunosuppressed pateints e.g  Burkitt's lymphoma
Human T cell leukemia virus in adult T cell lymphomas
22
Q

What is the normal role of an enhancer ig Ig genes? and how does it contribute to lymphomas?

A

Activate promoter of rearrnaged V segment

If rearrnaged infront of oncogene during chromosomal translocation, enhancer promotes expression of oncogene protein = non hodgkin lymphoma

23
Q

What chromosomal translocation happens in non hodkin lymphoma?

A

Translocation between chromosome 14 and 18 bringing the enhancer infront of BCL-2 gene causing overexpression of BCL-2

24
Q

What is BCL-2 gene?

A

encoded for BCL-2 (an apoptosis inhibtor) enahnced = excess cel proliferation due to low apoptosis

25
Q

Which chromosome translocations in in Burkitt’s lymphoma (type of nonhodkin lymphoma)

A

Chromsomes 8 MYC gene (oncogene)
Chromsome 14 IgH gene - enhancer

fuses causing constant oncogene gain of function

26
Q

How do virus infections e.g. EBV act as risk factor for non hodgkin lymphomas?

A

Viral oncogene carried in viruses (LMP-1 oncogene in EBV)

27
Q

What is EBV and how does it contribute to non hodgkin lymphomas?

A

Epstein Barr virus - almost everyone carries latently but in highly immunosuppressed indivuduals, endogenous latent EBV transform B cells and no longer elimiate T cytoxic T cells
- results in high grade lymphoma

28
Q

What are the classifications of non hodgkin lymphomas?

A

Low grade

High grade

29
Q

Comapre high grade and low grade lymphoma

A
30
Q

How do you diagose non hodgkin lymphomas?

A
31
Q

How do you treat non hodgkin lymphomas

A
32
Q

What are multiple myelomas?

A
33
Q

How does multiple myelomas present?

A
34
Q

What are the causes/risk factors of multiple myelomas?

A
35
Q

What is a paraprotein? and how is it charcaterised

A
36
Q

What 3 features of myeloma give rise to different clinical features

A
37
Q

v

A
38
Q

How do you diagnose mutliple myelomas?

A
39
Q

What is the treatment for multiple myelomas?

A