Investigating lymphadenopathy and Dx lymphoma

Question 1

Lymphoma

• presentation?
• investigations?

Answer 1

-a lump i.e. lymphadenopathy 
night sweats
weight loss
\+ itch without rash
alcohol induced pain 
fatigue 

-lymph node biopsy- whole node, not diagnosed on CT

Question 2

Lymphadenopathy

• what should be on the Ddx?
• when are nodes regionally and generally enlarged?
• see chart on slide 13 of lecture

Answer 2

-reactive
Bacterial infection
Viral infection
mets
Lymphoma 

-regional- bacterial inf/ mets/lymphoma
General- viral

Question 3

Lymph node biopsy 
-enables what?
-Describe the following investigations used to look at biopsied nodes:
Histology
Immunohistochemistry
Immunophenotyping
Cytogenetic analysis 
Molecular analysis

Answer 3

-exclude other causes e.g. reactive
classification of lymphoma to guide treatment

-Histology
Immunohistochemistry
(confirms lymphoma and helps subclassify, looks at pattern of proteins on surface of lymphoma cells and uses antibodies against these
stain brown if +)

Immunophenotyping
(uses cells in liquid phase
Cells tagged with antibodies attached to fluorochrome-emits a specific colour of light when laser shone on it so can determine pattern of CD numbers)

Cytogenetic analysis
(there are specific patterns of chromosome abnormality in certain lymphomas
Aspirate node, grow cells in culture and look at spread of chromosomes)

Molecular analysis
looks at patterns of genes switched on and off, can further identify lymphoma and subtypes suitable for specific treatment

Question 4

Describe the classification of lymphoma

Answer 4

Lymphoma can be:

• Hodgkin’s
• T cell NHL
• B cell NHL (high grade OR low grade)

Question 5

What is:

• Hodgkins Lymphoma
• Burkitt’s Lymphoma
• Mantle cell Lymphoma
• Marginal Zone lymphoma

Answer 5

• Lymphoma within which a Reed-Sternberg cell is detected
• NHL, starts in B cells
• NHL, also starts in B cells
• NHL,occurs outside lymph nodes between red and white pulp