Investigation of Lymphadenopathy

Question 1

What are the potential causes of lymphadenopathy?

Answer 1

• lymphoma
• infection
• metastatic cancer spread (breast/ovarian)
• Connective tissue disease (sarcoidosis or SLE)

Question 2

What other symptoms are common to lymphoma?

Answer 2

• Night sweats
• Weight loss
• Itch without rash
• alcohol induced pain
• fatigue

Question 3

What causes of lymphadenopathy are more likely to cause a localised reaction?

Answer 3

• bacterial infection

- toe/foot pathology (e.g. ingrown toenail/ cellulitis) can cause inguinal lymphadenopathy (closest region)

Question 4

What can cause generalised lypmhadenopathy?

Answer 4

viral infection (HIV, CMV, EBV)
metastatic cancer
Lymphoma

Question 5

HOw can you differentiate lymphadenopathy of a viral infection between that of cancer?

Answer 5

Lymphadenopathy from infection = normally very tender

Cancer nodes = non-tender

Question 6

Describe the texture of lymph nodes found in lymphoma versus in malignant cancer

Answer 6

• soft and rubbery (NOT HARD)

- malignancy = irregular, hard and tethered to underlying structure

Question 7

How are lymph nodes biopsied?

Answer 7

• Fine needle aspiration
• Core biopsy
• sometimes large sample needed to work out architecture for diagnosis

Question 8

HOw are lymph node biopsies analysed?

Answer 8

• histology
• immunohistochemistry if solid node
  => looks for antigens and positive result = BROWN
• Immunophenotyping of cells of blood/marrow

Question 9

In which type of Lymphoma would Immunohistochemistry identify CD20 antigens on cell surface?

Answer 9

Follicular Non-Hodgkins

• Type of low grade B cell lymphoma
• B cells have CD20

Question 10

In which type of lymphoma would immunohistochemistry find CD30 antigens on the cells?

Answer 10

• These are Reed-Sternberg Cells

- They are found in Hodgkins Lymphoma

Question 11

Describe how immunophenotyping is used to determine the antigens on the cell surface?

Answer 11

• Antibodies aimed at specific antigens
• looked at under laser
• they will fluoresce if antigen is present

Question 12

What forms of cytogenetic analysis is used to look at lymphoma biopsies?

Answer 12

• G banding (look for chromosomes)

- FISH

Question 13

What genetic abnormality is found in Follicular Non-Hodgkins Lymphoma?

Answer 13

Translocation between chromosomes 14 and 18

Question 14

What genetic abnormality is present in Mantle Cell Non-Hodgkins Lymphoma?

Answer 14

Translocation between chromosomes 11 and 14

Question 15

Reed-Sternberg cells found in Hodgkins lymphoma have lost what typical B cell surface protein?

Answer 15

CD20

Question 16

There are more B cell varieties of lymphoma than there are T cell varieties. TRUE/FALSE?

Answer 16

TRUE

Question 17

HOw are lymphomas graded in increasing severity?

Answer 17

Indolent (slow/low grade)
- e.g. follicular lymphoma or Marginal zone

Aggresive
- e.g. DLCL most common, Mantle Cell

Highly Aggressive
- e.g. Burkitt Lymphoma

Question 18

HOw does Burkitt Lymphoma usually appear on blood film?

Answer 18

“stormy sky” appearance

Question 19

What extranodal involvements are common in Burkitt Lymphoma?

Answer 19

• jaw involvement common in africa (assoc. with EBV)

- ileocaecal junction common elsewhere