L17 Lymphoma

Question 1

What is the function/nature of Bcl-2 gene?

Answer 1

Bcl2 encoded by Bcl-2 gene is an anti-apoptotic suppressor gene

Question 2

What does it mean by the leukemic phase in lymphoma?

Answer 2

When tumor cells spill over into blood

Question 3

The difference in stage of presentation and spread between Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma (NHL(.

Answer 3

HL

• early presentation
• spread: contiguous nodal groups, e.g. neck > mediastnum > abdomen

NHL

• late presentation
• spread: remote nodal groups involved

Question 4

What are the differential diagnosis of diffuse/focal lymphadenopathy? (5)

Answer 4

DDx: MIAMI

• Malignancies: lymphoma, metastasis
• Infections: TB, Syphilis = reactive lymphodenopathy
• Autoimmune: RA, SLE
• Miscellaneous: Kukichi lumphadenopathy, SHML (Sinus Histiocytosis and Massive Lymphadenopathy), storage disease (Gaucher disease)
• Iatrogenic drugs = reactive lymphadenopathy

Question 5

How can Hodgkin’s lymphoma be identified quickly?

Classifications?

Answer 5

• presence of Reed-Sternberg cells (RS)
• EBV detected in 50% of the cases

Classification

1. Non classical (CD20)
   - Nodular lymphocyte predominant
2. Classical (CD15/30)
   - nodular sclerosis
   - mixed cellularity
   - lymphocyte depleted
   - lymphocyte rich

Question 6

How can Non-Hodgkin’s lymphoma be classified?

Answer 6

1. B cell 85%
   - indolent
   - aggressive
   - highly aggressive
2. T/NK cell 15%

Question 7

Which of the following are clinical features of Hodgkin’s lymphoma?

A. Tender LN
B. Firm and rubbery LN
C. Splenomegaly
D. Fever
E. Pruritus 
F. Weight loss
G. Night sweat

Answer 7

All except A
Non-tender
- localized to a single peripheral LN enlargement

Question 8

What are the characteristic features of RS cells (Reed-sternberg cells)? (3)

Answer 8

1. Owl-eye appearance of binucleation
2. inclusion-like nucleoli with pale abundant cytoplasm
3. reactive inflammatory components rimming RS cells (lymphocytes, eosinophils, plasma cells, histiocytes)

Question 9

Which type of Hodgkin’s lymphoma is most common in young adults, with mediastinal involment (SVCO), EBV -ve and with good prognosis?

Answer 9

Nodular sclerosing lymphoma

Question 10

What are the 3 characteristics of Nodular lymphocyte predominant HL?

Answer 10

1. Good prognosis
2. Popcorn cells (RS cell variant)
3. CD20+, CD30-

Question 11

In NHL, what is the difference between low and high gradings?

Answer 11

Low (indolent)
- respond well to chemotherapy, difficult to cure

High/aggressive
- urgent treatment needed, but curable

Question 12

What is the causative agent of ATLL (Adult T-cell Lymphoma/leukemia)?

Answer 12

HTLV-1

how to remember: HTL virus

Question 13

What are the diseases (lymphoma) that can be caused by EBV? (3)

Answer 13

1. Burkitt’s lymphoma
2. NK/T cell lymphoma
3. PTLD (post transplant lymphoproliferative disease)

Question 14

Which lymphoma is caused by H.pylori?

Answer 14

MALToma of stomach

Question 15

Which type of lymphoma is involved in AIDS patients?

Answer 15

High grade B-cell lymphoma at unusual sites

Question 16

Give the 2 types of autoimmune related lymphoma and state their respective causes.

Answer 16

1. Salivary gland and GI lymphoma
   - Sjogren syndrome
2. Thyroid gland lymphoma
   - Hashimoto thyroiditis

Question 17

Which of the common clinical features of NHL are incorrect?

A. The constitutional syndromes of NHL is less severe than HL
B. The enlargement of lympho nodes are painful
C. Extranodal lymphoma MC is GIT
D. Skin: involved in mycosis fungosides (MF) that willl further progress to LN, lung, liver
E. Sezary syndrome is MF with leukemic phase
F. Thyroid is invovled

Answer 17

All except B
- painless

F: thyroid, brain, testis too

Skin: CD4 + T cell neoplasm

Question 18

Name the 2 types of indolent NHL and their respective associated cause.

Answer 18

1. Follicular lymphoma
   - overexpression of Bcl-2
2. MALToma
   - H.pylori
   - autoimmune: Sjogren, Hashimoto

Question 19

• Neoplastic follicles
• MC indolent form of NHL
• CD10+

=?

Answer 19

Follocular lymphoma

Question 20

What pathology is involved in MALToma?

Answer 20

Lymphoepithelial lesion (LEL),

it is the MC extranodal lymphoma

Question 21

Name the 2 types of aggresive NHL and their respective causes.

Answer 21

1. Diffuse large B cell lympho (DLBCL)
   - de novo
   - previous CLL (Richter’s transformation)
2. Extraodal NK/T-cell lymphoma
   - EBV

Question 22

What is the pathology of Extranodal NK/T-cell lymphoma? Where is the MC site?

Answer 22

• Angiocentric and angiodestructive

- Nasal cavity

Question 23

Name the highly aggressive NHL.

What is the associated causes (2)?

Answer 23

Burkitt’s lymphoma

1. EBV
2. MYC gene activation

• starry sky pattern, endemic, HIV related

Question 24

What investigations give the definitive diagnosis of lymphoma?

Answer 24

LN excisional and trucut biopsy

fine needle aspiration is not reliable

Question 25

What are the common Ag immunophenotype in
A. leukocyte
B. T cells
C. B cells

Answer 25

A: CD45
B: cCD3, C5, CD7
C: CD19, CD20, CD22, CD24

Question 26

FISH is best used for?

Give an example of the disease.

Answer 26

Detecting chormosomal translocation
e.g. Follicular lymphoma: t(14;18)
= Bcl-2 activation

Question 27

What is best used for clonal rearrangement of Ig genes (B cell) or TCR gene (T cell)?

Answer 27

molecular PCR

Question 28

Which Ann Arbor staging does this belong to?

Lymphoma involving more than one regional LN, confined to one side of the diaphragm

Answer 28

Stage 2

Question 29

Which Ann Arbor staging does this belong to?

Lymphoma involving single region

Answer 29

Stage 1

Question 30

Which Ann Arbor staging does this belong to?

Lymphoma involvement of both sides of the diaphragm

Answer 30

Stage 3

Question 31

Which Ann Arbor staging does this belong to?

Disseminated involvement of one or more extra-lymphatic organs e.g. liver, spleen, BM, lungs

Answer 31

Stage 4