L17 Lymphoma Flashcards
What is the function/nature of Bcl-2 gene?
Bcl2 encoded by Bcl-2 gene is an anti-apoptotic suppressor gene
What does it mean by the leukemic phase in lymphoma?
When tumor cells spill over into blood
The difference in stage of presentation and spread between Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma (NHL(.
HL
- early presentation
- spread: contiguous nodal groups, e.g. neck > mediastnum > abdomen
NHL
- late presentation
- spread: remote nodal groups involved
What are the differential diagnosis of diffuse/focal lymphadenopathy? (5)
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
How can Hodgkin’s lymphoma be identified quickly?
Classifications?
- presence of Reed-Sternberg cells (RS)
- EBV detected in 50% of the cases
Classification
- Non classical (CD20)
- Nodular lymphocyte predominant - Classical (CD15/30)
- nodular sclerosis
- mixed cellularity
- lymphocyte depleted
- lymphocyte rich
How can Non-Hodgkin’s lymphoma be classified?
- B cell 85%
- indolent
- aggressive
- highly aggressive - T/NK cell 15%
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
All except A
Non-tender
- localized to a single peripheral LN enlargement
What are the characteristic features of RS cells (Reed-sternberg cells)? (3)
- Owl-eye appearance of binucleation
- inclusion-like nucleoli with pale abundant cytoplasm
- reactive inflammatory components rimming RS cells (lymphocytes, eosinophils, plasma cells, histiocytes)
Which type of Hodgkin’s lymphoma is most common in young adults, with mediastinal involment (SVCO), EBV -ve and with good prognosis?
Nodular sclerosing lymphoma
What are the 3 characteristics of Nodular lymphocyte predominant HL?
- Good prognosis
- Popcorn cells (RS cell variant)
- CD20+, CD30-
In NHL, what is the difference between low and high gradings?
Low (indolent)
- respond well to chemotherapy, difficult to cure
High/aggressive
- urgent treatment needed, but curable
What is the causative agent of ATLL (Adult T-cell Lymphoma/leukemia)?
HTLV-1
how to remember: HTL virus
What are the diseases (lymphoma) that can be caused by EBV? (3)
- Burkitt’s lymphoma
- NK/T cell lymphoma
- PTLD (post transplant lymphoproliferative disease)
Which lymphoma is caused by H.pylori?
MALToma of stomach
Which type of lymphoma is involved in AIDS patients?
High grade B-cell lymphoma at unusual sites
Give the 2 types of autoimmune related lymphoma and state their respective causes.
- Salivary gland and GI lymphoma
- Sjogren syndrome - Thyroid gland lymphoma
- Hashimoto thyroiditis
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
All except B
- painless
F: thyroid, brain, testis too
Skin: CD4 + T cell neoplasm
Name the 2 types of indolent NHL and their respective associated cause.
- Follicular lymphoma
- overexpression of Bcl-2 - MALToma
- H.pylori
- autoimmune: Sjogren, Hashimoto
- Neoplastic follicles
- MC indolent form of NHL
- CD10+
=?
Follocular lymphoma
What pathology is involved in MALToma?
Lymphoepithelial lesion (LEL),
it is the MC extranodal lymphoma
Name the 2 types of aggresive NHL and their respective causes.
- Diffuse large B cell lympho (DLBCL)
- de novo
- previous CLL (Richter’s transformation) - Extraodal NK/T-cell lymphoma
- EBV
What is the pathology of Extranodal NK/T-cell lymphoma? Where is the MC site?
- Angiocentric and angiodestructive
- Nasal cavity
Name the highly aggressive NHL.
What is the associated causes (2)?
Burkitt’s lymphoma
- EBV
- MYC gene activation
- starry sky pattern, endemic, HIV related
What investigations give the definitive diagnosis of lymphoma?
LN excisional and trucut biopsy
fine needle aspiration is not reliable
What are the common Ag immunophenotype in
A. leukocyte
B. T cells
C. B cells
A: CD45
B: cCD3, C5, CD7
C: CD19, CD20, CD22, CD24
FISH is best used for?
Give an example of the disease.
Detecting chormosomal translocation
e.g. Follicular lymphoma: t(14;18)
= Bcl-2 activation
What is best used for clonal rearrangement of Ig genes (B cell) or TCR gene (T cell)?
molecular PCR
Which Ann Arbor staging does this belong to?
Lymphoma involving more than one regional LN, confined to one side of the diaphragm
Stage 2
Which Ann Arbor staging does this belong to?
Lymphoma involving single region
Stage 1
Which Ann Arbor staging does this belong to?
Lymphoma involvement of both sides of the diaphragm
Stage 3
Which Ann Arbor staging does this belong to?
Disseminated involvement of one or more extra-lymphatic organs e.g. liver, spleen, BM, lungs
Stage 4
