Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PT1 B2 > Lecture 48/49 - Lymphomas and Myelomas > Flashcards

Lecture 48/49 - Lymphomas and Myelomas Flashcards

1
Q

what is a luekemia vs lymphoma vs myeloma? where do they abnormalities present

A

L eukemia vs Lymphoma vs Myleoma
○ Leukemia – abnormal proliferation of immature lymphoid/myeloid cells (blasts; ALL)
§ Bone marrow

	○ Lymphoma -- Mature B cells growing out of control 
		§ Lymph Nodes 

	○ Myeloma -- plasma cell growing out of control 
		§ Bone marrow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the layers of a normal reactive LN from inner to outer?

A

Follicle
Mantle Zone
Marginal Zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the Ann Arbor Tumor staging for Lymphomas

A

Stage 1 – Single Location
Stage 2 – Multiple sites; same side of the diaphragm
Stage 1,2 – Localized disease; consider radiation therapy

Stage 3 – both sides of the diaphragm
Stage 4 – diffuse involvement of non lymphoid organs
Wide spread
Consider chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hodgkin Lymphoma –

what is it?

A

Localized single group of Nodes; contiguous spread

Extra nodal involvement is rare

Better Prognosis than Non-Hodgkin Lymphoma

Strongly associated with EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the classical morphology associated with Hodgkin Lymphoma

A

Reed Sternberg Cells

+Reactive benign Infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 classical subtypes of Hodgkin Lymphoma?

What is the immunophenotype in general?

which are associated with EBV

A

CD15, 30+) and are EBV associated but to varying degrees

Nodular sclerosing (most common)
Rare EBV association

Lymphocyte-rich
(do not confuse with lymphocyte-predominant)
40% EBV+

Mixed cellularity
70% EBV+

Lymphocyte depleted
90% EBV+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Immunophenotype of nonclassical HL subtype

A

CD15, CD30 and EBV Negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common Presentation + symptoms of HL

A

Enlarged LN in the neck, mediastinum, axilla

○ Often positive for EBV
○ 40% have B symptoms: night sweats, fevers, weight loss;
○ Itch
Sensitivity to alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of HL:

A

(ABVD) +/- radiation therapy

□ Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outcomes/prognosis of HL

A

○ Limited stage – 85% disease free 10 years later

○ Wide spread - 70% disease free 10 years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the NHL - B Cell Lymphomas?

Which are aggressive(more treatable)?

Which are indolent (less treatable)?

A

CLL/SLL

Diffuse Large B Cell Lymphoma — aggressive

Burkitts Lymphoma —- (some are EBV ASSOCIATED) — aggressive

Follicular Lymphoma – indolent

Marginal Zone – indolent
(H. Pylori associated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
NHL B Cell: DLBCL: 
- what is it/presentation 
- what are the causes? -
- 
-
A
  • Fast growing, large Bcell tumor mass; Disease may extend beyond LNs

Causes not well understood. Very Heterogeneous Origins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • what are the virally associated subtypes of DLBCL?

- what is are some possible genetic makers (translocation?

A

Immunodeficiency associated LBCL (eg such as with acquired immunodef or HIV)

Primary Effusion Lymphoma
HHV8 (Kaposis’ Sarcoma) Associated

Potential translocations: BCL6
t(14:18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of DLBCL

+ what drug is used for CNS prophylaxis

A

treatment: RCHOP
Rituximab (anti CD20); Cyclophosphamide, Doxorubicin, Vincristine, Prednisone +/- Radiation

CNS prophylaxis: Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NHL B Cell: Burkitt’s Lymphoma

  • what is it/presentation?
A

an aggressive B cell tumor: extremely fast growing. Medical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • NHL B Cell: Burkitt’s Lymphoma

what causes it?
- is there a viral association?

A

cMYC Translocations with an Ig – proto-oncogene that gets activated when attached to an Ig Loci and becomes constitutively activated

t(8:14) translocation

Viral association for some of
subtypes:
- African – all EBV associated
Sporadic and HIV – few are EBV associated

17
Q

What is the morphology of Burkitts?

A

“starry sky” – Sheets of lymphocytes with interspersed macrophages

High apoptotic rate: Macrophages in the background full of dead lymphoma cells

18
Q

NHL - B Cell – Follicular Lymphoma

  • what is it?
A

an indolent, slow growing B cell Lymphoma

Presentation: stage 3,4 disease; usually does not grow out of the Lymph Nodes

Can gradually transform to DLBCL

19
Q

NHL - B Cell – Follicular Lymphoma

  • what is the genetic origin?
  • how can this help with diagnosis (immunophenotype)
A

T(14:18): Translocations of BCL2 with IgH

Immunophenotype:
Test: Over expression of BCL2
A normal follicular center is BCL2 negative

20
Q

NHL - B Cell – Follicular Lymphoma

  • what is the standard of care?
  • when do you treat?
A

§ Current standard of Care:
□ Advanced Disease – Close surveillnace; treatment is not worth it

Treatment when the patient is symptomatic due to the lymphoma (eg the mass is compressing an important nerve or organ)

  • Rituximab + Chemo
  • Rituximab + Targetted therapy
21
Q

NHL - B Cell – Marginal Zone Lymphoma (MALToma)

  • what is it?
  • What bacteria is it associated with?
  • treatment
A

Indolent B cell Lymphoma that involves the mucosa;
— no enlarged LNs

– (H. Pylori)

– Treatment: if in the setting of H. pylor
® Triple therapy – 2 abx + PPI; followed by Surveillance Endoscopy

22
Q

Name of the Mature T Or NK-Cell Lymphomas:

A

Adult T Cell Lymphoma:

Anaplastic Large Cell Lymphoma (ALCL)

Extranodal NK/T Cell Lymphoma

Mycosis Fungoides/Sezary Syndrome:

Peripheral T Cell Lymphoma – Not Otherwise Specified

23
Q

Adult T Cell Lymphoma: What is the viral association?

A

Human T Lymphotrophic Virus 1: HTLV 1

24
Q

○ Anaplastic Large Cell Lymphoma (ALCL)

what is the Constitutively Activated protein

A

ALK

25
Q

Extranodal NK/T Cell Lymphoma

  • where does it commonly occur? What structures are invaded?
  • what is the viral association?
A

§ Very destructive tumor often involving the nasopharynx

§ Invades into blood vessels —> ischemic necrosis

§ Strongly associated with EBV

26
Q

Mycosis Fungoides vs Sezary Syndrome:

  • what is it? what is the difference between the two?
  • Treatment for the two:
A

Mycosis Fungoides: Malignant T Helper cells infiltrate the skin, eventually form discrete plaques and tumors; can progress to Sezary — treat topically

Sezary Syndrome: Typically associated with a leukemia
treat with chemotherapy

27
Q

Describe the progression of Plasma Cell Neoplasms

  • what is the common finding of all of these ?
A

1) MGUS: Monoclonal Gammopathy of Uncertain Significance
2) Smoldering Myeloma
3) Plasma Cell Myeloma – Plasmacytoma
4) Multiple Myeloma: Multiple Plasmacytomas

Common finding: Elevated M (monoclonal para) protein

28
Q

1) MGUS: Monoclonal Gammopathy of Uncertain Significance –

Presentation
what % become multiple myeloma
Clinical Findings:
what is notably absent

A

No masses; Asymptomatic

§ 1% will develop multiple myeloma

Clinical Findings: M protein
no CRAB findings

29
Q

Smoldering Myeloma:

  • presentation
  • clinical findings
A

§ No Masses
§ Asymptomatic

M protein elevated
Elevated Marrow Plasma Cells (>10%)

30
Q

Plasma Cell Myeloma – Plasmacytoma

A

§ a single Marrow based Tumors

§ Increased marrow plasma cells

• Elevated monoclonal Component

§ Solitary marrow mass; (if multiple, then its called Multiple Myeloma)

31
Q

Mutlitple Myeloma:
- what is it?

  • how do patients commonly present?
A

proliferation of plasma cells (in the marrow at multiple sites) – fully developed B cell that makes Ig

§ Excess Monoclonal Ig — M Protein;

§ Patient often presents with bony pain; new renal failure; new anemia

32
Q

What are the criteria for diagnosis of a Multiple Myeloma?

A

§ Dx – Bone marrow aspirate and biopsy

Criteria for Multiple Myeloma Diagnosis:

> 10% plasma cells in the bone marrow

An M protein (monoclonal protein, Ig) – -quantitative Ig Levels; serum, urine and electrophoresis

End organ Damage: CRAB findings

33
Q

What are the CRAB findings?

What symptoms can they cause?
what causes the renal damage?

A

◊ Calcium: hypercalcemia — can lead to dehydration and mental status changes (confusion)
◊ Renal failure — some of the M proteins can damage the kidneys

◊ Anemia

◊ Bone Lesions – skeletal survey — get every part of the body X-ray
Findings: Punched out lytic bone lesions;

34
Q

How is serum protein electrophoresis used in Multiple Myeloma?

A

Used to classify the type of Ig that being abnormally produced (IgG, IgA, or IgM ) and whether it is kappa or lambda light chain

35
Q

treatment of multiple myeloma?

A

treatment:
§ Multi-agent

Bisphosphonate therapy to stabilize bones

PT1 B2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions