LIMFOAME

Question 1

Limfom - def

Answer 1

neo al sist imunitar - afect ggl limfatici, splina, amigdale, mo in principal

Question 2

Limfom Hodgkin - def

Answer 2

neo limfoida caract prin prez cel Reed-Sternberg

Question 3

LH - clinic

Answer 3

debut insidios cu adenopatii laterocervicale
semne gen
durere in ariile limfatice interes dupa cons alcool
prurit
sdr compresiv

Question 4

LH - biopsie ggl

Answer 4

GRANULOM HODGKIN = CRS/H + pop polimorfa reactiva (Ly, Eo, Mfg)
cel REED STERNBERG - cel mare, nucl vol, polilobal, nucleoli vol (“bufnita”)
cel HODGKIN - var a CRS (uninucleata, uninucleolata)
ambele provin din linia B (CD 19, 20, 22, 30, 15, 25)

Question 5

LH clasic - caract

Answer 5

CRS & CH exprima CD15, CD 30

Question 6

LH clasic - scleroza nodulara

Answer 6

fibroza nod in jurul nodulilor limfoizi
CRS lacunare
prez frecv mediastinala, mai frecv la femei

Question 7

LH clasic - celularitate mixta

Answer 7

pop cel polimorfa - Ly, Mfg, PMN, eo, pl

frecv in stadii avansate

Question 8

LH clasic - bogat in Ly

Answer 8

infiltrat predominant cu ly mici, pred T in jurul CRS

prez cervic inalta

Question 9

LH clasic - depletie Ly

Answer 9

disparitia limfocitozei react

stadii avans la debut, prognostic nefav

Question 10

LH cu predominanta Ly si disp nodulara

Answer 10

cel neo rare cu nucl unic, lob = cel popcorn
CD20 +, CD 15, 30 -
adenopatii loc
evol indolenta

Question 11

LH - hlg

Answer 11

anemie

LEU crescute cu neutrofilie, eozinofilie, limfopenie

Question 12

Stadializarea ANN-ARBOR

Answer 12

I - afect unui singur ggl/ gr ggl
II - afect a >2 gr ggl sit de aceeasi parte a diafragmului
III - interes limfatica supra si sub diafragmatica
IV - stadiul de visceraliz prin disemin hematogena

+ A (fara semne gen)/B (cu semne gen)

+E (extindere viscerala prin contiguitate)

Question 13

LH - evol, prognostic

Answer 13

evol var, prognostic bun
FR - tip histo CM, DL, varsta >40 ani, sex masculin, VSH >40 mm/h, semne gen, stafiu III/IV, forma bulky, interes viscerala prin contig

Question 14

LH - tratament

Answer 14

linia 1 - chimioterapie (ABDV, BEACOPP) + radioterapie (forme bulky)
linia 2 (refract, recidiv) - DHAP/IGEV, chimio high doze + autotransplant, Ac monoclon (adcetris - anti CD30; nivolumab - anti PD1)
linia 3  (refract, a doua recidiv) - alta chimio, allogrefa de cel stem

Question 15

LNH - fact predispozanti

Answer 15

fact genetic
imuno - deficite imune congenit, SIDA, b autoimune
mediu - infectii bact (HP), infectii virale (HTLV, EBV, HCV), radiatii, chimicale

Question 16

LNH - anomalii citogenetice

Answer 16

\+ c-myc (protooncogena) t(8,14) -> limfom burkitt
\+ bcl2 t(14,18) - limfom folicular
t(11,14) ciclina D1 - de manta
t(2,5) gena ALK - limfom anaplastic
oncogene fam bcl
translocatii care intereseaza TCR

Question 17

LNH - patogeneza

Answer 17

prolif policlonala (+ Atg) -> acum anomalii citogen -> o clona capata avantaj de crestere => selectia clonei resp

Question 18

LNH - clinic

Answer 18

asimptomatici
adenopatii - dimens, consist var, generaliz, cu ext centrifuga, cu salt peste anumite statii ggl
hepatosplenomegalie
simpt gen
det limfomatoase cut
det GI (diaree, malabs, subocl)

Question 19

LNH - biopsie ggl

Answer 19

marimea cel, grad de dif, dispozitia

Question 20

LNH cu grad redus de malignitate

Answer 20

cel mici, mature, disp nod

Question 21

LNH cu grad inalt de malignitate

Answer 21

cel mari, imat, disp difuz

Question 22

LNH - hlg, BOM

Answer 22

N/ leucocitoza+anemie+trombopenie

infiltrat limfomatos in mo

Question 23

LNH indolente cu cel B

Answer 23

LNH limfocitic (LLC)
limfoplasmocitoid/ MGW
tip MALT
folicular gr I, II

Question 24

LNH agresive cu cel B

Answer 24

LNH folic gr III
LNH cel de manta
LNH difuz cu cel mari
LNH limfoblastib B (LAL B)
Burkitt

Question 25

LNH indolente cu cel T

Answer 25

Leucemia cu limfocite mari granulare

mycosis fungoides

Question 26

LNH agresive cu cel T

Answer 26

LNH T perif
LNH angioimunoblastic
LNH anaplazic T
LNH limfoblastic T
leucemia/limfomul cu cel T adulte

Question 27

LNH indolente - evolutie, prognostic

Answer 27

evolutie lunga, indolenta
stab dg - generaliz
nu sunt curabile
sv 5 ani 70-80%

Question 28

LNH agresive - evolutie, prognostic

Answer 28

evol rapide
surprinse in stad I, II
pot curabile (30-40%)
sv 5 ani - 30-40%

Question 29

LNH - index prognostic international

Answer 29

varsta > 60 ani
IP > 2
stad III, IV
>1 interes extraggl
LDH crescut
0-1 - risc scazut, 2 risc scazut/mediu, 2-3 mediu/crescut, 4-5 risc crescut

Question 30

LNH ale tes limfoide asoc muc (MALT)

Answer 30

de obicei indolente
prolif LyB mici
atingere extraggl izolat
disemin lenta cu invad altor MALT

Question 31

LNH gastric

Answer 31

etio - HP

erad HP -> vindec limfom in stadii incipiente

Question 32

LNH cutanata cu cel T - Mycosis fungoides

Answer 32

eritrodermie descuamativa +/- tu cut
infiltrat dermic cu LyT CD4+
cel maligne in sg perif - sdr Sezary

Question 33

LNH - tratament

Answer 33

observare - limfoame indolente
radioterapie - forme bulky, irad superf cu electroni (MF)
chimioterapia - R-CHOP
polichimioterapie de salvare - DHAP
high dose chimio + autotransplant de CSH
imunoterapie - rituximab, alemtuzumab (anti CD52)
radioimunoterapie - anti CD20 + iod/yttrium radioactiv