Lymphadenopathy Flashcards
what are the possible differentials of lymphadenopathy?
INDAM
infections/inflammation neoplasms drugs or toxins autoimmune metabolic
what are the B symptoms seen in lymphoma?
fever
night sweats
weight loss (10% over 6 months)
how can lymphoma present?
painless lump
B symptoms
itch
alcohol induced pain
describe the characteristics of the lymphadenopathy seen in lymphoma
painless rubbery soft smooth no inflammation not tethered
what investigations are done into lymphadenopathy?
FBC
biochemistry
biopsy
imaging
what is seen on FBC in chronic lymphocytic leukaemia (CLL)?
lymphocytosis
how is CLL diagnosed?
FBC
immunophenotyping
what is needed for a definitive diagnosis of lymphoma?
biopsy
what sample is taken for biopsy in lymphoma?
excise the whole node
what tests are done on the biopsy sample in lymphoma?
immunohistochemistry
genetic analysis
what is CD20 a marker of?
B cells
what is CD30 a marker of?
hodgkin lymphoma
what genetic tests can be done for lymphoma?
chromosome analysis
FISH or PCR
what genetic abnormality can be seen in follicular lymphoma?
T(14;18)
what genetic abnormality can be seen in burkitt lymphoma?
T (8;14)
what are the two types of lymphoma?
hodgkin
non hodgkin
what is the most common type of NHL?
B cell
what are the risk factors for lymphoma?
immunosuppression
autoimmune disorders
infections
genetics
what staging system is used to stage lymphoma?
ann arbor staging system
what is a stage I lymphoma?
involves only one lymph node or extra lymph node area
what is a stage II lymphoma?
involves two or more lymph nodes on one side of the diaphragm
what is a stage III lymphoma?
involves two or more lymph nodes on both sides of the diaphragm
what is a stage IV lymphoma?
disseminated disease or diseases affected multiple extra nodal areas
how is the presence of B symptoms noted in the staging of lymphoma?
adding B to the stage
i.e. IIB
what blood test can be done to provide information about prognosis in lymphoma?
lactate dehydrogenase (LDH)
when is the peak incidence of hodgkin lymphoma?
third decade
what infection has a link with hodgkin lymphoma?
EBV
describe the lymph node spread in hodgkin lymphoma
orderly - affects one side of the diaphragm before the other
what cell is seen on histology in hodgkin lymphoma?
reed-sternberg cells
how is hodgkin lymphoma managed?
multi-agent chemotherapy ± radiotherapy
what are the possible long term toxicity effects of treatment in hodgkin lymphoma?
secondary cancers
cardiovascular disease
infertility
what can be done for patients with hodgkin lymphoma who are not responding to chemotherapy?
immunotherapy or stem cell transplant
what is the most common high grade NHL?
diffuse large B cell lymphoma
what types of NHL can often have extra-nodal disease?
T cell NHL
burkitt lymphoma
how is NHL managed?
multi agent chemotherapy ± radiotherapy
what monoclonal antibody can be used for B cell NHL?
rituximab
what monoclonal antibody can be used for T cell NHL?
brentuximab
what viruses are associated with burkitt lymphoma?
EBV
HIV
what genetic abnormalities are seen in burkitt lymphoma?
chromosomal translocations involving c-myc
what characterises tumour lysis?
hypokalaemia hypercalcaemia hyperphosphataemia hyperuricaemia renal failure
what type of drug can be added to chemo regimens for lymphoma?
steroids
