Lymphadenopathy And Lymphoma

Question 1

Differential diagnoses of lymphadenopathy?

Answer 1

Lymphoma
Infection
Metastatic cancer
Connective tissue disease - sarcoidosis , SLE

Question 2

Specific symptoms of lymphoma?

Answer 2

Itch without rash
Alcohol induced pain
Fatigue, night sweats, weight loss

Question 3

Are lymphoma lymph nodes tender?

Answer 3

No

Question 4

Consistency of lymphoma lymph nodes?

Answer 4

Rubbery/ soft

Question 5

Is skin inflamed over lymphoma lymph nodes?

Answer 5

No

Question 6

Investigations to assess lymph node pathology?

Answer 6

Histology microscopic appearances 
Immunohistochemistry
Immunophenotyping 
Genetic analysis 
Molecular analysis

Question 7

What is Ibnutinib?

Answer 7

Inhibitor of cell signalling pathway- overexpression of activation markers in B cell Lymphoma respond well to this

Question 8

2 main classifications of lymphoma?

Answer 8

Hodgkin

Non- Hodgkin

Question 9

What cells are characteristic in Hodgkin lymphoma?

Answer 9

Reed-Sternberg cells

Question 10

What age group is hodgkins most common in?

Answer 10

Adolescents and young adults

Question 11

What virus does hodgkins have a connection with?

Answer 11

EBV

Question 12

Diagnosis of hodgkins?

Answer 12

Lymph node biopsy

Histological exam

Question 13

Main presentation of hodgkins?

Answer 13

Firm, painless swelling of lymph node

Question 14

Treatment of early stage hodgkins?

Answer 14

Brief chemo - ABVD

Followed by field irradiation

Question 15

Treatment of advanced hodgkins?

Answer 15

Cyclical combination chemo - 8 cycles ABVD

With field irradiation at sites of bulk disease

Question 16

Stage one Hodgkin’s lymphoma?

Answer 16

Single lymph node region / extra lymphatic organ or site

Question 17

Stage 2 lymphoma?

Answer 17

2 or more lymph node regions on same side of diaphragm

Question 18

Stage 3 Hodgkin’s lymphoma?

Answer 18

Lymph node regions on both sides of diaphragm - may also have splenic / extralymphatic involvement

Question 19

Stage 4 Hodgkin’s lymphoma?

Answer 19

Diffuse/ disseminate involvement of one or more extralymphatic organs or tissues with/ without associated lymph node involvement

Question 20

What Hodgkin’s lymphoma is most common?

Answer 20

B cell

Question 21

What is lymphoma?

Answer 21

Disorders caused by malignant proliferations of lymphocytes. They accumulate in lymph nodes causing lymphadenopathy

Question 22

When does non Hodgkin’s lymphoma typically present ?

Answer 22

> 40 yrs old

Question 23

Presentation of non Hodgkin’s lymphoma?

Answer 23

Painless peripheral lymphadenopathy

Question 24

Investigations or non Hodgkin’s lymphoma?

Answer 24

Blood count
Lymph node biopsy
Bone marrow aspiration
CXR, CT

Question 25

Treatment of low grade non Hodgkin's?

Answer 25

Radiotherapy if localised Chlorambucil in diffuse Remission maintained with rituximab

Question 26

Management of high grade non Hodgkin's?

Answer 26

R-CHOP - rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisolone