lymphadenopathy and lymphoma Flashcards
causes of lymphadenopathy
lymphoma
infection (viral, bacterial)
metastatic cancer eg breast, ovarian
connective tissue disease (SLE)
what are symptoms associated with lymphadenopathy
night sweats weight loss itch without rash alcohol induced pain fatigue
how does lymphadenopathy direr in bacterial and viral infection
bacterial tends to be regional
viral tends to be generalised
describe viral lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment
tender: yes
consistency: hard
surface: smooth
skin inflammation: no
attached to underlying tissues: no
describe bacterial lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment
tender: yes
consistency: hard
surface: smooth
skin inflamed: yes
attached to underlying tissues: maybe
describe lymphoma lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment
tender: no
consistency: rubbery/soft
skin inflamed: no
attached to underlying tissues: no
describe metastatic lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment
tender: no
consistency: hard
surface: irregular
skin inflamed: no
attached to underlying tissues: yes
what investigation should be carried out if lymphoma or other malignancy is suspected?
biopsy
preferably excisions biopsy as FNA or core biopsy is often insufficient
can lymphoma be diagnosed on CT
NOPE
how is lymph node pathology assessed
histological microscopic appearances immunohistochemistry solid node immunophenotyping blood/marrow genetic analysis molecular analysis
what is immunohistochemistry used for
confirming lymphoma diagnosis
subclassification
reed Sternberg cells are associated with what type of lymphoma
hodgkin’s
CD20 +ve cells are associated with which type of lymphoma
non-hodgkin’s
CD30 +ve cells are associated with which type of lymphoma
Hodgkin’s
what is immunophenotyping used for
determines patterns of CD numbers
useful for lymphomas involving marrow
how is immunophenotyping performed
cells are tagged with antibodies attached to a fluorochrome that emits a specific light when laser is shone on it
what types of cryogenic analysis are used in investigation of lymphoma
G-banding (looking at chromosome numbers)
FISH (looking for specific abnormalities)
what does molecular analysis show
patterns of genes that are switched on or off
why is molecular analysis useful
identifies subtypes that are suitable for specific treatments
what are the main types of lymphoma
B-cell NHL (90% of NHL, spill into low and high grade)
T-cell NHL (10%)
hodgkin’s
clinical features of burkitt’s lymphoma
rapid growth
requires chemo everyday
clinical features of mantle cell lymphoma
looks low grade but grows rapidly
not curable
clinical features of marginal zone NHL
very slow changing
good prognosis
can live without treatment for decades
