lymphadenopathy and lymphoma

Question 1

causes of lymphadenopathy

Answer 1

lymphoma
infection (viral, bacterial)
metastatic cancer eg breast, ovarian
connective tissue disease (SLE)

Question 2

what are symptoms associated with lymphadenopathy

Answer 2

night sweats 
weight loss
itch without rash
alcohol induced pain
fatigue

Question 3

how does lymphadenopathy direr in bacterial and viral infection

Answer 3

bacterial tends to be regional

viral tends to be generalised

Question 4

describe viral lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment

Answer 4

tender: yes
consistency: hard
surface: smooth
skin inflammation: no
attached to underlying tissues: no

Question 5

describe bacterial lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment

Answer 5

tender: yes
consistency: hard
surface: smooth
skin inflamed: yes
attached to underlying tissues: maybe

Question 6

describe lymphoma lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment

Answer 6

tender: no
consistency: rubbery/soft
skin inflamed: no
attached to underlying tissues: no

Question 7

describe metastatic lymphadenopathy in terms of tenderness, consistency, surface, inflammation and attachment

Answer 7

tender: no
consistency: hard
surface: irregular
skin inflamed: no
attached to underlying tissues: yes

Question 8

what investigation should be carried out if lymphoma or other malignancy is suspected?

Answer 8

biopsy

preferably excisions biopsy as FNA or core biopsy is often insufficient

Question 9

can lymphoma be diagnosed on CT

Answer 9

NOPE

Question 10

how is lymph node pathology assessed

Answer 10

histological microscopic appearances
immunohistochemistry solid node
immunophenotyping blood/marrow 
genetic analysis 
molecular analysis

Question 11

what is immunohistochemistry used for

Answer 11

confirming lymphoma diagnosis

subclassification

Question 12

reed Sternberg cells are associated with what type of lymphoma

Answer 12

hodgkin’s

Question 13

CD20 +ve cells are associated with which type of lymphoma

Answer 13

non-hodgkin’s

Question 14

CD30 +ve cells are associated with which type of lymphoma

Answer 14

Hodgkin’s

Question 15

what is immunophenotyping used for

Answer 15

determines patterns of CD numbers

useful for lymphomas involving marrow

Question 16

how is immunophenotyping performed

Answer 16

cells are tagged with antibodies attached to a fluorochrome that emits a specific light when laser is shone on it

Question 17

what types of cryogenic analysis are used in investigation of lymphoma

Answer 17

G-banding (looking at chromosome numbers)

FISH (looking for specific abnormalities)

Question 18

what does molecular analysis show

Answer 18

patterns of genes that are switched on or off

Question 19

why is molecular analysis useful

Answer 19

identifies subtypes that are suitable for specific treatments

Question 20

what are the main types of lymphoma

Answer 20

B-cell NHL (90% of NHL, spill into low and high grade)

T-cell NHL (10%)

hodgkin’s

Question 21

clinical features of burkitt’s lymphoma

Answer 21

rapid growth

requires chemo everyday

Question 22

clinical features of mantle cell lymphoma

Answer 22

looks low grade but grows rapidly

not curable

Question 23

clinical features of marginal zone NHL

Answer 23

very slow changing
good prognosis
can live without treatment for decades