Lymphadenopathy and Lymphoma Flashcards
what can cause lymphadenopathy
lymphoma
infection
mets
CTD (sarcoidosis, SLE)
what can cause night sweats
lymphoma/ other malignancy
infection
menopause
too thick duvet/ heating
what usually causes regional lymphadenopathy
bacterial infection
what usually causes generalised lymphadenopathy
viral infection
what are nodes like in viral infections
tender hard smooth no skin inflammation not tethered
what are nodes like in bacterial infection
tender hard smooth skin inflamed maybe tethered
what are nodes like in lymphoma
non tender rubbery/soft smooth no skin inflammation no tethered
what are nodes like in mets
non tender hard irregular surface no skin inflammation tethered
what Ix if you suspect lymphoma/ malignancy
biospy: FNA or core biopsy
can lymphoma be diagnosed by CT
no
what is the role of the lymph node biopsy
exclude other reactive causes
classification of lymphoma (guides Tx and prognosis)
understand pathogenesis
how do you assess lymph node pathology
histology- microscopic appearances immunohistochemistry solid node immunophenotyping blood/ marrow genetic analysis molecular analysis
is a whole node sample or CT guided biopsy prefered in lymphoma
whole node biopsy
what is the role of immunohistochemistry in lymphoma
confirms lymphoma diagnosis
helps to subclassify
looks at pattern of proteins on the surface of lymphoma cells uses antibodies against these ans enzyme reactions
brown= +ve
what is the role of immmunophenotyping
uses blood or bone marrow cells
tags with antibodies attached to fluorochrome
determines patterns of CD numbers: v uselful in leukaemias and lymphomas involving marrow (e.g. burkitts)
how is cytogenic analysis done
(looks for chromosomal abnormalities)
G banding (aspirate node)
FISH
what does molecular analysis do
analyses patterns of gene expression
helps classify and find subtypes suitable for specific Txs
what are the types of lymphoma
hodgkins
T cells NHL (10%)
B cell NHL (90%): low grade B cell, high grade B cell, burkitts, mantel cell lymphoma, marginal zone NHL
what cells do hodgkins lymphomas have
reed-sternberg cells
what determins the treatment and prognosis of lymphoma
classification of the type and stage
what are the two types of hodgkins lymphoma
classical HL (more common, nodular sclerosis, mixed cellularity, lymphomcyte rich/ depleted) nodular lymphocyte predominant HL (doesnt have reed-sternberg cells, more common in immunosuppressed and EBV)
what infection is seen in 50% of patients with HL
EBV
how does HL present
large asymptomatic lymph node in lower neck/ supraclavicular region
mediastinal masses common, seen on CXR: chest discomfort, cough, dyspnoea
systemic symptoms (aka b symptoms: night sweats, unexplained fever)
alcohol induced pain at sited of nodal disease
lymphadenopathy, hepatomegaly, splenomegaly
what is NHL more likely to do than HL
disseminate to extra nodal sites
what is the prognosis for NHL
low grade= ~10 years
high grade = many can be cured
what are the classifications of NHL
precursor B lymphoblastic lymphoma
mature (peripheral) B cell neoplasms (high grade e.g. burkits and low grade (e,g, follicular)
Precursor T-lymphoblastic lymphoma
mature (peripheral) T cell neoplasms: high grade and low grade
what is the median age for NHL
> 50
what are the most common types of NHL
follicular lymphomas (low grade) diffuse large B cell lymphoma (high grade)
how do low grade lymphomas present
painless slow peripheral lymphadenopathy
systemic symptoms present in end stage disease
spleno and hepato megaly
cytopenia
how do high grade lymphomas present
rapidly growinf and bulky lymphadenopathy
system symptoms
extra nodal involvement (GI, skin, bone marrow, sinuses, GU, thyroid, CNS))
how does burkitts lymphoma commonly present
with a large abdominal mass and symptoms of bowel obstruction
