Lymphoma Flashcards
What are two types of lymphoma?
- Hodgkin’s
- Non-hodgkin’s
What age is affected by HL?
bimodal incidence 20-30 and 50+
What age is affected by NHL?
increases with age
What cell is affected in HL?
only b cell
What cell is affected in NHL?
B or T cell
Does HL spread?
single group of nodes affected
Does NHL spread?
tends to affect multiple nodes
What are RF for HL?
- EBV infection
- positive FHx
- young adults
What is RF for NHL?
- age >50 years
- EBV
- HTLV-1
- male sex
- Hpylori
What are common types of NHL?
- Diffuse large b cell lymphoma ( most common in adults)
2. Follicular lymphoma (most common indolent lymphoma)
What are types of HL and how are they differentiated?
- Nodular lymphocyte predominant HL: men CD20 and CD45
2. Classical HL: CD15 and CD30
What cell does HL have that NHL not have?
- Reed stenberg cells (multinucleated)
- Hodgkin cell (large and mononuclear)
What is key feature of HL?
pain after alcohol intake
What are general symptoms of lymphoma?
- Painless lymphadenopathy
- Fever, night sweats, weight loss
- Puritus
What are HL signs?
- Lymphadenopathy
- Cachexia
- Anaemia
- Spleno- or hepatomegaly
- Painless cervical lymphadneopathy
What are NHL signs?
- Extra nodal disease: go anywhere (gut (bowel obstruction), BM (fatigue, easy bruising) , spinal cord (loss of sensation)
- Pancytopenia from barrow involvement
- Lymphadenopathy
- Splenomegaly
What are HL DDx?
- NHL
- Lymphadenopathy from other malignancies
- Infectious mononucleosis
- Reactive lymph nodes
What are NHL DDx?
- Hodgkin’s lymphoma
- Acute lymphocytic leukaemia
- Infectious mononuecleosis
- Hep C
- TB
What investigations do you do for HL?
- Bloods:
1. FBC with differential
2. Metabolic profile
3. ESR - Imaging:
4. CXR
5. PET-CT scan
6. Gallium scan
7. Contrast CT neck, chest and abdo - Other:
8. Excisional lymph node biopsy
9. Immunohistochemical studies
What investigations do you do for NHL?
- Bloods:
1. FBC with differential
2. Blood smear
3. LFTs
4. LDH
5. Basic metabolic panel - Other:
1. Lymph node biopsy
2. Skin biopsy
3. BM biopsy
What would FBC with differential be with HL?
- low Hb
- platelets
- WBC high or low
Why do you do an immunohistochemical studies?
differentiate HL from other types
What is FBC with differential in NHL?
- thrombocytopenia
- pancytopenia
- lymphocytosis
What would blood smear show in NHL?
- nucleated rbc
2. left shift
What will LDH be in NHL?
high
What is the management plan for HL?
- depends on stage, age and general health
1. chemotherapy
2. radiation therapy - For nodular lymphocytes predominant: rituximab
What is the management plan for NJL?
- Chemotherapy and radiation therapy
- depends on subtype, aggression, and spreading
- If CD20+ can use rituximab
What are possible complications of HL?
- Radiotherapy related thyroid abdnormalties
- Chemotherapy+ radiotherapy related cardiac disease, secondary malignancies
- Impaired immunity
What are possible complications of NHL?
- Chemotherapy related complications
- Radiation related complications
- BM transplant related complications
- TLS
What system is used in HL?
Ann arbour system
Which lymphoma has best prognosis?
- classical Hodgkin lymphoma, lymphocyte rich has best prognosis
- HL better than NHL
What is a subtype of for NHL?
Burkitt’s lymphoma
What are RF for Brukitt’s lymphoma?
- EBV infection
- chronic malaria reduced resistance to EBV infection
- HIV
- Children in Africa and Brazil
What is presentation for Burkitt’s lymphoma?
Rapidly enlarging lymph node in jaw
What is buzzword for Burkitt’s lymphoma?
Starry sky appearance under microscope
What is 3 main difference between NHL and HL?
HL: 1. Reed-sternberg cells 2. Skin exoriations 3. Neutrophilia NHL: 1. NO reed-sternberg cells 2. Skin rashes e.g. mycosis fungoides 3. Neutropenia
