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Scarlett's pathology flashcards > lymphoma > Flashcards

lymphoma Flashcards

1
Q

what is lymphoma

A

Neoplastic tumour of lymphoid tissue
• Often lymph nodes (+ Bone marrow +/- spill out to blood)
• Sometimes other lymphoid tissues – spleen, MALT (mucosal associated lymphoid tissue)
• Rarely, “anywhere” – skin (often T-cell), CNS, testes, breast

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2
Q

what is the epidemiology of hodgkins

A
  • M>F; bimodal age incidence – 20-29 year olds and >60 year olds
  • EBV-associated
  • Spreads contiguously to adjacent lymph nodes; often involves single LN group
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3
Q

What are the clinical symptoms of hodgkins

A

• Asymmetrical painless lymphadenopathy +/- obstructive/mass effect symptoms
• “B-symptoms” o Fever >38. Classical Pel-Ebstein fever (cyclical 1-2wk) seen in a minority o Drenching sweats at night
o Weight loss >10% in 6 months unintentional
• Pain in affected nodes after alcohol
• Nodes tend to be mediastinal / cervical but not always

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4
Q

what investigations in hodgkins

A
  • CT/PET. Tissue diagnosis: LN or BM biopsy - cells stain with CD15 & CD30
  • Reed-Sternberg cell – bi-nucleate/multinucleate (‘owl eyed’) cell on a background of lymphocytes & reactive cells
  • Subtypes: nodular sclerosing (most common), mixed cellularity, lymphocyte rich, lymphocyte depleted, nodular lymphocyte predominant (not classical HL)
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5
Q

ann arbor staging

A

Stage 1 – one LN region (LN region can include spleen)
Stage 2 – two or more LN regions on the same side of the diaphragm
Stage 3 – two or more LN regions on opposite sides of the diaphragm
Stage 4 – extranodal sites (liver, BM)

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6
Q

what is the treatment for hodgkins

A
  1. Combination chemotherapy – o Used in most cases
    o ABVD: Adriamycin, bleomycin, vinblastine and dacarbazine o 2-4 cycles in stage 1/2, 6-8 cycles in stage 3/4
  2. Radiotherapy – o Often used alongside chemo in bulky areas or limited disease– very high risk of breast cancer in women
  3. Intensive chemo (e.g. BEACOPP) and autologous SCT – o Relapsed patients
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7
Q

what acronym for hodgkins chemo

A

ABVD

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8
Q

classic histology of burkitts

A

starry sky

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9
Q

three types of burkits

A

endemic, sporadic, immunodeficiency

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10
Q

which subtype of burkitts has jaw involvement

A

endemic

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11
Q

types of non hodgkin lymphoma

A

High Grade
Very Aggressive – Burkitt’s
Aggressive – Diffuse Large B-Cell, Mantle Cell o Low Grade
Indolent – Follicular, Marginal Zone, Small Lymphocytic

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12
Q

diffuse large b cell

A

Middle aged and
elderly Aggressive Richter’s transformation
Other lymphomas occur secondary to
DLBCL

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13
Q

what is the histology of diffuse large b cell lymphoma

A

“Sheets of large lymphoid

cells”

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14
Q

mantel cell lymphomas

A

Middle-aged, M>F
Aggressive Disseminated at presentation Median survival 3-5 years
t(11;14) translocation Cyclin D1 deregulation

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15
Q

follicular lymphoma

A

Indolent
Mostly incurable
Median survival 12-15 yrs
t(14:18) translocation

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16
Q

histology of lymphoma follicular

A

follicular or nodular pattern

17
Q

malt

A

Marginal zone NHL
Middle-aged Chronic antigen stimulation:
• H. pylori à gastric MALT lymphoma
• Sjogren’s syndrome à parotid lymphoma

18
Q

t cell lymphomas

A

anaplastic large cell lymphoma, peripheral t cell lymphoma, adult t cell lymphoma, enteropathic associated t cell lymphoma, cutaneous t cell lymphoma

19
Q

which lymphoma is associated with coeliac disease

A

enteropathy associated t cell lymphoma (EATL)

20
Q

Which lymphoma is associated with mycosis fungoides

A

cutaneous t cell lymphoma

21
Q

anaplastic large cell lymphoma

A

Children and young adults
Aggressive
Large “epithelioid” lymphocytes t(2;5)
Alk-1 protein expression

22
Q

what are some pathways to lymphoma

A

immune system disease (drives disease by constant antigen stimulation e.g. h pylori - MALT), loss of T cell function (permits EBV driven b cell lymphoma)

23
Q

lymphoma histology

A

o Generative LR tissue  generation/maturation of lymphoid cells
 Bone marrow and thymus
o Reactive LR tissue  development of immune reaction
 Lymph nodes and spleen
o Acquired LR tissue  development of local immune reaction
 Extra-nodal lymphoid tissue (e.g. skin, stomach, lung)

24
Q

lymphoma CD markers

A

o CD19, CD20 = B-cells

o CD3, CD5 = T-cells

25
Q

hodgkins lymphoma

A

o S/S: Young and middle-aged, single group of lymph nodes
o Arises from the germinal centre or post-germinal centre cells
o Associated with EBV
o Histopathology
 Sclerosis
 Mixed cell population with Reed-Sternberg/Hodgkin cells (binucleate ‘owl’s’ eyes)
 Lymphoma cells are relatively few in number and tend to be scattered around
 Eosinophils
o Prognosis:
 Moderately aggressive
 Diagnostic markers = CD30, CD15

26
Q

Hodgkins vs non nodhkins lymphoma

A

Hodgkins is more localised and spreads contiguosly to adjacent lymph nodes

27
Q

what are the types of HL

A

NODULAR SCLEROSING, MIXED CELLULARITY, LYMPHOCYTE RICH

28
Q

What is the histopathology of hodgkins lymphoma

A

CD5, CD19 markers,
owl eyes - reed sternberg cells
eosinophils,

29
Q

What is the features of nodular lymphocyte predominant lymphoma

A

80% of HL, F > M (20-29yo)
o Neck nodes and a mediastinal mass; may have B symptoms
o Spreads contiguously
o Needs tissue diagnosis

30
Q

what are the diagnostic markers for hodgkins lymphoma

A

cd5, cd19

31
Q

how is hodgkins lymphoma treated

A

with Combined therapy, chemo first and then radio to eliminate remaining cells

32
Q

what chemo is used for hodgkins

A

ABVD - adriamycin, Bleomycin, vinblastine, dacarbazine

33
Q

what are the features of follicular NHL

A

It is indolent, i.e.g incurable with a prognosis of 15 years

34
Q

name some extra nodal marginal zone lymphomas

A

MALToma-h pylori
parotid lymphoma - psjogrens
lacrimal gland lymphoma - psittaci
thyroid - hashimotos

35
Q

what are the features of EATL

A

Very aggresive cancer associated with excessive gliadin exposure in coeliac patients

Scarlett's pathology flashcards (47 decks)

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