Lymphoma Flashcards
Lymphoma
Clonal proliferation of lymphoid cells within lymph nodes or the spleen - B cells or T cells
Types of lymphoma
Non-Hodgkin lymphoma:
- high grade
- low grade
Hodgkin lymphoma
Low grade non-Hodgkin lymphoma features
Slow growing
May be asymptomatic or have mild B symptoms
Starting treatment early does not affect outcome
Not cured as always risk of relapse
High grade non-Hodgkin lymphoma features
Fast growing
Survival is worse in first few years but then levels out after 3 years
Requires treatment
Can be in long term remission and cured
Examples of high grade non-Hodgkin lymphoma features
Burkitts lymphoma
Diffuse large B cell lymphoma
Examples of low grade non-Hodgkin lymphoma features
Follicular lymphoma
How can lymphoma be classified
Pathological description - cell origin
Immunophenotypic - antigens, disease-associated proteins
Cytogenic - translocations, karyotyping, FISH
Disease sites e.g. gastric MALT, splenic, cutaneous
Causative factors e.g. post-transplant, enteropathy
Hodgkin lymphoma histology
Reed - Sternberg cells
Life cycle of a B cell
- Produced in bone marrow
- Mature into naïve B cells
- Travel through blood
- Stored in lymph node follicles and lymph organs
- Differentiate into plasma cells in the medulla of a lymph node
- Produce antibodies
Where are T cells stored
Paracortex of lymph nodes
Surface proteins on B cells
CD20 (usually) - help B cell antigens bind to specific pathogen
Causes activation into plasma cells and antibody production (igM)
or
causes cluster of B cells making a germinal centre (centroblast) which produces IgG or IgA
Then differentiates to a centrocyte which makes plasma cells or memory B cells
Types of T cell
Helper T cell - cd4
Cytotoxic T cell - cd8
Complications of non-Hodgkin lymphoma
- Spread to GI tract - bowel obstruction
- Bone marrow spread - pancytopenia
- Spinal cord compression
Diffuse large B cell lymphoma features
Most common
Aggressive
Follicular lymphoma features
Indolent
From chromosomal translocation of chromosome 14 and 18
Burkitt lymphoma
Highly aggressive
From chromosomal translocation of chromosome 8 and 14
Associated with Epstein Barr virus
In Africa, extranodal involvement of jaw
Outside of Africa - GI involvement of ileocaecal junction
Burkitt lymphoma histology
Starry sky appearance
Mantle cell lymphoma features
Aggressive
From chromosomal translocation of chromosome 14 and 11
Marginal zone lymphoma
Indolent
Commonly associated with MALT
Associated with H.pylori infection
Waldenstrom macroglobulinaemia
Thick and viscous blood due to accumulation of M proteins secreted by defective plasma cells in lymphoplasmacytic lymphoma
Symptoms of non - Hodgkins lymphoma
Painless lymphadenopathy
Fever
Drenching night sweats
Weight loss
Investigations for Non-Hodgkin’s lymphoma
Lymph node biopsy
CT CAP
Treatment of for Non-Hodgkin’s lymphoma
Chemotherapy
Radiotherapy
Immunotherapy - rituximab
Rituximab
Monoclonal antibodies for CD20
Staging system
Ann Arbor
Ann Arbor staging
Stage I - one lesion
Stage II - Multiple lesions on same side of diaphragm
Stage III - On either side of diaphragm
Stage IV - diffuse and at least one extra lymphatic lesion e.g. spleen
