Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IMED2002 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

Which sites have the capacity to undergo lymphoid malignancy

A

Primary and secondary lymphoid organs are all potential sites of lymphoid malignancy

All regions of the lymph node (primary, secondary follicles, germinal centres, mantle zone, interfollicular zone) can undergo malignant transformation –> lymphoma

T cells reside in the interfollicular zone
B cells reside in the primary, secondary follicles & the germinal centres & the mantle area

Lymphomas are malignancies of lymphoid cells, in solid tissue sites –> then the malignancies can spread to the BM and blood circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the key difference between leukaemia and lymphoma

A

Leukaemias commence in the bone marrow and then they spread to the blood

Whilst lymphomas are malignancies of solid tissue sites, and will not appear in the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 types of lymphomas

A

Non-Hodgkin lymphoma

Hodgkin lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is characteristic of lymphoma

A

The replacement of normal lymphoid tissue with abnormal cells

Formation of neoplasms which are an abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should. Neoplasms may be benign (not cancer) or malignant (cancer).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which lymphoma type is easiest to diagnose?

A

Hodgkin lymphoma with the characteristic Reed Sternberg cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 grades of non-Hodgkin lymphoma?

A

Low or High

Low: slow-growing, indolent, generally incurable

High: fast-growing, aggressive, potentially curable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What determines the prognosis of non-Hodgkin lymphoma?

A

The type: B or T cell origin
The grade: Low or High
The stage: extent (amount) of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What determines the prognosis of non-Hodgkin lymphoma?

A

The type: B or T cell origin
The grade: Low or High
The stage: extent (amount) of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain the aetiology of non-Hodgkin lymphoma

A

1) Immune suppression due to organ transplant, AIDS
2) Viral causes like EBV (Burkitt lymphoma), HTLV-I (Adult T cell lymphoma)

3) Geography - Burkitt = tropical Africa
Adult T cell lymphoma = Japan & Caribbean

4) Chronic inflammation/antigenic stimulation with helicobacter pylori (MALT lymphoma of the stomach)
5) Age: Low grade is rare in young, incidence increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical features of non-Hodgkin lymphoma?

A

Lymphadenopathy (swelling of lymph nodes)
Hepatosplenomegaly

Fever, night sweats, weight loss

Interference with normal organ function:
Solid-organ infiltration (kidneys, liver, other)
Skin, brain

As we have lymphoid tissue throughout the body, the lymphoma can be anywhere in the body and can cause localised symptoms/interfere with that organ system

Lymphoma can infiltrate and evolve and grow in the bone marrow
Bone marrow failure –> pancytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is non-Hodgkin lymphoma diagnosed?

A

Biopsy (obtain tissue of the involved region), then determine based on pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which pathological features do you look out for in a biopsy, when trying to diagnose non-hodgkin lymphoma?

A

The pattern: whether nodular or diffuse
Cell size: small or large
Cell differentiation: well or poorly differentiated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other tests may be useful to diagnose non-hodgkin’s lymphoma?

A

cell phenotype/ lineage (B or T)

Genetics on extracted cells, FISH analysis on specific chromosomal regions
Molecular genetics for mutations in particular genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which of the following is used to determine the clinical stage of non-hodgkin lymphoma?

(a) blood film phenotyping
(b) tissue biopsy phenotyping
(c) genetical testing using FISH
(d) radiologic examination
(e) molecular genetics and flow cytometry

A

d - physical, radiologic examination determines the extent of disease and the stage (CT scanning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage I lymphoma involves

A

a single lymph node region or single extra lymphatic site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stage II lymphoma involves

A

two or more sites, on the same side of the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stage IIIs lymphoma involves

A

Both sides of the diaphragm, or spleen (s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage IV lymphoma involves

A

Diffuse involvement of extra lymphatic sites eg. the bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bone marrow failure as a feature of lymphoma is characteristic of which stage?

(a) Stage I
(b) Stage II
(c) Stage IIIs
(d) Stage IV

A

Stage IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

There are 2 grades of lymphoma (high and low), classify the types of non-Hodgkin lymphoma within these 2 grades

A

Low grade: Follicular lymphoma

High grade: Burkitt lymphoma
Diffuse large B cell lymphoma

19
Q

Order the 3 non-Hodgkin lymphomas based on how common they are

A

Diffuse large B cell lymphoma = most common

Follicular lymphoma

Burkitt lymphoma

20
Q

What stage is follicular lymphoma at when diagnosed?

A

Stage IV = widely disseminated, including in the BM

as it is low grade, it grows slowly, indolent

21
Q

Follicular lymphoma

A

Affects adults over 40 years old

It is a B cell type lymphoma

There is a 5 -year survival upon diagnosis
Rarely curable

Some patients can progress from the chronic, indolent phase to a much more aggressive tumour (after 7 years from initial diagnosis)

The aggressive phase can be rapidly fatal unless treated

can only teat in the aggressive state, hig-grade state, not before

this has to do with the turnover rate of the malignant cells, can kill them with cytotoxic chemotherapy when they are active in the cell cycle

22
Q

What is the growth pattern of follicular lymphoma?

A

Follicular growth pattern

23
What causes follicular lymphoma?
The development of most FL tumours in adults depends on the overexpression of B cell leukaemia/lymphoma 2 (BCL-2) located on chromosome 18. BCL-2 is an oncogene that blocks programmed cell death (apoptosis). As such, overexpression results in increased cell survival. The t(14; 18) chromosomal translocation of human follicular lymphoma recombines the BCL-2 gene from chromosome 18 with the immunoglobulin heavy chain joining region. The immunoglobulin heavy chain is heavily transcribed, and now along with it, the antiapoptotic protein Bcl-2 is also upregulated in expression. This results in inhibition of programmed cell death, and generation of abnormal follicles
24
Why watch and wait?
Watch & wait if indolent If not impacting other organs Unlikely to cure the patient, can promote resistance to the drugs then aggressive lymphoma won't be cured
25
Indications to treat are
Constitutional symptoms, painful lymph nodes Anatomic obstruction, organ dysfunction Marrow failure
26
Treatment options
Radiotherapy Chemotherapy Antibody-based therapy (Rituximab, anti-CD20 which is a B cell antigen, is expressed by the tumour) remember this is a B cell type cancer Combination therapy with antibody and chemotherapy Bone marrow transplant
27
Where is Burkitt lymphoma located in the lymph node
in the germinal centre
28
Aetiology of Burkitt lymphoma
Endemic, sporadic, immuno-deficiency related The African variety causes jaw tumours, abdominal mass, orbital tumours and is EBV driven or sometimes HIV Most common childhood tumour in sub-Saharan Africa
29
Which age group does Burkitt lymphoma affect?
Child or adult
30
Grade low or high? Burkitt
Rapidly growing high grade lymphoma
31
Genetics of burkitt lymphoma
Translocation t(8;14) Translocation of c-MYC (proto-oncogene) from chromosome 8 to IgH gene on chromosome 14 (this coming together causes the tumour) MYC is a cancer causing gene (oncogene), it is upregulated when in close proximity to the IgH (which is highly upregulated)
32
Burkitt lymphoma biopsy
Again, B cell type lymphoma derived from the germinal centre B cells Shows a monotonous B cell infiltrate Very large nucleus of the B cells, with basophilic cytoplasm and distinct vacuoles Starry sky nucleus - high mitotic rate
33
Treatment and cure chances
Treatment with aggressive chemotherapy | Potentially curable
34
Diffuse Large B cell Lymphoma (presentation, pathology, histology)
``` Most common (30%) Disease of adults mean age = 65 years ``` Presentation: rapidly enlarging masses Pathology is not follicular, it is diffuse infiltration by large cells (usually B) Diverse histology, poorly differentiated, bizarre morphology, high proliferation rate High grade lymphoma
35
Treatment
Combination chemotherapy with monoclonal antibody therapy complete remission rates = 60 - 70% Approximately 30% curable Stem cell transplant in younger patients CAR T cells potentially curable due to the high turnover rates
36
DLBCL clinical features
enlarged lymph nodes Spleen is involved by the lymphoma There are poorly differentiated, large cells
37
Which factors are important in determining prognosis for DLBCL
Age (whether over 60, or under 60) Performance status (capable or bedridden) LDH enzyme (less than 1 or more than 1) Disease stage 1, 2, 3, 4 Extranodal involvement (less than 1 or more than 1) Treatment depends upon the sites, stage, age
38
Hodgkin lymphoma is characterised by
the Reed-Sternberg cell | which makes up a very small amount of the tumour, but causes a big inflammatory reaction
39
Hodgkin lymphoma age:
Hodgkin lymphoma peaks in young adults (20-30 years), and then the incidence increases over 50 years of age
40
What does the Reed Sternburg cell look like?
It is a large cell, with 2 big nuclei that are positively stained
41
Hodgkin lymphoma clinical features:
large, painless, non-tender, rubbery lymph nodes cervical 60-70% axillary 10-15% shortness of breath, mediastinal involvement Splenomegaly is rare at presentation Then the constitutional symptoms like fever, itch, weight loss
42
What are other features of Hodgkin lymphoma
Reactive blood count & film features: Normochromic, normocytic anaemia Leucocytosis, mild eosinophilia, neutrophilia (increase in WBC count) Reactive granulocytic hyperplasia (as if responding to an infection) Bone marrow has reactive changes, that are rarely involved at presentation Noticed as staging procedure Reduced cell immunity with the loss of immunologically competent T cells Cell immunity is compromised and patients are susceptible to viral infections
43
How is a hodgkin lymphoma diagnosed?
Histology of lymph tissue/node Noticing the reed sternberg cell (large, bi or multi nucleate, prominent nucleoli cell) Inflammatory cells like lymphocytes, plasma cells, eosinophils Variable fibrosis
44
Immunophenotyping of hodgkin lymphoma
Reed sternberg cells express CD15 and CD30 | antigens and are CD45 negative
45
Treatment of hodgkin lymphoma
Potentially curable, early stage is favourable (1 or 2) short duration chemotherapy, combined with drugs field radiotherapy in advanced disease: stage 3 and 4 more intensive combined chemotherapy needed
46
Late effects of therapy
Second malignancies, 10% chance at 10 years 25% chance at 30 years Lung cancer from radiotherapy is the most common AML from the cumulative dose of alkylating agents --> damage to HSC at large doses of chemotherapy Breast cancer, because of radiotherapy to mediastinum / axilla dose-response relation exists Skin cancers Aim is to cure, and 80 - 90% will be
47
Prognosis of Hodkin lymphoma
It is a curable maliganancy 80% will be cured Prognosis is based on the stage of disease Infections mean reduced cell mediated immunity Relapsed disease is difficult to treat need BM transplant second malignancies can occur 5%

IMED2002 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions