lymphoma

Question 1

regarding N. H. L
1_subtypes reflect what?, origin
2_mechanism of lymphomagenesis
3_risk factors 
4_epidemiology

Answer 1

1_reflect the stage of development of lymphocytes, mostly B lymphocytes, rest T or null
2_genetic alteration, infection, Ag stimulation, immunosuppression.
3_family history, immunosuppression, C. T disease, infections, ionizing radiation.
4_malse more than F
most frequently diagnosed cancer
6th most common cause of cancer in us

Question 2

Mention the types of lymphoma with their life expectancy and treatment

Answer 2

1_indolent: 
LE in years, Incurable, 90% present in stage 3,4
2_intermediate 
3_Aggressive
LE, in weaks 
potentially curable

Question 3

Mention the types of lymphoma according to working classification.

Answer 3

1_low grade: 
small lymphocytic L
follicular small cleaved L
Follicular mixed. 
2_intermediate grade
Follicular large cell L
diffuse large cell L
diffuse small cleaved cell L
diffuse mixed
3_high grade 
large cell immunoblastic L
lymphoblastic lymphoma 
small non cleaved cell «Burkitt, Non. Burkitt

Question 4

Mention the types of lymphoma according to Rappaport classification

Answer 4

1_low: 
DWDL, NPDL, NM
2_intermediate: 
NH, DPDL, DM, DHL
3_high grade: 
DHL, DL, DU

Question 5

mention the types of lymphoma not included in working and Rappaport classifications

Answer 5

1_mycosis fungoids 
2_marginal zone B cell L(malt) 
3_mantle cell lymphoma 
4_peripheral T cell lymphoma 
5_Angioimmunoblastic lymphoma

Question 6

Mention the types of lymphoma according to REAL classification

Answer 6

1_indolent disseminated L: B (small cell L, lymphoblastic lymphoma, HCL, Plasmocytoma, Splenic marginal z L)
T(T cell lymphocytic L, large granular LL)
2_indolent nodal L: B(nodal marginal z L, Follicular L, mantle cell L, monocytoid B cell L).
3_indolent extranodal L:
B(Extranodal marginal z «MALT», monocytoid B cell lymphoma)
T(mycosis fungoids).
4_Aggressive lymphoma: B(diffuse large)
T(Anaplastic large cell ki +peripheral T cell lymphoma, Angioammunoblastic Angiocentric intestinal T)
5_highly aggressive L:
B(precursor B lymphoblastic L, Burkitts, B. like L).
T(precursor T lymphoblastic lymphoma, Adult T cell L)
6_hodgkin disease.

Question 7

what is the eitology of NHL?

Answer 7

1_DNA repair defect: ataxia telangectasis, xeroderma pigmentosm.
most common translocation t(14:18)
2_immunosuppression: congenital«Wiskott-Aldrich», AIDS, organ transplantation, old age.
3_chronic inflammation: H. Pylori,IBD Chlamydia psittaci«ocular adnexal T»
Sjogren syndrome.
4_Viral causes: EBV; Burkitts L
HTLV1;T cell lymphoma /leukemia
HTLV5;cutanous T cell lymphoma
Hepatitis C V

Question 8

Mention the clinical features of NKL

Answer 8

1_lymphadenopathy
2_hepatosplenomegaly
3_cytopenia
4_systemic B symptoms: fever, night sweat
5_hematogenous spread with no predictable pattern
6_waldeyers ring involvment in GI L

Question 9

How can you diagnose NHL?

Answer 9

_definitve diagnosis by excisional lymph node biobsy. 
_immunohistochemistry: LCA, Monoclonal staining with IG kapa and lamda. 
_Flow cytometry: CD 19,20 for B L
CD3,4,8 for T lymphoma 
_chromosome changes: 
14:18 translocation in follicular L
t(11:14) mantle cell lymphoma 
t(8:14), t(2:8), t(8:22) for Burkitts L
_

Question 10

what are stages of lymphoma according to Ann Arbor.

Answer 10

1one lymph node region or structure.
2> one lymph node region or structure, same side of diaphram
3_both sides of diaphragm
4_Extranodal sites

Question 11

why do we treat indolent advanced lymphoma?

Answer 11

1_constitutional symptoms 
2_cosmotic considerations
3_painful lymph node 
4_cytopenia
5_organ dysfunction 
6_Anatomic obstruction

Question 12

explain the charecters of lymphoblastic lymphoma.

Answer 12

T Cell lymphoma
Mediastinal mass
male adolescents
T cell variant of T cell ALL

Question 13

explain some charecters of Burkitts lymphoma.

Answer 13

most rapidly growing humen tumor
African variant: jaw tumor, strongly linked to EBV.
May present as abdominal mass
typical chromosome abnormalities: c-myc oncogen linked to one of the immunoglobulin genes

Question 14

explain some charecters of Mycosis Fungoids.

Answer 14

malignancy of helper T cells
Affinity for skin
treated by UV light, electron beam radiation, topical Alkylating agntes

Question 15

explain some charecters of Adult T cell lymphoma /leukemia

Answer 15

Associated with HTLV1 infection

lumphadenopathy, Hepatosplenomegaly, leukocytosis, skin involvment, lytic lesions of bones, hypercalcemia.

Question 16

Explain some charecter of AIDS lymphoma

Answer 16

Aggressive lymphoma of B cell origin
Burkitts, Burkitts like, large cell immunoblastic lymphoma
treatment often limited by immune compromise of the ptn

Question 17

which one is more common HL OR NHL?

Answer 17

HL is one seventh common as NHL

Question 18

what are the subtypes of HL according to WHO classification

Answer 18

1_classic HL:
NS, MC, LD, LP
2_NLPHL

Question 19

Give some charecters of Lymphocyte predominant HL

Answer 19

_Diffuse or vaguely nodular infiltration of mature lymphocytes admixed with variable number of bening histiocytes
_RS Cells scattered b/w them.
_majority of pt are males, under35,limited disease.
_prognosis: excellent.
_without RS cells it could be mistaken with one of the lymphocytic forms of NHL

Question 20

give some charecters of MC HL

Answer 20

_intermediate clinical position between Lp, LD
_plentiful RS Cells but fewer lymphocytes than LP
_Diffuse involvment of lymph nodes

Question 21

give some charecters of LD HL

Answer 21

_paucity of lymphocytes and relative abandance of RS cells.
_present in 2 forms:
_Diffuse fibrosis: hypocellular node replaced by proteinaceous fibrillar material «non-birefringent C. T», plemorphic histiocyte, few atypical and typical RS cells, some lymphocytes.
_Reticular variant: is more cellular, composed of highly anaplastic large plemorphic cells that resemble RS cells.

Question 22

give some charecter of NS HL

Answer 22

_presence of a particular variant of RS cells (lacunar cells); large and has single hyperlobated nuclus with multiple nucleoli and abundant pale cytoplasm
_collagen bands that divide the lymphoid tissue into circumscribed nodules
_

Question 23

give some charecter of Lymphocyte rich HL

Answer 23

_ mononuclear Hodgkin and RS cells, togother with vaguely nodular background of small lymphocytes
_nodules represent remenants of mantle zones and germinal centers.
_the background cellularity is less heterogeneous.
_

Question 24

Mention the signs and symptoms of HL

Answer 24

1_lymph nodes enlargement «cervical, Mediastinal»
2_pain on drinking alchohol
3_Systemic B symptoms
4_Pel Epestin fever«high grade, relapsing, spike abrubt in onset and treatment, periodicity of 7-10 days.
5_T cell mediated immunodeficiency even in early stage and even after cure (shingles).
6_predictable contiguous spread

Question 25

what is the epidimiologic distribution of HL In relation with age?

Answer 25

more common in affluent families with few siblings
1_developed: bimodal distribution
young adult, after 50 years
2_developing: more common in children

Question 26

How can you diagnose HL

Answer 26

excisional lymph node biobsy

Question 27

Mention the late complications of HL

Answer 27

1_second malignancy
2_leukemia in pt receiving Alkylating agents or chemo/XRT
3_lung and brast cancer with XRT
4_hypothyroidism
5_constrictive pericarditis
6_heart failure after adrimycin treatment
7_infertility