lymphoma Flashcards
regarding N. H. L 1_subtypes reflect what?, origin 2_mechanism of lymphomagenesis 3_risk factors 4_epidemiology
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
Mention the types of lymphoma with their life expectancy and treatment
1_indolent: LE in years, Incurable, 90% present in stage 3,4 2_intermediate 3_Aggressive LE, in weaks potentially curable
Mention the types of lymphoma according to working classification.
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
Mention the types of lymphoma according to Rappaport classification
1_low: DWDL, NPDL, NM 2_intermediate: NH, DPDL, DM, DHL 3_high grade: DHL, DL, DU
mention the types of lymphoma not included in working and Rappaport classifications
1_mycosis fungoids 2_marginal zone B cell L(malt) 3_mantle cell lymphoma 4_peripheral T cell lymphoma 5_Angioimmunoblastic lymphoma
Mention the types of lymphoma according to REAL classification
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.
what is the eitology of NHL?
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
Mention the clinical features of NKL
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
How can you diagnose NHL?
_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 _
what are stages of lymphoma according to Ann Arbor.
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
why do we treat indolent advanced lymphoma?
1_constitutional symptoms 2_cosmotic considerations 3_painful lymph node 4_cytopenia 5_organ dysfunction 6_Anatomic obstruction
explain the charecters of lymphoblastic lymphoma.
T Cell lymphoma
Mediastinal mass
male adolescents
T cell variant of T cell ALL
explain some charecters of Burkitts lymphoma.
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
explain some charecters of Mycosis Fungoids.
malignancy of helper T cells
Affinity for skin
treated by UV light, electron beam radiation, topical Alkylating agntes
explain some charecters of Adult T cell lymphoma /leukemia
Associated with HTLV1 infection
lumphadenopathy, Hepatosplenomegaly, leukocytosis, skin involvment, lytic lesions of bones, hypercalcemia.
Explain some charecter of AIDS lymphoma
Aggressive lymphoma of B cell origin
Burkitts, Burkitts like, large cell immunoblastic lymphoma
treatment often limited by immune compromise of the ptn
which one is more common HL OR NHL?
HL is one seventh common as NHL
what are the subtypes of HL according to WHO classification
1_classic HL:
NS, MC, LD, LP
2_NLPHL
Give some charecters of Lymphocyte predominant HL
_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
give some charecters of MC HL
_intermediate clinical position between Lp, LD
_plentiful RS Cells but fewer lymphocytes than LP
_Diffuse involvment of lymph nodes
give some charecters of LD HL
_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.
give some charecter of NS HL
_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
_
give some charecter of Lymphocyte rich HL
_ 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.
_
Mention the signs and symptoms of HL
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
