Lymphoma

Question 1

Lymphocytes develop in ……….. and circulate towards ……………….

Answer 1

Primary lymphoid tissue (bone marrow and thymus)
Secondary lymphoid tissue (lymph nodes, spleen and MALT)

Question 2

Function of lymphocytes

Answer 2

Production of antibodies
Antigen presentation
Coordination of the immune response
Suppression of immune response

Question 3

Lymphoma

Answer 3

Heterogenous tumours caused by accumulation of malignant lymphocytes within lymph nodes, they have striking diversity and variable outcomes even within pathologic diagnoses. HK or Non-HK

Question 4

Put these in order of prevalence in NI

Leukaemia, myeloma and lymphoma

Answer 4

Lymphoma
Leukaemia
Myeloma

Question 5

Viral causes of lymphoma

Answer 5

EBV -> Burkitt lymphoma; Hodgkin lymphoma
HIV -> DLBCL; primary CNS lymphoma
HTLV-1 -> T cell leukaemia
Hep C -> splenic marginal zone lymphoma

Question 6

Bacterial causes of lymphoma

Answer 6

Helicopter pylori -> gastric MALT lymphoma
Chlamydia psttaci-> ocular adnexal MALT lymphoma

Question 7

Most lymphomas ________ have an identifiable cause

Answer 7

DO NOT

Question 8

Clinical presentations of lymphoma

Answer 8

Lymphadenopathy
B symptoms
- fevers
- night sweats
- weight loss
Fatigue
Itch

Question 9

Causes of lymphadenopathy

Answer 9

Haematological
- HK
- Non-HK
- Leukaemia

Malignancy

CT disorders
- RA
- SLE
- Sarcoid

Infection

Question 10

Investigations (7)

Answer 10

Clinical history
Bloods
Blood cultures
Viral titres
Imaging
Biopsy
IHC preferred

Question 11

Conventional cytogenetics required ___________cells.

Answer 11

Dividing

Question 12

FISH in molecular diagnostics

Answer 12

Fluorophore labeled DNA probes hybridise to specific DNA sequences
Used to detect non-random chromosomal translocations in lymphoma

Question 13

Stage I and II Ann arbor

Answer 13

Stage I -> Single lymph node region
Stage II -> Two or more; same side of diaphragm

Question 14

Stage III and IV Ann Arbor

Answer 14

Stage III -> both sides of diaphragm
Stage IV -> diffuse involvement of extralymphatic sites +- nodal disease -> outside lymph system

Question 15

Hodgkin lymphoma

Answer 15

Rare in children; peak incidence in young adults
Male predominance
Reed sternberg cells
4 types of classical lymphoma:
[1] nodular sclerosis
[2] lymphocyte rich
[3] lymphocyte deplete
[4] mixed cellularity

Question 16

Nodular lymphocyte predominant Hodgkin’s lymphoma accounts for what percent?

Answer 16

5%

Question 17

Staging of HK lymphoma

Answer 17

Stage I-II -> 2-4 courses of chemo plus radiotherapy
Advanced -> 6x cycles with or without radiotherapy

Question 18

Non-HK lymphoma cell prevalence percentages

Answer 18

85% are B cell
15% are T or NK cell

Question 19

Treatment for DLBCL

Answer 19

RCHOP
Pol-R-CHP
Radiotherapy for bulky disease
Stem cell transplant may be an option for refractory or relapsed disease

Question 20

ABC lymphomas have a __________diagnosis.

Answer 20

Poorer

Question 21

Double hit DLBCL

Answer 21

Concurrent Myc and BCL2 and or BCL6 rearrangement -> poor prognosis
RCHOP -> poorer outcome
FISH to identify and adapt treatments accordingly

Question 22

Follicular lymphoma

Answer 22

25% of NHL
Low grade
Indolent relapsing course
T(14;18) -> BCL2(Chromosome 18) to Ig heavy chain on chromosome 14 => BCL2 over-expression

Question 23

BCL2 function

Answer 23

Anti-apoptosis
Mutation=> cells lose their programmed cell death and accumulate in lymph nodes

Question 24

Common treatments for lymphoma

Answer 24

Corticosteroids
Chemo
Radio
MAb
Immuno
Stem cell
CAR-T

Question 25

Rituximab

Answer 25

Bind CD20 on B-cells to treat lymphoma

Question 26

BiTe

Answer 26

B specific T cell engager
Attaches to protein on tumour cell and other arm activates immune cells to kill cancer cells

Question 27

BTK

Answer 27

Bruton tyrosine kinase - > inhibitors such as ibrutinib
Important in B cell signalling