Lymphoma Flashcards
Lymphocytes develop in ……….. and circulate towards ……………….
Primary lymphoid tissue (bone marrow and thymus)
Secondary lymphoid tissue (lymph nodes, spleen and MALT)
Function of lymphocytes
Production of antibodies
Antigen presentation
Coordination of the immune response
Suppression of immune response
Lymphoma
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
Put these in order of prevalence in NI
Leukaemia, myeloma and lymphoma
Lymphoma
Leukaemia
Myeloma
Viral causes of lymphoma
EBV -> Burkitt lymphoma; Hodgkin lymphoma
HIV -> DLBCL; primary CNS lymphoma
HTLV-1 -> T cell leukaemia
Hep C -> splenic marginal zone lymphoma
Bacterial causes of lymphoma
Helicopter pylori -> gastric MALT lymphoma
Chlamydia psttaci-> ocular adnexal MALT lymphoma
Most lymphomas ________ have an identifiable cause
DO NOT
Clinical presentations of lymphoma
Lymphadenopathy
B symptoms
- fevers
- night sweats
- weight loss
Fatigue
Itch
Causes of lymphadenopathy
Haematological
- HK
- Non-HK
- Leukaemia
Malignancy
CT disorders
- RA
- SLE
- Sarcoid
Infection
Investigations (7)
Clinical history
Bloods
Blood cultures
Viral titres
Imaging
Biopsy
IHC preferred
Conventional cytogenetics required ___________cells.
Dividing
FISH in molecular diagnostics
Fluorophore labeled DNA probes hybridise to specific DNA sequences
Used to detect non-random chromosomal translocations in lymphoma
Stage I and II Ann arbor
Stage I -> Single lymph node region
Stage II -> Two or more; same side of diaphragm
Stage III and IV Ann Arbor
Stage III -> both sides of diaphragm
Stage IV -> diffuse involvement of extralymphatic sites +- nodal disease -> outside lymph system
Hodgkin lymphoma
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
Nodular lymphocyte predominant Hodgkin’s lymphoma accounts for what percent?
5%
Staging of HK lymphoma
Stage I-II -> 2-4 courses of chemo plus radiotherapy
Advanced -> 6x cycles with or without radiotherapy
Non-HK lymphoma cell prevalence percentages
85% are B cell
15% are T or NK cell
Treatment for DLBCL
RCHOP
Pol-R-CHP
Radiotherapy for bulky disease
Stem cell transplant may be an option for refractory or relapsed disease
ABC lymphomas have a __________diagnosis.
Poorer
Double hit DLBCL
Concurrent Myc and BCL2 and or BCL6 rearrangement -> poor prognosis
RCHOP -> poorer outcome
FISH to identify and adapt treatments accordingly
Follicular lymphoma
25% of NHL
Low grade
Indolent relapsing course
T(14;18) -> BCL2(Chromosome 18) to Ig heavy chain on chromosome 14 => BCL2 over-expression
BCL2 function
Anti-apoptosis
Mutation=> cells lose their programmed cell death and accumulate in lymph nodes
Common treatments for lymphoma
Corticosteroids
Chemo
Radio
MAb
Immuno
Stem cell
CAR-T
Rituximab
Bind CD20 on B-cells to treat lymphoma
BiTe
B specific T cell engager
Attaches to protein on tumour cell and other arm activates immune cells to kill cancer cells
BTK
Bruton tyrosine kinase - > inhibitors such as ibrutinib
Important in B cell signalling
