Lymphoma

Question 1

What are lymphomas?

Answer 1

Neoplasms of lymphoid cells, originating in lymph nodes or other lymphoid tissues
Arises from Mature B cells

Question 2

Hodgkins lymphomas account for what percentage of all lymphomas?

Answer 2

15%

Question 3

What histological feature is diagnostic for Hodgkins lymphoma?

Answer 3

Reed Sternberg cells

“OWL EYES”

Question 4

3 risk factors for Hodgkins lymphoma

Answer 4

FHx
EBV
Young adult

Question 5

List 3 B symptoms of Hodgkins lymphoma

Answer 5

Fever > 38 degrees: If cyclical = Pel-Ebstein fever
Night sweats
Weight loss > 10% body weight in 6/12

Question 6

Common presentation in Hodgkins lymphoma

Answer 6

Painless enlarging mass
Rubbery, superficial, firm
Most common in neck (+/- axilla +/- groin)
May become painful after alcohol ingestion

Question 7

List 7 signs of Hodgkins lymphoma

Answer 7

Lymphadenopathy
Splenomegaly /hepatosplenomegaly
Skin excoriations  
Signs of intrathoracic disease (e.g. pleural effusion, SVCO) 
Cachexia
Tonsillar enlargement
Pallor (anaemia)

Question 8

Describe bloods in Hodgkins lymphoma

Answer 8

Anaemia of chronic disease (Low Hb, low platelets)
Leucocytosis (Lymphopaenia in advanced disease)
High neutrophils
High eosinophils
High ESR + CRP
High LDH (released in cell turnover)

Question 9

Ix in Hodgkins lymphoma?

Answer 9

Bloods
PET-CT: May show mediastinal mass
Biopsy: Reed Sternberg Cells

Question 10

What system is used for staging in Hodgkins lymphoma?

Answer 10

Ann Arbor Staging

Question 11

Why may Bone Marrow Aspirate and Trephine Biopsy be performed in Hodgkins lymphoma?

Answer 11

Can spread to bone marrow in late stages

Question 12

What is non-hodgkin’s lymphoma?

Answer 12

All lymphomas without Reed-Sternberg cells
Diverse group:
85% B cell
15% T cell + NK cell forms

Question 13

5 RF for non-hodgkin’s lymphoma

Answer 13

Radiotherapy 
Immunosuppressive agents 
Chemotherapy 
HIV, HBV, HCV, EBV
AI conditions: RA, Coeliac, SLE

Question 14

3 systemic sx in non-hodgkin’s lymphoma

Answer 14

B Sx: Fever, Night sweats, Weight loss > 10% body weight
Fatigue
Sx of hypercalcaemia

Question 15

Mass in non-hodgkin’s lymphoma

Answer 15

Painless enlarging mass (in neck, axilla or groin)

Question 16

4 Signs of non-hodgkin’s lymphoma

Answer 16

Painless firm rubbery lymphadenopathy
Mycosis fungoides: looks like fungal infection but is a cutaneous T-cell lymphoma
Abdominal mass
Hepatosplenomegaly

Question 17

Bloods in non-hodgkin’s lymphoma

Answer 17

Thrombocytopenia/ Pancytopenia
Lymphocytosis
High ESR/ CRP

Question 18

Ix for non-hodgkin’s lymphoma

Answer 18

Excision biopsy

PET CT

Question 19

Tx for non-hodgkin’s lymphoma

Answer 19

Radiation + Chemotherapy
CHOP:
cyclophosphamide, doxorubicin, vincristine, prednisolone

Question 20

In which type of lymphoma is extra nodal involvement more common?

Answer 20

Non Hodgkins Lymphoma

GIT + CNS

Question 21

Vague presenting Sx in Hodgkin’s lymphoma

Answer 21

Pruritis
Cough
Lymphadenopathy

Question 22

3 Vague presenting Sx in Hodgkin’s lymphoma

Answer 22

Pruritis
Cough
Lymphadenopathy

Question 23

Tx for Hodgkin’s lymphoma

Answer 23

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)

+ Radiotherapy