Lymphoma Flashcards
What is Hodgkin’s lymphoma?
Most common specific type of lymphoma
Bimodal age distribution with peaks around 20-25 and 80 years
Risk factors for Hodgkin’s lymphoma
HIV
Epstein-Barr virus
Autoimmune conditions, such as rheumatoid arthritis and sarcoidosis
Family history
Different types of NHL
Diffuse large B cell lymphoma
Burkitt lymphoma
MALT lymphoma
What is Diffuse large B cell lymphoma?
Rapidly growing painless mass in older patients
What is Burkitt lymphoma?
Associated with Epstein-Barr virus and HIV
What is MALT lymphoma?
Affects the mucosa-associated lymphoid tissue, usually around the stomach
Risk factors for non-Hodgkin’s lymphoma
HIV
Epstein-Barr virus
H. pylori - MALT lymphoma
Hepatitis B or C
Exposure to pesticides/ trichloroethylene
Family history
Non-tender lymph nodes and feel firm or rubbery
Lymphoma
Patients with ____________ may experience lymph node pain after drinking alcohol
Hodgkin’s lymphoma
B symptoms refer to systemic symptoms of lymphoma. These are..
Weight loss > 10% in last 6 months
Fever > 38ºC
Night sweats
Ix for lymphoma
Lymph node biopsy
CT, MRI, and PET scans
What does the image show?
Reed-Sternberg cells - HL
Outline lugano’s classification
1: one node or group of nodes
2: more than one group of nodes but on the same side of the diaphragm (either above or below)
3: lymph nodes both above and below the diaphragm
4: widespread involvement, including non-lymphatic organs, such as the lungs or liver
A: no systemic symptoms other than pruritus
B: weight loss > 10% in last 6 months, fever > 38c, night sweats
Tx for Hodgkin’s lymphoma
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)
BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone)
Radiotherapy
CMT
Hematopoietic cell transplantation - relapse/refractory
Side effects of chemotherapy
Infections, cognitive impairment, secondary cancers (e.g., leukaemia) and infertility
Side effects of radiotherapy
Tissue fibrosis, secondary cancers and infertility
What are the different types of HL?
Nodular sclerosing
Mixed cellularity
Lymphocyte predominant
Lymphocyte depleted
Which type of HL has the best prognosis?
Lymphocyte predominant
Which type of HL has the worse prognosis?
Lymphocyte depleted
Nodular sclerosing is more common in __________ and is associated with __________ cells
Nodular sclerosing is more common in women and is associated with lacunar cells
Mixed cellularity is associated with a large number of _______ cells
Reed-Sternberg cells
What are the FBC findings in HL?
Normocytic anaemia
Eosinophilia
LDH raised
Complications of HL treatment
Secondary malignancies - breast and lung
Burkitt’s lymphoma is a high-grade ___-cell neoplasm
B
What are the two forms of Burkitt’s lymphoma?
Endemic (African) form: typically involves maxilla or mandible
Sporadic form: abdominal (e.g. ileo-caecal) tumours in patients with HIV
Burkitt’s lymphoma is associated with the ________ translocation, usually ________
C-myc gene translocation, usually t(8:14)
_____ is strongly implicated in the development of the African form of Burkitt’s lymphoma and to a lesser extent the sporadic form
EBV
What does the image show?
‘Starry sky’ appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells
Mx of Burkitt’s lymphoma
Chemotherapy
Rasburicase beforehand to prevent ‘tumour lysis syndrome’
Complications of tumour lysis syndrome include..
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyperuricaemia
Acute renal failure
Tx for MALT lymphoma
H. pylori eradication
Paraproteinaemia
MALT lymphoma
Which one’s more common? HL or NHL?
NHL
T or F: B’ symptoms typically occur earlier in Hodgkin’s lymphoma and later in non-Hodgkin’s lymphoma
True
T or F: Extra-nodal disease is much more common in Hodgkin’s lymphoma than in non-Hodgkin’s lymphoma
False - more common in non-Hodgkin’s lymphoma than in Hodgkin’s lymphoma
Ix for NHL/HL
Excisional node biopsy
CT abdomen, chest and pelvis
HIV test
FBC and blood film
ESR
LDH
Which one has a worse prognosis? Low or high grade NHL?
Low-grade non-Hodgkin’s lymphoma has a better prognosis
High-grade non-Hodgkin’s lymphoma has a worse prognosis but a higher cure rate
Mx for NHL
Rituximab in combination with conventional chemotherapy regimes (e.g. CHOP)
All patients will receive flu/pneumococcal vaccines
Patients with neutropenia may require antibiotic prophylaxis
Tender, hard, smooth lump with no tethering or skin inflammation
Viral
Tender, hard, smooth lump with skin inflammation +/- tethering
Bacterial
Rubbery/soft, smooth no skin inflammation/tethering
Lymphoma
Non-tender, hard, irregular, tether lump
Metastatic carcinoma
Assessing lymph node pathology
Histology-microscopic appearances
Immunohistochemistry of solid node (Brown= positive)
Immunophenotyping of blood/marrow
Genetic analysis
Molecular analysis
________ cells in follicular B cell NHL
CD20 +ve cells
__________ cells in Hodgkin’s Disease
CD30 +ve Reed Sternberg
