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NM By Myself > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

MTS

A

Spleen
Liver
Bone
Kidney
CNS
Lung

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2
Q

Aggressive features

A

> 60 years
DLBCL
CNS involvement
Advanced stage
High SUV (not for HL)

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3
Q

Lugano I

A

1 LN region or lymphoid structure

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4
Q

Lugano and Ann Arbor II

A

> 2 LN regions on same side of diaphragm

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5
Q

Lugano and Ann Arbor III

A

LN regions on both sides of diaphragm
Or above diaphragm + spleen (Lugano)

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6
Q

Lugano IV

A

LN
Extranodal site

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7
Q

Ann Arbor IV

A

> 1 Extranodal site
Liver
Bone marrow
Lung
CSF

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8
Q

Ann Arbor I

A

Single lymphatic site
Nodal region
Waldeyers ring
Thymus
Spleen

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9
Q

Cutaneous staging

A

I - <10% skin surface
II - >10%
III - >1 cm
IV - erythema >80% of body surface

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10
Q

FDG non avid

A

Cutaneous
Bowel
Bone marrow
Mucosal surface

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11
Q

Richters transformation

A

CLL to DLBCL
High uptake in single lesion or SUV >10 in indolent
FDG > FLT in transformation

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12
Q

Threshold for biopsy

A

SUV 14

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13
Q

FDG detect bone marrow

A

If >30% involved

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14
Q

Bone marrow false positive

A

Systemic illness
Administration of Hematopoietic growth factor

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15
Q

FDG after chemo

A

Min 10 days

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16
Q

FDG True negative scan

A

Deintensify or discontinue therapy
Esp early HL

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17
Q

FDG Positive scan

A

Biopsy
Intensify therapy

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18
Q

HL negative PET

A

Biopsy to exclude bone marrow infiltration

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19
Q

Hematopoietic stimulating agents

A

Diffuse splenic uptake
Returns to normal after 1 month

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20
Q

Rituximab

A

Flare response

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21
Q

Residual mediastinal mass after therapy

A

Fibrosis, necrosis, inflammation (uncommon)
PET dd residual tumor vs fibrosis

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22
Q

Thymic rebound due to lymphatic hyperplasia

A

Within 6-12 months after treatment in children
PET dd residual/recurrent mass vs lymphatic hyperplasia

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23
Q

No FDG uptake after treatment

A

Predict disease free survival

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24
Q

SUV drop >66% after 2 cycles in DLBCL

A

Good prognosis

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25
Q

F-FLT

A

Worse than FDG in intensity
Better DD Indolent from aggressive
Uptake correlates with Ki67

26
Q

Deaville score

A

1 - no uptake > background
2 - < mediastinal blood pool
3 - > mediastinal BP, but < liver
4 - > liver (partial response - failure of treatment)
5 -&raquo_space; liver or new lesions - progressive disease

27
Q

Complete response

A

All nodes <1.5 cm
Disappearance of all findings

28
Q

Partial response

A

> 50% decrease in disease burden
50% decrease in spleen size

29
Q

Stable disease

A

<50% decrease in disease burden

30
Q

Progressive disease

A

New or increased adenopathy

31
Q

HL risk of transformation type

A

Nodular lymphocyte-predominant type - - never EBV, Indolent

32
Q

Classic HL

A

HRS cells 1.5% of tumor mass
Express CD30 and CD15
Most common - nodular sclerosing type

33
Q

HL risk factors

A

Male >45
Stage IV
Hb <10.5
WBC >15
Lymphocyte <0.6 or <8% WBC
Albumin <40

34
Q

Flare reaction to immunotherapy

A

Remain on treatment until progressive disease is confirmed by biopsy
Circulating DNA test

35
Q

Follicular lymphoma

A

Indolent
Low-moderate FDG uptake
Chromosomal translocation

36
Q

DLBCL

A

High uptake
De novo
Transformation from CLL, FL, MZL, HL

37
Q

Mantle cell lymphoma

A

Aggressive
Widespread LN, bone marrow, splenomegaly, bowel infiltration, circulating tumor cells
CD5+/CD23-
Richter 20-30%

38
Q

CLL

A

Indolent
Low or no uptake
CD5+/CD23 +
Richter 2-8%

39
Q

MZL

A

Malt (gastric, bowel) - H. Pylori, Indolent, FDG avid
Spleen MZL - HCV, aggressive 20%
Nodal MZL
Chronic microbial infection and autoimmune disorder

40
Q

Anaplastic lymphoma

A

Breast implant ass

41
Q

Primary CNS lymphoma

A

Most DLBCL
No systemic involvement
Mimic GBM

42
Q

Secondary CNS lymphoma

A

Brain parenchymal lesions
Leptomeningeal - subarachnoid nodules
Intradural spinal cord lesions
Cranial nerve involvement
Intraocular/orbital
Intravascular

43
Q

Nasopharyngeal lymphoma

A

Diffuse involvement of Waldeyers ring

44
Q

Mediastinum

A

Young females
Pleural and pericardial effusion
SVC sy

45
Q

T cell cutaneous lymphoma

A

Patch - without elevation and induration
Plaque - elevated, indurated, ulcerated
FDG avid

46
Q

T cell entheropathy ass

A

Aggressive
Type I - long standing Celiac
Type II
Transmural growth – GI bleeding, perforation
Mimic IBD

47
Q

Zevalin

A

Y90-ibritumomab
Anti-CD20 for FL
Combi with rituximab to block CD20 on normal B cells and spleen
Over 10 min 0.4 mCi/kg
Toxicity - bone marrow suppression, reversible

48
Q

HL risk

A

Immune suppression
EBV
Familial history
Solid organ transplantation
Autoimmune disease

49
Q

Ass with EBV

A

HL mixed cellularity type - highest FDG uptake

50
Q

HL presentation

A

Painless Lymphadenopathy in supraclavicular and low neck nodes, mediastinum

51
Q

HL treatment

A

ABVD and 20 Gy radio

52
Q

Bone marrow biopsy

A

When FDG is negative in DLBCL

53
Q

False negative FDG

A

<30% bone marrow involvement
Lower grade
Primary non-avid disease

54
Q

C-Methionine

A

Equally well as FDG in staging
Uptake not correlated with outcome in untreated patients

55
Q

Biodistribution of Zevalin

A

Diagnostic dose of surrogate
In111-ibritumomab tiuxetan

56
Q

TNMB staging

A

Primary CNS lymphoma
Mucosis fungoides
Sezart sy

57
Q

Contra Zevalin

A

> 25% bone marrow involvement
History of myelotoxicity
Neutrophils <1500 cells/mm^2
PLT <10000 (100-149 reduced dose)

58
Q

B symptoms more common in

59
Q

Liver involvement

A

Hepatomegaly - non specific, poor predictor of tumor involvement
Periportal Nodal mass - - biliary obstruction
Diffuse infiltration or nodular lesions

60
Q

Most common Extranodal lymphoma

NM By Myself (25 decks)

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