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Year 2 - 2nd Semester > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What is lymphoma?

A

A group of cancers that affect lymphocytes in the lymphatic system, causing lymphadenopathy due to the proliferation of cancerous lymphocytes in lymph nodes

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1
Q

What are the key features of Hodgkin lymphoma?

A

(1) It accounts for 1/5 of lymphomas caused by proliferation of B-lymphocytes, with a bimodal age distribution (peaks at ~20 and ~75 years).

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2
Q

Name risk factors for Hodgkin lymphoma

A

(1) Immunosuppression (e.g., HIV)
(2) Autoimmune diseases (e.g., rheumatoid arthritis)

(3) EBV infection, and family history

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3
Q

What is Burkitt lymphoma associated with?

A

Epstein-Barr virus
Malaria
HIV
t(8;14) translocation.

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4
Q

What infection is commonly associated with MALT lymphoma?

A

H. pylori infection

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5
Q

Name risk factors for non-Hodgkin lymphoma

A

(1) Infections (HIV, EBV, H. pylori)
(2) Hepatitis B/C
(3) Exposure to pesticides, and trichloroethylene.

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6
Q

What is the hallmark symptom of lymphoma?

A

Lymphadenopathy
= enlarged, non-tender, rubbery lymph nodes.

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7
Q

What are “B symptoms” in lymphoma?

A

Fever, night sweats, and weight loss.

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8
Q

How does lymphadenopathy differ between Hodgkin and non-Hodgkin lymphoma?

A

Hodgkin lymphoma usually presents with localised lymphadenopathy, while non-Hodgkin lymphoma typically has generalised lymphadenopathy

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9
Q

What unusual symptoms might some Hodgkin lymphoma patients experience?

A

Pain in the lymph nodes after drinking alcohol

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10
Q

What is the key diagnostic test for lymphoma?

A

Lymph node biopsy

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11
Q

What is the characteristic finding on lymph node biopsy in Hodgkin lymphoma?

A

Reed-Sternberg cells – large B cells with bilobed nuclei and an “owl’s eye” appearance

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12
Q

What imaging is used to stage lymphoma?

A

CT, MRI, and PET scans

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13
Q

Describe the Ann-Arbor staging system for lymphoma

A

I: Single lymph node region.

II: Multiple regions, same side of the diaphragm

III: Both sides of the diaphragm

IV: Spread beyond lymph nodes (e.g., liver, bone marrow)

A: No systemic symptoms. B: Systemic symptoms (e.g., weight loss, fever, night sweats)

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14
Q

What is the main treatment regimen for Hodgkin lymphoma?

A

ABVD – adriamycin, bleomycin, vinblastine, and dacarbazine

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15
Q

What side effect is associated with bleomycin in ABVD treatment?

A

Pneumonitis

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16
Q

What are the long-term risks of Hodgkin lymphoma treatment?

A

Secondary cancers, cardiovascular disease, and infertility (with intensive treatment)

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17
Q

What is the main treatment regimen for non-Hodgkin lymphoma?

A

R-CHOP

R - rituximab
C - cyclophosphamide
H - hydroxydaunorubicin (doxorubicin) O - Oncovin®
P - Prednisolone

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18
Q

How is MALT lymphoma treated?

A

Triple therapy with a PPI (e.g., omeprazole) and two antibiotics (e.g., amoxicillin and clarithromycin)

19
Q

What is Richter transformation in lymphoma?

A

Transformation of a low-grade lymphoma (e.g., CLL) into a high-grade lymphoma (e.g., DLBCL)

20
Q

Why should steroids be used cautiously before a biopsy in suspected lymphoma?

A

They can cause cell necrosis and distort tissue architecture, complicating the diagnosis

21
Q

What is the significance of lactate dehydrogenase (LDH) in lymphoma?

A

Elevated LDH is often seen in Hodgkin lymphoma but is non-specific

22
Q

What is a poor prognostic factor in Hodgkin lymphoma?

A

Elevated ESR or decreased haemoglobin

23
Q

What factors indicate a poor prognosis in Hogkin’s lymphoma?

A

Lymphocyte depleted type
B symptoms
Male
Stage 4 disease

24
Q

What are the types of Hogkin’s lymphoma?

A

(1) Nodular Sclerosing
(2) Mixed cellularity
(3) Lymphocyte rich
(4) Lymphocyte deplete

25
Q

Which type of Hogkin’s lymphoma is the most common?

A

Nodular Sclerosing (about 70% )

26
Q

A 25-year-old male patient presents to the general practitioner with a 4-week history of an enlarging non-tender left neck mass. He also reports feeling generally unwell with fever, night sweats and a 2kg weight loss in the last month.

Excisional lymph node biopsy reveals Reed-Sternberg cells. A PET-CT scan reveals the involvement of cervical, mediastinal, and inguinal lymph nodes.

What is the Lugano stage of this disease?

A

Stage III (B)
The patient is not asymptomatic and presents with B symptoms

27
Q

When does Lymphocyte-depleted occur?

A

Rare
Typically presents in older patients or those with HIV
Poorer prognosis

28
Q

When does Nodular Sclerosis occur?

A

Most Common

Often affecting young adults and presenting with mediastinal involvement.

Although it has a good prognosis, especially in early-stage disease, it is not as favourable as lymphocyte-predominant Hodgkin lymphoma

29
Q

When does Mixed Cellularity occur?

A

More common in older adults
May present with a more advanced disease.
It has an intermediate prognosis

30
Q

When does Lymphocyte-predominant occur?

A

Rare subtype that typically has a very favorable prognosis compared to other subtypes.

It is often diagnosed at an early stage and responds well to treatment

31
Q

A 25-year-old male patient presents to the general practitioner with a 4-week history of an enlarging left neck mass. He reports the mass is generally painless, but he notices it is sometimes painful after he drinks alcohol. He denies any other symptoms. He has epilepsy and takes carbamazepine.

Physical examination reveals non-tender cervical lymphadenopathy. Excisional lymph node biopsy reveals large cells with bilobed nuclei and eosinophilic nucleoli.

Given the likely diagnosis, which subtype has the best prognosis?

A

Lymphocyte-predominant

32
Q

A 20-year-old male presents to his General Practice with persistent cervical lymphadenopathy fever weight loss and night sweats. He is referred for a biopsy which shows Reed-Sterberg cells. On further investigation, it is noted that he has inguinal lymphadenopathy that also shows Reed-Sterberg cells on biopsy. There is no evidence of liver, spleen or marrow involvement.

Given his likely diagnosis, what stage is his disease?

A

3 B

33
Q

A 70-year-old woman with a two-month history of fatigue, weight loss, shortness of breath and painless neck swelling is urgently referred to haematology for further investigations. These include a chest x-ray which shows a mediastinal lesion, a lymph node biopsy which shows infiltrating lymphocytes and the absence of Reed-Sternberg cells, and a CT TAP which shows multi-organ involvement

Which classification is the most appropriate to stage this type of cancer?

A

Lugano classification

34
Q

A 27-year-old male has presented with a non-tender supraclavicular lump which has gradually increased in size over the last 3 months. On direct questioning, he admits having night sweats and 10 kg unintentional weight loss.

He has no significant past medical history. An urgent ultrasound reported abnormal cervical lymph nodes in the neck and supraclavicular fossae.

What is the next best investigation?

A

Excisional node biopsy

35
Q

What translocation is commonly found in Burkitt’s Non-Hodgkins lymphoma?

A

t(8;14) IgH-Myc translocation

36
Q

What are the poor prognostic markers in non-Hodgkin’s lymphoma?

A
  1. Presence of B symptoms (weight loss, night sweats, and fever)
  2. lymphadenopathy/organomegaly
  3. Advanced tumour stage
  4. Advanced age
  5. Anaemia
  6. Raised serum LDH
37
Q

What translocation is commonly found in Follicular Non-Hodgkins lymphoma?

A

t(14;18)

38
Q

An 18-year-old man is undergoing chemotherapy for lymphoma.
His past medical history includes Epstein-Barr Virus (EBV) infection.
Histology of a lymph node aspirate shows a ‘starry sky appearance’ typical of his type of lymphoma.

Which chromosomal translocation is associated with this type of lymphoma?

A

Translocation between chromosomes 8 and 14

= The question describes Burkitt’s lymphoma. It is associated with EBV infection

39
Q

A 71-year-old woman is undergoing treatment for non-Hodgkin’s lymphoma, specifically a high-grade B cell lymphoma.

In addition to CHOP chemotherapy, what targeted therapies is the patient likely to receive?

A

Rituximab

40
Q

An 84-year-old man is referred to Oncology with weight loss, night sweats and lymphadenopathy. A lymph node biopsy confirms the diagnosis of mantle cell lymphoma.

Which chromosomal translocation is associated with this diagnosis?

A

t(11;14)

41
Q

A 24-year-old female is referred to haematology by her GP. She had presented with night sweats, fatigue, and weight loss and was found to have cervical lymphadenopathy. She has no medical history of note.

What investigation will give a definitive diagnosis?

A

Lymph node biopsy

42
Q

What are the Low-Grade Non-Hodgkin Lymphomas (Indolent) ?

A
  1. Follicular lymphoma
    = t(14;18), increased BCL-2 transcription.
  2. MALT lymphoma
    = Associated with H. pylori infection.
  3. Small lymphocytic lymphoma (SLL)
    = Similar to CLL, slow progression.
43
Q

What are the High-Grade Non-Hodgkin Lymphoma (Aggressive)

A
  1. Diffuse large B-cell lymphoma
    = Most common, rapidly growing painless mass, typically in older adults.
  2. Burkitt lymphoma
    = Associated with EBV, malaria, HIV, t(8;14).
  3. Mantle cell lymphoma
    = t(11;14), cyclin D1 overexpression, poor prognosis.
44
Q

A 40-year-old male presents to the GP with a swollen neck, night sweats and weight loss.

He has a past medical history of hyperthyroidism, gout, and HIV for which he takes carbimazole, allopurinol, and antiretrovirals, respectively. Several years ago he was involved in a road traffic accident where he received two units of packed red blood cells for treatment of blood loss. His sister has just received a diagnosis of breast cancer.
He is investigated and later receives a diagnosis of lymphoma.

What subtypes is this patient most likely to have?

A

Burkitt’s lymphoma

= Burkitt’s lymphoma is strongly associated with immunosuppression, particularly in HIV-positive individuals

45
Q

A 65-year-old male presents with fever, night sweats, and fatigue. On examination, he has generalised lymphadenopathy. A biopsy of the enlarged lymph nodes reveals the presence of atypical lymphoid cells with an irregular nucleus and a high mitotic rate

What is the most likely diagnosis?

A

Non-Hodgkin’s lymphoma

46
Q
A

Year 2 - 2nd Semester (24 decks)

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