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Year 6 Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What is Burkitt’s lymphoma?

A

Burkitt’s lymphoma is a high-grade B-cell neoplasm.

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2
Q

What are the two major forms of Burkitt’s lymphoma?

A

The two major forms are endemic (African) form and sporadic form.

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3
Q

What characterizes the endemic form of Burkitt’s lymphoma?

A

The endemic form typically involves the maxilla or mandible.

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4
Q

What characterizes the sporadic form of Burkitt’s lymphoma?

A

The sporadic form commonly presents with abdominal tumours, such as ileo-caecal tumours.

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5
Q

What genetic association is found in Burkitt’s lymphoma?

A

Burkitt’s lymphoma is associated with the c-myc gene translocation, usually t(8:14).

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6
Q

What virus is implicated in the development of Burkitt’s lymphoma?

A

The Epstein-Barr virus (EBV) is strongly implicated in the development of the African form and to a lesser extent the sporadic form.

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7
Q

What is the microscopy finding in Burkitt’s lymphoma?

A

‘Starry sky’ appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells.

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8
Q

How is Burkitt’s lymphoma managed?

A

Management is with chemotherapy, which tends to produce a rapid response.

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9
Q

What syndrome may occur due to rapid response in Burkitt’s lymphoma treatment?

A

‘Tumour lysis syndrome’ may occur due to the rapid response to chemotherapy.

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10
Q

What is Rasburicase used for in Burkitt’s lymphoma treatment?

A

Rasburicase is given before chemotherapy to reduce the risk of tumour lysis syndrome.

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11
Q

What are the complications of tumour lysis syndrome?

A

Complications include hyperkalaemia, hyperphosphataemia, hypocalcaemia, hyperuricaemia, and acute renal failure.

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12
Q

What is allantoin and its significance in Burkitt’s lymphoma treatment?

A

Allantoin is 5-10 times more soluble than uric acid, making renal excretion more effective.

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13
Q

What is Hodgkin’s lymphoma?

A

A malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell.

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14
Q

What is the bimodal age distribution of Hodgkin’s lymphoma?

A

Most common in the third and seventh decades.

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15
Q

What is the most common histological type of Hodgkin’s lymphoma?

A

Nodular sclerosing

Around 70% of cases.

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16
Q

What is the prognosis for nodular sclerosing Hodgkin’s lymphoma?

A

Good prognosis.

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17
Q

What is the frequency of mixed cellularity Hodgkin’s lymphoma?

A

Around 20%.

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18
Q

What is the prognosis for mixed cellularity Hodgkin’s lymphoma?

A

Good prognosis.

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19
Q

What is the frequency of lymphocyte predominant Hodgkin’s lymphoma?

A

Around 5%.

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20
Q

What is the prognosis for lymphocyte predominant Hodgkin’s lymphoma?

A

Best prognosis.

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21
Q

What is the frequency of lymphocyte depleted Hodgkin’s lymphoma?

A

Rare.

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22
Q

What is the prognosis for lymphocyte depleted Hodgkin’s lymphoma?

A

Worst prognosis.

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23
Q

What are ‘B’ symptoms in Hodgkin’s lymphoma?

A

‘B’ symptoms imply a poor prognosis: weight loss > 10% in last 6 months, fever > 38ºC, night sweats.

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24
Q

What factors are associated with a poor prognosis in Hodgkin’s lymphoma?

A

Age > 45 years, stage IV disease, haemoglobin < 10.5 g/dl, lymphocyte count < 600/µl or < 8%, male, albumin < 40 g/l, white blood count > 15,000/µl.

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25
What is Hodgkin's lymphoma?
Hodgkin's lymphoma (HL) is a malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell.
26
What are the bimodal age distributions for Hodgkin's lymphoma?
Hodgkin's lymphoma is most common in the third and seventh decades of life.
27
What are the risk factors for Hodgkin's lymphoma?
Risk factors include HIV and Epstein-Barr virus.
28
What is the most common feature of Hodgkin's lymphoma?
Lymphadenopathy occurs in 75% of cases.
29
Where is lymphadenopathy most commonly found in Hodgkin's lymphoma?
Most commonly in the neck (cervical/supraclavicular), followed by axillary and inguinal regions.
30
Describe the lymphadenopathy in Hodgkin's lymphoma.
It is usually painless, non-tender, and asymmetrical.
31
What is a characteristic symptom of Hodgkin's lymphoma related to alcohol?
Alcohol-induced lymph node pain is characteristic but seen in less than 10% of patients.
32
What are 'B symptoms' in Hodgkin's lymphoma?
'B symptoms' include weight loss, pruritus, night sweats, and fever (Pel-Ebstein).
33
What other presentations may occur in Hodgkin's lymphoma?
Other possible presentations include a mediastinal mass, which may be symptomatic (e.g. cough) or found incidentally on a chest x-ray.
34
What are common investigation findings in Hodgkin's lymphoma?
Common findings include normocytic anaemia, eosinophilia, and raised LDH.
35
What causes eosinophilia in Hodgkin's lymphoma?
Eosinophilia is caused by the production of cytokines, e.g. IL-5.
36
What is the diagnostic method for Hodgkin's lymphoma?
Lymph node biopsy is diagnostic.
37
What are Reed-Sternberg cells?
Reed-Sternberg cells are large cells that are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli, giving an 'owl's eye' appearance.
38
What is Hodgkin's lymphoma?
Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell. It has a bimodal age distribution being most common in the third and seventh decades.
39
What imaging technique is used for staging Hodgkin's lymphoma?
Positron emission tomography/computed tomography (PET/CT) is the mainstay of imaging for staging Hodgkin's lymphoma.
40
What is the Ann-Arbor staging system?
The Ann-Arbor staging system was historically the main way patients with Hodgkin's lymphoma were staged.
41
What are the stages of the Ann-Arbor staging system?
Stage I: single lymph node Stage II: 2 or more lymph nodes/regions on the same side of the diaphragm Stage III: nodes on both sides of the diaphragm Stage IV: spread beyond lymph nodes.
42
What does A/B designation mean in Ann-Arbor staging?
A = no systemic symptoms other than pruritus B = weight loss > 10% in last 6 months, fever > 38°C, night sweats (poor prognosis).
43
What is the Lugano classification?
The Lugano classification is a system used to stage Hodgkin's lymphoma, developed to update and replace the older Ann Arbor staging system.
44
What are the stages of the Lugano classification?
Stage I: Involvement of a single lymph node region (I) or a single extralymphatic organ or site (IE). Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site and one or more lymph node regions on the same side of the diaphragm (IIE). Stage III: Involvement of lymph node regions on both sides of the diaphragm (III), which may also be accompanied by localized involvement of an extralymphatic organ or site (IIIE), involvement of the spleen (IIIS), or both (IIIE+S). Stage IV: Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph node involvement.
45
What does the A/B symptom designation mean in the Lugano classification?
The absence of significant symptoms is designated as 'A', while the presence of fever, night sweats, or weight loss is designated as 'B'.
46
What do the letters E, S, and X represent in the Lugano classification?
E: The presence of extranodal disease. S: Involvement of the spleen. X: Bulky disease (large tumor mass).
47
What is the mainstay of treatment for Hodgkin's lymphoma?
Chemotherapy is the mainstay of treatment.
48
What are the two chemotherapy regimens used for Hodgkin's lymphoma?
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine): considered the standard regime. BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone): alternative regime with better remission rates but higher toxicity.
49
What are other management options for Hodgkin's lymphoma?
Radiotherapy, combined modality therapy (CMT), chemotherapy followed by radiotherapy, and hematopoietic cell transplantation may be used for relapsed or refractory classic Hodgkin lymphoma.
50
What are the complications of treatment for Hodgkin's lymphoma?
Most patients now achieve long-term survival free of Hodgkin's lymphoma with modern therapy. Complications of treatment are therefore more of an issue for these patients, with secondary malignancies being a risk, particularly solid tumours: breast and lung.
51
What is the prevalence of NHL compared to HL?
NHL has a higher prevalence than HL.
52
What is the mean age of diagnosis for NHL?
The mean age of diagnosis for NHL is older than for HL.
53
How does the spread of NHL differ from HL?
NHL has non-contiguous, multicentric spread.
54
Is extranodal involvement common in NHL?
Yes, extranodal involvement is common in NHL.
55
What is the prevalence of NHL compared to HL?
NHL has a higher prevalence than HL.
56
What is the mean age of diagnosis for NHL?
The mean age of diagnosis for NHL is older than for HL.
57
How does the spread of NHL differ from HL?
NHL has non-contiguous, multicentric spread.
58
Is extranodal involvement common in NHL?
Yes, extranodal involvement is common in NHL.
59
What is lymphoma?
Lymphoma is the malignant proliferation of lymphocytes which accumulate in lymph nodes or other organs.
60
How is lymphoma classified?
Lymphoma may be classified as either Hodgkin's lymphoma or non-Hodgkin's lymphoma.
61
What is non-Hodgkin's lymphoma?
Non-Hodgkin's lymphoma is every type of lymphoma that is not Hodgkin's lymphoma.
62
How common is non-Hodgkin's lymphoma in the UK?
Non-Hodgkin's lymphoma is the 6th most common cause of cancer in the UK.
63
Which cells can non-Hodgkin's lymphoma affect?
Non-Hodgkin's lymphoma may affect either B or T-cells.
64
What are the grades of non-Hodgkin's lymphoma?
Non-Hodgkin's lymphoma can be further classified as high grade or low grade.
65
Who is typically affected by non-Hodgkin's lymphoma?
It typically affects the elderly, with one-third of cases occurring in those over 75 years of age.
66
What is the incidence rate of non-Hodgkin's lymphoma?
The incidence rate is 28 for men and 20 for females per 100,000 of the population.
67
What are some risk factors for non-Hodgkin's lymphoma?
Risk factors include elderly age, Caucasian ethnicity, history of viral infection, family history, exposure to certain chemicals, history of chemotherapy or radiotherapy, immunodeficiency, and autoimmune disease.
68
What are common symptoms of non-Hodgkin's lymphoma?
Common symptoms include painless lymphadenopathy, constitutional symptoms (fever, weight loss, night sweats, lethargy), and extranodal disease symptoms.
69
What are some signs of non-Hodgkin's lymphoma?
Signs include weight loss, lymphadenopathy, palpable abdominal mass, testicular mass, and fever.
70
What is the diagnostic investigation of choice for non-Hodgkin's lymphoma?
Excisional node biopsy is the diagnostic investigation of choice.
71
What imaging is used for staging non-Hodgkin's lymphoma?
CT chest, abdomen, and pelvis are used to assess staging.
72
What is the Lugano staging system for non-Hodgkin's lymphoma?
The Lugano staging system includes four stages based on lymph node involvement and extranodal disease.
73
What does 'A/B symptom designation' mean in non-Hodgkin's lymphoma staging?
'A' indicates absence of significant symptoms, while 'B' indicates presence of fever, night sweats, or weight loss.
74
What is the management approach for non-Hodgkin's lymphoma?
Management typically includes watchful waiting, chemotherapy, or radiotherapy depending on the specific subtype.
75
What is a common treatment used for non-Hodgkin's lymphoma?
Rituximab is commonly used in combination with conventional chemotherapy regimes.
76
What are some complications of non-Hodgkin's lymphoma?
Complications include bone marrow infiltration, superior vena cava obstruction, metastasis, spinal cord compression, and treatment-related side effects.
77
What is the prognosis for low-grade vs high-grade non-Hodgkin's lymphoma?
Low-grade non-Hodgkin's lymphoma has a better prognosis, while high-grade has a worse prognosis but a higher cure rate.

Year 6 Haematology (21 decks)

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