Lymphoma Flashcards
Definition of Lymphoma
Neoplastic tumor of lymphoid tissue
Where can lymphoma affect
Often lymph nodes + BM +/- spill out to blood
Sometimes other lymphoid tissue - spleen, MALT (mucosal associated lymphoid tissue)
Rarely ‘anywhere’ - skin (T-cell), CNS, testes, breast
Incidence of Hodgkins lymphoma
M>F Bimodal age 20-29 and >60 EBV associated Spreads to adjacent LNs, often only single group affected 20% of lymphoma
Presentation of Hodgkins Lymphoma
Assymmetrical painless lymphadenopathy +/- obstructive symptoms
+/- Consitutional symptoms - wt loss, low grade fever, night sweats, pruritus, fatigue
Pel-Ebstein fever (cyclical 1-2 week) in majority
Pain in affected nodes after alcohol
Investigations of Hodgkins Lymphoma
CT/PET
LN or BM biopsy - cells stain with CD15 and CD30
Reed-Sternberg cell - ni/multinucleate ‘owl-eyed’ cell on lymphocytes and reactive cells
Subtypes: nodular sclerosing, mixed cellularity, lymphocyte rich, lymphocyte depleted, nodular lymphocyte predominant
Staging of Lymphoma
Stage 1 - one LN region (can be spleen)
Stage 2 - 2 or more on same side of diaphragm
Stage 3 - 2 or more on opposite sides of diaphragm
Stage 4 - extranodal sites (liver, BM)
A: no constitutional symptoms B: symptoms
Treatment of Hodgkins Lymphoma
Prognosis excellent esp in young
Combination Chemo - most cases
- ABVD Adriamycin, bleomycin, vinblastine, dacarbazine
- 2-4 cycles in stage 1/2, 6-8 cycles in stage 3
Radiotherapy - alongside chemo
Intensive chemo and autologous SCT
- Relapsed patients
Autologous SCTs are used more often in the treatment in which disease?
Multiple myeloma and lymphoma particularly in relapse
Classification of Non-Hodgkins
Mature/immature
High grade - very aggressive, aggressive
Low Grade - indolent
Lineage - B cell, T cell
Common features of Non-Hodgkins
Painless lymphadenopathy often multiple sites
Consititutional symptoms
No pain after alcohol
Staging as per Hodgkins
Aggressive T CEll lympoma affaecting children and YAs
Large ‘epitelioid’ lymphocytes
t(2;5)
Alk-1 protein expression
Anaplastic large cell lymphoma
Aggressive T cell lymphoma affecting the middle-aged and elderly with large T-cells
Peripheral T cell lymphoma
Aggressive T cell lymphoma attacking the carribean and japanese with an association with HTLV-! infection
Adult T cell leukaemia/lymphoma
T cell lymphoma assoc with long standing coeliac
Enteropathy associated T cell lymphoma
T cell lymphoma associated with mycosis fungoides
Cutaneous T cell lymphoma
Aggressive B cell lymphoma with t(8;14)
C-myc oncogene overexpression and rapid response to Rx
Burkitt’s lymphoma
Histological finding of Burkitt’s lymphoma
Starry sky appearance
Treatment of Burkitt’s lymphoma
Chemo - Rituximab and leukaemia protocol
or SCT
Three types of Burkitt’s
Endemic - most common malignancy in equatorial africe - EBV-assoc - Characteristic jaw involvement with abdo masses Sporadic - FOund outisde AFrica - EBV associated - Jaw less common Immuno deficiency - Non-EBV - HIV/post-transplant
Aggressive B Cell affaecting middle aged and elderly. COmmonly from Richter’s transformation and assoc with other secondary lymphomas
Diffuse Large B-cell
Histology Finding in DLBC
Sheets of large lymphoid cells
Treatment for DLBC
RItuximab CHOP
Auto-SCT for relapse
Aggressive B cell lymphoma affecting middle aged men. Disseminated at presentation with a median survival of 3-5 years
t(11;14), Cyclin D1 deregulation
Mantle cell lymphoma
Histology finding of mantle cell lymphoma
Angular nuclei
Treatment for mantle cell lymphoma
RItuximab CHOP
Auto-SCT for relapse
Indolent, incurable B cell lymphoma with a survival of 12-15 years
t(14;18)
Follicular
Histology for FOllicular lymphoma
Follicular pattern and nodular appearance
Treatment for Follicular Lymphoma
Watch and Wait
Rituximab CVP
B cell lymphoma affecting the Marginal zone in middle aged patients caused by chronic antigen stimulation
Mucosal associated lymphoid tissue
H. pylori - gastric MALT
Sjogren’s - parotid lymphoma
Treatment for MALT
Remove antigenic stimulus
eg H. pylori triple therapy
Chemo
