Lymphoma

Question 1

symptoms of lymphoma

Answer 1

lymphadenopathy [highly likely that this is due to another cause]

night sweats: lymphoma, infection, menopause, too warm

weight loss: lymphoma, other malignancy, infections etc

itch without a rash

alcohol induced pain

fatigue

Question 2

what usually has to be done w suspicion of lymphoma

Answer 2

LN biopsy
need a bigger sample rather than FNA or a core biopsy
basically take out the whole node

Question 3

ddx

Answer 3

reactive : bacterial (regional) or viral (generalised)

metastatic malignancy

lymphoma

Question 4

approach to lymphadenopathy

Answer 4

is it regional

is it generalised lymphadenopathy

Question 5

what is seen on a biopsy

Answer 5

exclude other causes
classification
understand pathogenisis

Question 6

how is LN pathology assessed

Answer 6

histology
immunohitochemistry on a solid node
immunphenotyping blood/marrow if liquid sample 
genetic analysis 
molecular analysis

Question 7

histology of LN

Answer 7

follicular lymphoma - abnormal follicles - low grade

lower grade have small cells
high grade - more immature looking cells, more blast type cells

Question 8

immunohistochemistry

Answer 8

looks at patterns of proteins on the surface of lymphoma cells
use antibodies -CD
brown = positive

Question 9

CD20

CD30

Answer 9

b cell lymphoma / follicular NHL

hodgkins +ve to reed sterner cells

Question 10

immunophenotyping

what is this useful in

Answer 10

add the antibody and instead of looking for a colour change it is put through a machine

leukaemia, lymphomas involving marrow such as Burkitts lymphoma

Question 11

cryogenic analysis

Answer 11

specific patterns of chromosome abnormality in certain lymphomas

G banding - just look at them under the microscope
FISH- use probes that emit a specific light colour

Question 12

molecular analysis

Answer 12

patterns of gene expression

looking for genes that are switched both on and off

Question 13

gene expression profiling has shown what

Answer 13

hodgkins - B cell lymphoma - reed sternberg cells

Question 14

types of lymphoma

Answer 14

hodgkins
high grade B cell NHL
low grade B cell NHL
Burkitts - v high grade
Mantle cell lymphoma - looks like low grade higkins and has the same phenotype but is actually very aggressive and is incurable with chemo
marginal zone NHL - low grade sometimes don’t need treated at all if localised and not causing any symptoms