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RUSVM SAM 2 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What is the most common hematopoietic tumor?

A

Lymphoma

—> proliferation of malignant lymphoid cells

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2
Q

Etiology of lymphoma?

A

Genetics
Molecular aberrations
Immunological factors — chronic inflammatory dz
Infections — viral (FIV or FELV) or bacterial (helicobacter)
Immunosuppressive therapy
Toxins/insecticides

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3
Q

How are lymphomas anatomically classified ?

A

Multicentric (peripheral lymph nodes) 80-85%

Alimentary
Cutaneous
Misc - CNS, heart, nasal cavity, ocular

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4
Q

What are the histopatholgical classifications of lymphomas?

A

Low, intermediate, or high grade

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5
Q

What is the difference between lymphoblastic and lymphocytic lymphoma?

A

Lymphoblastic lymphoma - is a large cell and has a high grade (grows quickly and is more likely to spread)

Lymphocytic lymphoma- small cell and a low grade neoplasm (grows slower and is less likely to spread)

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6
Q

T/F: most canine lymphomas are B cell derivatives

A

True

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7
Q

T/F: prognosis is better for Tcell lymphomas than Bcell lymphomas

A

False

B cells is better, T cells are terrible

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8
Q

What are most common forms of lymphoma in felines?

A

Alimentary/GI form

-> most are intermediate large cells

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9
Q

What uncommon form of feline lymphoma is often associated with FeLV?

A

Mediastinal

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10
Q

Canine multicentric nodal lymphoma is primarily seen in what age group?

A

Middle-aged to older dogs

No sex or breed predilection

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11
Q

What is substage a vs b canine multicentric nodal lymphoma

A

Substage a - clinically healthy

Substage b

  • lethargy, weakness and other non-specific clinical signs
  • paraneoplasic hypercalcemia —>PU/PD with hyperCa
  • bone marrow involvement (myelophthisis) —> neutropenia bleeding from thrombocytopenia, or anemia
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12
Q

Clinical signs of alimentary lymphoma ?

A

GI signs, vomiting, diarrhea, weight loss, inappetence

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13
Q

Clinical signs of canine mediastinal lymphoma?

A

Respiratory signs, dyspnea
Muffled heart sounds
Pre-caval syndrome (pitting edema of head, neck, and forelimbs)
50% have paraneoplasic hypercalcemia

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14
Q

Clinical signs of canine cutaneous lymphoma?

A

Plaques/nodules on the skin

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15
Q

Clinical signs of alimentary lymphoma in cats?

A

Weight loss
Unkept haircoat
Inappentace

Chronic diarrhea and vomiting

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16
Q

Clincial signs of feline mediastinal lymphoma??

A

Resp distress
Unable to compress thorax
Pleural effusion

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17
Q

Clinical signs of renal lymphoma?

A

PU/PD and renal failure

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18
Q

Clincial signs of feline nasal lymphoma

A

Sneezing and nasal discharge

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19
Q

What can you find on PE in an animal with lymphoma?

A

Palpable lymphnodes
Rectal exam - sublumbar lymph nodes
Mucous membranes pallor/petechiae

Organometallic
-splenomegaly/hepatomegaly

Intestinal wall thickening
Uveitis/retinal hemorrhage

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20
Q

You do a CBC on your lymphoma patient, what do you expect to find?

A

Anemia - normocytic normochronic non-regenerative anemia

Myelopthisis - neutropenia, thrombocytopenia, anemia

21
Q

You want to do a bone marrow aspirate to stage your lymphoma dog.. where can you do this?

A

Greater tubercle of humerus or iliac crest

22
Q

You want to do a bone marrow aspirate to stage your lymphoma CAT.. where can you do this?

A

Femoral intertrocanteric fossa

23
Q

What can you see on a serum biochem in a lymphoma patient?

A

40% are hypercalcemia - PTHrp production

Azotemia - renal lymphoma

Hepatic involvement?

24
Q

What test do you want to do in cats with lymphoma that is important for your diagnosis, prognosis, and husbandry for those cats?

A

FeLV and FIV status

25
What is standard of care for diagnosis of multicentric lymphoma
Histopathology of biopsy and flow-cytometry of FNA
26
T/F: based off of FNA, pathologists can diagnose lymphoma in cats
False They can make the diagnosis from FNA in dogs, but not cats
27
Why do we want to do histopathology with lymphoma
Immunophenotype the tumor - Bcell better prognosis than Tcell Assess grade of neoplasm
28
What is PARR?
PCR for antigen receptor rearrangement Neoplasia lymphoid cells have DNA that is permanently rearranged Bcell DNA for immunoglobulins Tcell DNA for Tcell receptors
29
How can lymphoid phenotyping be done?
Flow cytometry Immunohistochemistry (biopsy) Immunohistochemistry (smear) PARR
30
If you leave a lymphoma untreated.. what is the survival time?
4-6weeks
31
Chemotherapy is used for intermediate and high grade lymphoma.. what is the median remission and survival time in dogs vs cats?
Dog - 90% response rate - > 20-25% are alive 2 years post protocol - >remission is 8-12months Cat - 70% response rate - > MST 6-8months - > remission 4-6months
32
What is the most common chemo protocol for canine lymphoma?
CHOP Cyclophosphamide Hydroxydanorubicin (doxorubicin) Oncovin (vincristine) Prednisone
33
What is the response of canine lymphoma if you decide to only treat with prednisolone?
Short lived remission, 1-2months ** if you have already used pred, response to chemo after is much lower**
34
What is the response rate of canine lymphoma to doxorubicin ONLY?
70% of cases respond Remission 5 months MST 7months
35
What do you do if you have a clinically significant hypercalcemia due to lymphoma?
Should disappear once you start treatment IV fluids and diuretics (furosemide) Prednisolone (calciuric) Biphosphonates —> inhibit osteoclast cells Calcitonin -> oppose action of PTH, regulate Ca and P in blood
36
What is the MOA of rababfosadine
Interferes with cells DNA synthesis machinery and halts growth and causes apoptosis of cells
37
What is the feline lymphoma treatment?
Multi-agent chemo Some use COP protocol —> complete response rate 50-80% —>MST 4-6months
38
What does it mean for there to be complete response with lymphoma ?
Disappearance of all target lesions at >4weeks
39
What is the treatment for cats with a low grade small cell alimentary lymphoma?
Chlorambucil with pred MST 2-3yrs
40
What is the treatment for dogs with indolent/low-grade lymphoma?
Chlorambucil and pred OR Cyclophosphamide and pred Surgery is confined to spleen or single lymph node
41
What is your treatment for a relapsed lymphoma?
>2 months after end of chemo —> re-induction of previous chemo protocol <2moths and no response to chemotherapy —> use drugs not in CHOP protocol “rescue chemo”
42
What are prognostic factors for lymphoma?.
``` Stage Substage (b worse than a) Histopathology Phenotype (T worse than B) Previous pred therapy (worse prog) Mediastinal lymphoma - greater complicates and shorter response rate Anatomical location Chemo induced neutropenia - prolonged remission rate ```
43
What is a lymphoid leukemia?
Proliferation of neoplasic cells of bone marrow Acute vs chronic RARE disease
44
What are the clinical signs of acute lymphoblastic leukemia?
``` Lethargy Weight loss Intermittent pyrexia Hepatospenomegaly Abdominal pain Neurological signs ``` Anemia, thrombocytopenia, and leukopenia
45
Clinical signs for chronic lymphocytic leukemia?
``` Lethargy Pyrexia PU/PD Hemorrhage (thrombocytopenia) Intermittent lameness and collapse ``` Peripheral lymphocytosis
46
T/F: chronic lymphocytic leukemia has a better response to therapy than acute lymphoblastic leukemia
True
47
Clinical signs associated with multiple myeloma?
Lameness Weakness Lethargy Pain High levels of circulating gamma proteins —> hyperviscosity syndrome - neuro signs - bleeding diathesis - ophthalmic abnormalities - increased cardiac workload Renal dz — PU/PD and dehydration - proteinuria - tumor into renal tissue - hyperCa - amyloidosis
48
Diagnosis of multiple myeloma ?
BM aspirate —> plasmacytosis Serum or urine myeloma protein —> electrophoresis Rads - > osteolytic lesions - > pathological fractures - > can have bone lysisi
49
Treatment for multiple myeloma?
Melphalan with pred Melphalan can cause myelosuppreesion —> thrombocytopenia so monitor CBC Hypercalcemia therapy Plasmapheresis for hyperviscocity syndrome Fluid therapy for renal impairment

RUSVM SAM 2 (44 decks)

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