Lymphoma Flashcards
What are lymphomas?
Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and cause characteristic clinical features of lymphadenopathy.
What are the two major subdivisions of lymphomas?
Hodgkin and non-Hodgkin lymphoma.
How is this characterization done?
Based on the appearance of Reed-Sternberg cells in Hodgkin lymphoma.
What is the purpose of the cells seen in Hodgkin lymphoma?
The RS and associated mononuclear cells are neoplastic whereas the infiltrating inflammatory cells are reactive
What is the lineage of the RS cells?
Studies have suggested that the RS cells are of B-lymphoid lineage.
What virus has been detected in over 50% of Hodgkin tissue?
EBV
At what age is Hodgkin most likely to present?
Can present at any age but is rare in children and has a peak incidence in young adults.
Is Hodgkin most likely to present in a specific gender?
2:1 predominance in males
What are the most common symptoms of Hodgkin lymphoma?
- Painless non-tender, asymmetrical, firm, discrete and rubbery enlargement of superficial lymph nodes. 60-70% cervical lymph nodes 10-15% axillary nodes 6-12 inguinal nodes.
- Modest splenomegaly in 50% of patients
- Weight loss, profuse night sweats, weakness, fatigue, anorexia
What are common findings?
- Normochromic mormocytic anemia is most common
- 1/3 of patients have neutrophilia; eosinophilia is frequent
- Advanced disease is associated with lymphopenia and loss of cell mediated immunity
- Platelet count normal or increased in erly disease reduced in later stages
- Serum lactate dehydrogenase is raised initially in 30-40% of cases
How is diagnosis made?
By histological examination of an excised lymph node (polyploid multinucleate RS cell is central to diagnosis four classic types.
What is the immunophenotype present in Hodgkin Lymphoma?
1.CD30 & CD15 RS cells
2.
The presence of infiltrating of what infiltrating cell is a negative prognosis?
Macrophages
What are the four classic types of Classical Hodgkins?
- Nodular lymphocyte predominant (BEST PROGNOSIS)
- Nodular sclerosing (women>men)
- Mixed cellularity (most associated with EBV)
- Leukocyte depleted (worst prognosis)
What features give the best prognosis?
Lymphocyte rich histology
How is clinical staging performed?
Through X-Ray, MRI, and CT
What is absent from Nodular lymphocyte predominant?
Reed-Sternberg cells are absent, PAX-5 positive
How is stage I characterized?
Stage I indicates involvement in 1 lymph node are.
What does stage II involve?
Stage II indicates disease involves 2 or more lymph nodal areas confined to one side of the diaphragm.
What does stage III involve?
Disease involves lymph nodes above and below the diaphragm
What is Stage IV?
Stage IV indicates movement outside the lymph node areas and refers to diffuse or disseminated disease in the bone marrow, liver and other extra nodal sites.
What is the treatment for HL?
Radiotherapy, chemotherapy or a combination of both.
In what stages is Radiotherapy curative by itself?
Stage I and IIA
What therapy is used for Stage III and IV?
Chemotherapy ABVD Adriamycin, Bleomycin, vinblastine, and Dacarbazine
What are some of the modalities used in mordern lymphoma diagnosis?
- Clinical features
- Imprint cytomorphology
- Routine H&E
- Immunophenotyping
- Flow cytometry
- Immunochemistry - Routine Karyotyping
- Molecular genetics
- DNA
- FISH
- PCR - RNA
- CISH
- RTPCR
What are the immunochemical markers in Follicle center Lymphoma?
- Surface Ig
- CD10
- CD19,CD20,CD22,CD79a