Lymphoma

Question 1

Lymphoma

What percentage paed malignancy

Hodgkin vs NHL
Number nodes
Spread
Extranodal involvement

Answer 1

10% all

Hodgkin
Single node
Orderly spread
Mesenteric & Waldeyer’s ring rarely involved
BM involvement uncommon
Focal liver involvement rather than diffuse

NHL
Multiple nodes
Random spread
Mesenteric nodes & Waldeyers commonly involved 
Extranodal common

Question 2

Hodgkin lymphoma
% of lymphomas <15y
Characterised by \_\_\_\_\_\_ chain lymphadenopathy 
HSM \_\_\_\_\_
Special cell \_\_\_\_
Three peaks
RFs (3)

Answer 2

40%
Single chain lymphadenopathy 
HSM absent
Reed Sternberg cell
<14y
15-34y
55-75y

EBV
Primary immunodeficiency (eg. AT)
First degree relative

Question 3

Is Reed Sternberg pathognomic of HL?

HL at risk of what infections

Answer 3

No also seen in NHL and EBV

Probably a monocyte

Viral/fungal/TB infection
30% get VZV

Question 4

Clinical features of HL

Answer 4

Lymphadenopathy- painless, firm, rubbery

Cervical, supraclavicular, > inguinal axillary

Anterior mediastinal mass in 60%

B sx

• fever for >72h
• drenching night sweats
• Low >10% in 6 mo

Question 5

Investigations in HL

ESR
Rads

Answer 5

Neutrophilia in 30%
Coombs positive haemolysis
ESR good marker of disease activity 
ITP
Ferritin 
Copper 

CXR

Question 6

Cytogenetic markers of Reed Sternberg

Answer 6

CD15, CD30, BLA-36

Question 7

NHL

Rate of onset
___ chain lymphadenopathy
Extranodal involvement
Cell type in order of commonest

Answer 7

Explosive onset

Multiple chain lymphadenopathy
HSM common
Clonal proliferation of B cells, T cells, indeterminate

Question 8

NHL

3 histological subtypes

Answer 8

Lymphoblastic

• usually T cell origin
• <25% blasts in BM , extra medullary disease
• overlap with ALL
• mediastinal mass

Small non-cleaved cell lymphoma
- B cell origin
Burkitts (surface Ig positive) or non burkitts
- below diaphragm

T or B cell

• anaplastic large cell
• cutaneous presentation

Question 9

NHL

Bloods
Special marker
Rads
When is biopsy indicated

Answer 9

Tumour lysis bloods
LDH: tumour burden
CSF

CXR
CT staging
BMA and trephine
Biopsy ASAP: rapid progression

Question 10

NHL

Rx

Complications of treatment

Which type better prognosis

Answer 10

CHOP

Cyclophosphamide
Hydroxy danorubicin
Vincristine
Prednisone

Very sensitive to steroid

Tumour lysis high risk

B cell slightly better prognosis

Question 11

NH

Relapse prognosis

Answer 11

Extremely poor prognosis

Occurs early