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LYMPHOMA Flashcards

1
Q

What proportion of lymphoma’s are non-Hodgkins lymphoma?

A

85%

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2
Q

What is a lymphoma?

A

A collection of white blood cells

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3
Q

What are the two types of lymphocytes that may form a lymphoma?

A

B and T

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4
Q

What are the markers that you should look for which would indicate a B cell lymphoma?

A

CD-19

CD-20

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5
Q

What are the markers that you should look for which would indicate a T cell lymphoma?

A

CD-4

CD-8

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6
Q

What characterises Hodgkin’s lymphoma?

A

The presence of Reed-Sternberg cells

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7
Q

What percentage of non-Hodgkin’s lymphomas are B cell lymphomas?

A

80%

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8
Q

What percentage of the B cell non-Hodgkin lymphomas are follicular?

A

50%

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9
Q

What is the difference between follicular and diffuse lymphomas?

A

Follicular is more differentiated - less proliferative - and restricted to lymph nodes
Diffuse is more primitive - more proliferative - and more widespread

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10
Q

Are T-cell lymphomas follicular or diffuse?

A

Diffuse. Follicular is only in the lymph node, which is where the B cell reside.

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11
Q

From a biopsy, what factors might help you work out how proliferative the cells of lymphoma are?

A

Cleaved cells are less proliferative
Smaller cells are less proliferative
Mature cells (more like normal cells) are less proliferative
Follicular cells (versus diffuse) are less proliferative

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12
Q

What are the main low grade non-Hodgkins lymphomas?

A

Small lymphocytic lymphoma
Follicular lymphoma
Marginal zone B-cell lymphoma (Extranodal lymphoma)
Mantle cell lymphoma (sometimes considered intermediate grade)
Lymphoplasmacytic lymphomas (including Waldenstrom’s)
Mycoisis fungoides

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13
Q

What are the features of small lymphocytic lymphoma?

A 
B cell
Diffuse
Mature cells
Small cells
CD5 marker positive
CLL without high white cell count in the blood
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14
Q

What is the translocation responsible for 85% of the follicular lymphoma?

A

t(14,18) Bcl-z which leads to dysfunction of apoptosis

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15
Q

What are the features of follicular lymphoma?

A 
B cell
Follicular
Cleaved cells
Small cells
Lymphoma of follicle centre B cells (centrocytes and centroblasts)
Most common type of low grade lymphoma
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16
Q

What are the positive markers in follicular lymphoma?

A

CD19
CD20 - this is a target for some treatments
CD10
CD22

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17
Q

What are the features of marginal zone B-cell lymphoma (extranodal lymphoma)?

A

B cell
Small cell
Associated with mucosa-associated lymphoid tissue (MALT)
Lymphoma starts in the mucosa not in the lymph nodes

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18
Q

Where is the most common place for MALT lymphomas to develop?

A

Stomach

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19
Q

Other than the stomach, where are the common places for MALT lymphomas to develop?

A 
Small bowel
Salivary glands
Thyroid glands
Tear glands
Lungs
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20
Q

What is the infection associated with MALT lymphomas?

A

H. pylori

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21
Q

Are marginal zone B-cell lymphomas positive or negative for CD5?

A

Negative

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22
Q

Are marginal zone B-cell lymphomas positive or negative for CD10?

A

Negative

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23
Q

What is the marginal zone, which is affected by marginal B-cell lymphomas?

A

The marginal zone is the region at the interface between the non-lymphoid red pulp and the lymphoid white-pulp of the spleen or lymph node.

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24
Q

What are the lymphomas associated with the protein marker CD5?

A

Small lymphocytic lymphoma

Mantle cell lymphoma

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25
Q

What are the features of mantle cell lymphoma?

A

B cell

Found in the mantle zone which surrounds normal germinal centre follicles

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26
Q

What is the chromosomal translocation associated with mantle cell lymphoma?

A

t(11:14)

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27
Q

What is the protein that mantle cell lymphoma cells tend to overexpress as a result of the translocation t(11:14)?

28
Q

What are the features of Waldenstrom’s macroglobulinaemia?

A

B cell
Excessive amounts of IgM
Causes hyperviscosity

29
Q

What are the features of mycosis fungoides?

A

T cell lymphoma

Generally affects the skin

30
Q

What are the main high-grade non-Hodgkin lymphomas?

A

Diffuse large B cell lymphoma
Burkitt’s lymphoma
Peripheral T cell lymphoma
Lymphoblastic lymphoma

31
Q

What is the most common type of high-grade non-Hodgkin lymphoma?

A

Diffuse large B cell lymphoma

32
Q

Is diffuse large B cell lymphoma more common in men or women?

33
Q

Which group of patients are most likely to develop Burkitt’s lymphoma?

A

Children and young adults

34
Q

What are three main clinical variants of Burkitt’s lymphoma?

A

Endemic
Sporadic
Immunodeficiency-associated lymphoma

35
Q

What infections are associated with endemic Burkitt’s lymphoma?

A

EBV

Malaria is believed to reduced resistance to EBV

36
Q

Which parts of the body are typically involved in endemic Burkitt’s lymphoma?

A 
Facial bones especially jaw
Distal ileum
Caecum
Ovaries
Kidney
Breast
37
Q

Which parts of the body are typically involved in sporadic Burkitt’s lymphoma?

38
Q

What is most commonly associated with immunodeficiency lymphoma?

39
Q

What is the gene affected in Burkitt’s lymphoma?

A

c-myc gene

40
Q

What is the most common translocation associated with Burkitt’s lymphoma?

41
Q

Are Reed-Sternberg cells usually positive or negative for CD20?

42
Q

What markers are Reed-Sternberg cells usually positive for?

A

CD30 and CD15

43
Q

What is the main recognised risk factor for Hodgkin’s lymphoma?

A

EBV infection

44
Q

Are T cells or B cells affected in Hodgkin’s lymphoma?

A

Most commonly B cells.

45
Q

What are the B symptoms of lymphoma?

A

Weight loss
Night sweats
Fever

46
Q

Apart from the B symptoms, what are the other classic symptoms of lymphoma?

A 
Lymphadenopathy
Loss of apetite
Fatigue
Respiratory distress
Itching
Hepatosplenomegaly
Symptoms of bone marrow failure
47
Q

What is the definitive method of diagnosis for lymphoma?

A

Lymph node biopsy

48
Q

What tests might be carried out on the lymph node biopsy?

A

Immunophenotyping
Flow cytometry
FISH (fluorescence in situ hybridisation)

49
Q

What is the system used for staging lymphomas?

A

Ann-Arbor staging system

50
Q

What does stage I mean in the Ann-Arbor staging system of lymphomas?

A

The cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.

51
Q

What does stage II mean in the Ann-Arbor staging system of lymphomas?

A

The cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.

52
Q

What does stage III mean in the Ann-Arbor staging system of lymphomas?

A

The cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.

53
Q

What does stage IV mean in the Ann-Arbor staging system of lymphomas?

A

Diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

54
Q

What does the A or B mean in the staging of lymphoma?

A

Absence or presence of B symptoms

55
Q

What does the S mean in the staging of lymphoma?

A

Splenic involvement

56
Q

What does the E mean in the staging of lymphoma?

A

Disease is “extranodal” (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.

57
Q

What stage would you assign to a lymphoma where two affected lymph nodes are found both above the diaphragm in someone experiencing night sweats?

58
Q

What stage would you assign to a lymphoma where two lymph nodes above the diaphragm are found to be affected as well as the spleen in someone experiencing frequent fevers?

A

Stage IIIB S

59
Q

What grade of lymphoma are most successfully treated?

A

High grade

60
Q

What is the initial approach to the treatment of low-grade lymphomas?

A

Wait and watch

61
Q

What is an alternative approach to the wait and watch strategy in someone with follicular lymphoma?

62
Q

What is the approach for someone diagnosed with high-grade lymphoma?

A

Aggressive chemotherapy

63
Q

What is the chemotherapy regimen often used in the treatment of high-grade lymphoma?

A 
CHOP
Cyclophosphamide
Hydroxydaunorubicin (or Adriamycin)
Oncovin (vincristine)
Prednisolone

Rituximab can be added to make R-CHOP

64
Q

How is early staged Hodgkin’s lymphoma treated?

A

Often with radiotherapy alone as long as it can be localised

65
Q

What is the chemotherapy regimen used in more advanced Hodgkin’s lymphoma treated?

A 
ABVD
Adriamycin (Hydroxydaunorubicin in the CHOP regime)
Bleomycin
Vinblastine
Dacarbazine
66
Q

After relapse of high-grade lymphoma, what is the treatment of choice?

A

High-dose chemotherapy followed by autologous stem cell transplantation

67
Q

What is the peak age for Hodgkin’s lymphoma?

haem (17 decks)

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