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CSP1 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

Where do different types of lymphomas occur?

A

Depends on stage of B cell maturation :

  • germinal centre proliferation = follicular lymphoma
  • differentiation = classical Hodgkin lymphoma
  • mature cells = ABC-DLBCL
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2
Q

What cell types undergo lymphomas?

A

90% B cells

10% T and NK cells

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3
Q

How are lymphomas classified?

A
  • non-Hodgkin are vast majority
  • also get Hodgkin
  • low grade vs. high grade/aggressive
  • B cell vs T cell/NK
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4
Q

Features of non-Hodgkin lymphomas

A
  • follicular

- diffuse large B cell (germinal centre type and activated B cell type)

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5
Q

Types and examples of Hodgkin lymphomas

A 
CLASSICAL = 
- nodular sclerosing
- mixed cellularity
- lymphocyte rich
- lymphocyte deplete
vs rarer = 
- nodular lymphocyte predominant
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6
Q

Associations with lymphoma

A
  • viral infections = EBV, HIV, Hep C, TLV, HHV 8
  • Bacterial infections = H. pylori, chlamydia psittaci
  • inflammatory conditions = coeliac disease, Sjogren’s syndrome
  • medical exposure = ionising radiation, benzene, immunosuppression
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7
Q

What is the patient pathway?

A
  • referral from GP/hospital
  • look for signs and symptoms
  • investigations (blood tests, biopsy, CT imaging, specific tests so diagnosis is made)
  • treatment (depends on late effects, fertility, psychosocial, prognosis)
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8
Q

What are some disease specific treatments?

A
  • curative = transplantation, novel agents

- clinical trial

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9
Q

What are some non-disease specific treatments?

A
  • symptoms relief
  • palliative
    (steroids, immunotherapy, chemo, radio, supportive)
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10
Q

Symptoms of lymphoma

A
  • fever >38
  • night sweats
  • > 10% weight loss
  • may be asymptomatic
  • fatigue
  • pain/swelling from lymphadenopathy
  • pruritus (itching)
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11
Q

Signs on exam of lymphoma

A

Hepatomegaly
Lymphadenopathy (neck, axillae, abdo, groin)
- skin (pallor, jaundice)
- organ specific (enlargement)

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12
Q

Investigations of lymphoma

A 
FBC
blood film
high WBC = lymphoma
- immunophenotyping
- LDH, uric acid = raised as high cell turnover and breakdown of cells (tumorlysis)
- serum electrophoresis
B2 macroglobulin
serology = hep B, C, HIV
- biopsy
- imaging = CT for where there are masses or CT PET (radioactive in whole body to see where)
- MRI if CNS involvement or lumbar puncture
- USS abdominal?
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13
Q

Types of biopsy for lymphoma

A
  • fine needle aspirate (often don’t get enough cells and info on architecture)
  • core biopsy taking more of material out
  • excision lymph node biopsy is gold standard
  • may do biopsy of bone marrow instead of lymph node
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14
Q

Classification of Lymphomas

A
  • stage 1 to 4
  • 1) 1 localised lymph node above or below diaphragm
    2) more than 1 on one side of diaphragm
    3) on both sides of diaphragm
    4) bone marrow and extra nodal involvement

A or B
A - no associated symptoms
B - unexplained fever, night sweats, weight loss >10% in last 6 months

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15
Q

Genetic hallmark of follicular lymphoma

A

translocation 14:18
use CD20 B cell for staining
use CD3 T cell for staining
CD10 positive!

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16
Q

Diagnostic characteristics of stage 4 A follicular lymphoma

A 
Blood film
-  cleaved lymphocytes
Biopsy
- darker smaller centrocytes
- larger paler centroblasts with nucleolus (centroblasts = follicular)
- effaced with tumour cells
Bone Marrow
- paratrabecular infiltration of small lymphocytes (bone marrow involvement = sage 4)
  • A as no B symptoms
17
Q

Treatment for follicular lymphoma

A

variable depending on severity/burden = asymptomatic/mild symp/high tumor burden

  • watch and wait
  • non chemo or chemo?
  • rituximab
  • radioimmunotherapy
18
Q

Pathophysiology of follicular lymphoma

A
  • pre B cells in bone marrow
  • translocation of 14:18 but also secondary genetic alterations
  • migration into germinal centre with accumulation of these 2ry events
19
Q

Features of follicular lymphoma

A
  • 65 years
  • low grade, hard to cure
  • B symptoms uncommon
  • most stage 3 or 4
  • high risk survival is 50% and low risk is 90%
20
Q

Diagnostic features of diffuse large B cell lymphoma

A
  • normal blood film with normal segmented neutrophils and red cells
    Biopsy
  • centroblasts normal large and non cleaved
  • lack of other cells or inflamm infiltrate
21
Q

Treatment of diffuse large B cell lymphoma

A

Scoring system dependent

  • 4 categories of system which are age, LDH, stage, performance status, extra-nodal sites
  • standard treatment regime = 6 cycle intense regime RCHOP (rituximab, cyclophosphoramide, doxorubicin, vincristine and prednisolone)
  • CNS prophylaxis in high risk disease
22
Q

Pathophysiology of diffuse large B cell lymphoma

A

heterogeneous differential gene expression =

  • germinal centre type (better prognosis via BCL2 pathway)
  • activated B cell type (worse prognosis via NF-Kappa B pathway)
23
Q

Features of diffuse large B cell lymphoma

A
  • 64 years
  • common B symptoms
  • aggressive high grade
  • potentially curable
  • commonly stage 1-2
  • low risk 90% survival, high 50%
24
Q

Diagnostic features of Classical Hodgkin Lymphoma (nodular sclerosing type)

A 
- normal blood film
Biopsy
- reed Sternberg cell with hourglass appearance
- inflammatory infiltrate/fibrosis
- eosinophil
- lacunar cell
CT PET disease just above diaphragm
- CT very sensitive for bone marrow involvement
25
Q

Treatment of Hodgkin lymphoma

A

stratify again

  • limitied, intermediate and advanced stage
  • based on RF and stage of disease
  • 2 cycles ABVD treatment = doxorubicin, bleomycin, vinblastine, dacarbazine
  • then PET scan, if positive still then escalate chemo but negative continue chemo as it is
  • involved node radiotherapy on top
26
Q

Pathophys of Hodgkin lymphoma

A
  • germinal centre cell
  • mutation/transforming event
  • RS cell and loss of apoptosis and cytokines = inflammatory/fibrosis/eosinophillia/macrophage activation
27
Q

Hodgkin Lymphoma Features

A 
Bimodal age distribution
Aggressive/curable
40% presence of B symptoms
Stage 1 and 2 most common
80-90% cured
28
Q

How do you assess response to treatment?

A

at 6-8 weeks clinical assessment and PETCT scan

- 3 monthly for first 1-2 years, then 6 monthly, yearly from 5 years

29
Q

Example of classes of different target therapies

A
  • anti CD20 mAB
  • HDAC inhibitors
  • alkylators
  • BCL-2 inhibitors
  • checkpoint inhibitors
  • proteasome inhibitors
  • Kinase inhibitors

CSP1 (20 decks)

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