Lymphoma

Question 1

What is the classic histologic halmark of Hodgkin disease?

Answer 1

Hodgkin lymphoma is defined by the presence of Reed-Sternberg cells, which are multinucleated large cells (“owl’s eyes”) that divide rapidly and live longer than normal cells. *** Image 24-25

Question 2

What are the three subtypes of non-Hodgkin lymphoma?

Answer 2

Burkitt lymphoma, lymphoblastic lymphoma, and large cell lymphoma.

Question 3

What (4) features, if present in conjunction with lymphadenopathy, would be worrisome for the presence of lymphoma?

Answer 3

Systemic symptoms (fever, night sweats, weight loss, etc.); fixed, nontender nodes; supraclavicular nodes; and lymph nodes > 2cm with no response to a 2 week course of antibiotics.

Question 4

How is lymphoma diagnosed?

Answer 4

Biopsy of the worrisome lymph node or mass.

Question 5

Within what age range is the incidence of Hodgkin lymphoma highest?

Answer 5

The highest incidence is seen in adolescents between 15 and 19 years of age.

Question 6

T/F: Hodgkin disease is mostly of B cell lineage.

Answer 6

True. Although T-cell lineage is occasionally noted.

Question 7

What is the most common presentation for Hodgkin disease?

Answer 7

The most common presentation for Hodgkin lymphoma is asymptomatic lymphadenopathy, which often involves the cervical or supraclavicular region.

Question 8

What are “B” symptoms in Hodgkin disease? What does their presence usually indicate?

Answer 8

Fever, drenching night sweats, and unexplained weight loss. The presence of B symptoms usually indicates a more advanced disease and a worse prognosis.

Question 9

What infection is common in patients with Hodgkin lymphoma, due to their impaired cellular immunity?

Answer 9

Varicella Zoster

Question 10

What does ingestion of alcohol cause in a patient with Hodgkin disease?

Answer 10

It can cause alcohol-induced pain localized to areas of disease involvement (bones, lymph nodes, etc.).

Question 11

How do you definitively diagnose Hodgkin disease?

Answer 11

Excisional biopsy of an accessable lymph node.

Question 12

T/F: A staging laparotomy is routinely performed in patients with Hodgkin disease.

Answer 12

False. Staging includes several laboratory and imaging studies, but does not include laparotomy.

Question 13

In general, how are patients treated for Hodgkin disease?

Answer 13

The combination of radiation and chemotherapy was found to improve treatment outcomes in patients with Hodgkin lymphoma, compared with radiation alone.

Question 14

What are the two multi-agent chemotherapy regimens used to treat Hodgkin lymphoma?

Answer 14

MOPP (nitrogen Mustard, vincristine (i.e. Oncovin), Procarbazine, and Prednisone) and ABVD (doxorubicin (Adriamycin), Bleomycin, Vinblastine, and Dacarbazapine).

Question 15

What are the (2) treatment-related risks of MOPP chemotherapy in patients with Hodgkin lymphoma?

Answer 15

AML and infertility.

Question 16

What are the (2) treatment-related risks of ABVD chemotherapy in patients with Hodgkin lymphoma?

Answer 16

Dose-dependent side effects of cardiomyopathy (doxorubicin) and pulmonary toxicity (bleomycin).

Question 17

What is the most common type of lymphoma in pediatrics?

Answer 17

Non-Hodgkin lymphoma. NHL accounts for 60% of pediatric lymphomas, with Hodgkin making up the other 40%.

Question 18

What is the male:female ratio for non-Hodgkin lymphoma?

Answer 18

Males outnumber females 3:1.

Question 19

What four conditions have a high rate of developing non-Hodgkin lymphoma?

Answer 19

Ataxia-telangiectasia, Wiskott-Aldrich syndrome, HIV, and other immunosuppressive diseases.

Question 20

What is the most common form of non-Hodgkin lymphoma in pediatrics in the U.S.?

Answer 20

The sporadic form of Burkitt lymphoma, which accounts for ~50% of pediatric non-Hodgkin lymphomas.

Question 21

In which anatomic location do most cases of Burkitt lymphoma originate in US patients?

Answer 21

90% of Burkitt-type lymphomas originate from relatively mature B-cells in Peyer patches within the GI tract, most commonly at the ileocecal junction.

Question 22

How do most children with Burkitt lymphoma present?

Answer 22

A majority of patients present with an abdominal mass or pain with nausea and vomiting.

Question 23

What is a common complication of Burkitt lymphoma?

Answer 23

Burkitt lymphoma is the fastest-growing malignant tumor (it can double in size in 2-3 days). Consequently, tumor lysis syndrome is common.

Question 24

What sites are commonly affected in lymphoblastic lymphoma?

Answer 24

Anterior mediastinum, cervical/supraclavicular/axillary nodes, and involvement of the liver, spleen, and kidneys.

Question 25

How does the lymphadenopathy of large cell non-Hodgkin lymphoma differ from that of the other forms of lymphoma?

Answer 25

The lymphadenopathy with large cell NHL is usually tender, which separates it from the other lymphomas.

Question 26

Describe the staging system for non-Hodgkin Lymphoma.

Answer 26

Staging is generally based on the volume of the tumor. Stage I: single tumor or anatomic node, excepting the mediastinum or abdomen. Stage II: ≥ 2 nodal areas on the same side of the diaphragm, 2 extranodal tumors on the same side of the diaphragm, or a resectable primary GI tumor. Stage III: involvement of both sides of the diaphragm, all mediastinal or intrathoracic tumors, all unresectable abdominal disease, and all paraspinal or epidural tumors. Stage IV: any CNS or bone marrow involvement.

Question 27

T/F: Radiation therapy is a major component of most therapy for non-Hodgkin lymphoma.

Answer 27

False. Radiation therapy is usually limited to CNS disease or emergency situations (airway obstruction).

Question 28

How is most non-Hodgkin lymphoma treated?

Answer 28

The mainstay is chemotherapy, with the typical regimen being CHOP (Cyclophosphamide, doxorubacin (Hydroxydaunorubicin), vincristine (Oncovin), and Prednisone).