Lymphoma Flashcards
define hodgkins lymphoma?
lymphomas are disorders caused by malignant proliferations of lymphocytes ->accumulate in lymph nodes causing lymphadenopathy-> can also be found in peripheral blood or infiltrate organs
histologically divided into Hodgkins and non- Hodgkin
s Hodgkin’s lymphoma ( 15% of all lymphomas) diagnosed by presence of reed-sternberg cells (cells with mirror image nuclei)
what is a histopathological feature of Hodgkin’s lymphoma?
Reed-sternberg cells ( binucleate lymphocytes)- OWL EYES
what are the signs of Hodgkin’s lymphoma?
Painless enlarging mass – enlarged, painless, non-tender, rubbery, superficial
- Most commonly in the neck
- Can also be in the axilla or groin
The mass may become painful after alcohol ingestion
Mediastinal lymph node involvement can cause mass effect e.g. bronchial/SVC obstruction
B symptoms of Lymphoma (systemic)
- Fever > 38 degrees
- If this is cyclical it is referred to as Pel-Ebstein fever
- Night sweats
- Weight loss > 10% body weight in the past 6 months
Other symptoms
- Pruritis
- Cough
- Dyspnoea
- Chest/abdo pain – if extensive mediastinal adenpathy
what are the B symptoms of a lymphoma?
fever > 38 degrees-> if this is cyclical it is referred to as Pel- Ebstein fever Night sweats Weight loss> 10% Of body weight in the past 6 months
what are the 2 divisions of lymphomas?
Hodgkins and and non-Hodgkins
Explain the aetiology / risk factors for hodgkins
UNKNOWN
Likely to be an environmental trigger in a genetically susceptible individual
EBV genome has been detected in 50% of Hodgkin’s lymphomas
Risk factors
- FHx
- EBV
Summarise the epidemiology of Hodgkin’s lymphoma
Bimodal age distribution with peak at 20-30 years and more than 50 More common in males (2:1)
What are the appropriate investigations for Hodgkin’s lymphoma?
Bloods
Lymph node biopsy
Bone marrow aspirate and trephine biopsy-> Can spread to bone marrow in late stage
Imaging - CXR, CT, PET
What bloods do you need for hodkin’s lymphoma and describe the results?
FBC:
- high WCC
- Low Hb and plts
- Leucocytosis
- High neutrophils
- High eosinophils
- High ESR and CRP
- High LDH (released during cell turnover)
Baseline thyroid, renal and liver functions
What will be seen in the lymph node biopsy in Hodgkin’s lymphoma
Reed- sternberg cells
what is the Ann Arbor staging?
I= single lymph node region II= 2+ lymph node regions on one side of the diaphragm III= lymph node regions on both sides of the diaphragm IV= extranodal involvment
outline the different letters to describe each stage?
A= no systemic symptoms other than pruritis B= presence of B symptoms-> worse prognosis E= extranodal extension S= involvement of spleen
What are the subtypes of Hodgkin’s lymphoma?
Mixed cellularity subtype: It is pathologically characterized by a mixture of lymphocytes and Reed Sternberg cells, and is the subtype often noted to have the greatest abundance of Reed Sternberg cells. It has the closest association with Epstein-Barr Virus among all the subtypes.
Nodular Sclerosing subtype: While the nodular sclerosing subtype is the most common type of HL (65-75%), it predominantly occurs in young middle-aged women. Its pathology shows collagen banding separating nodular regions- good prognosis
Nodular lymphocyte predominant subtype: It is pathologically characterized by an abundance of lymphocytes relative to Reed-Sternberg cells. It occurs more often in younger men. This has the best prognosis.
lymphocyte depleted- poor prognosis
define a non-Hodkin’s lymphoma?
All lymphomaas without Reed-sternberg cells ( makes 85% of all lymphomas)
most derived from B cell lines-diffuse large B cell lymphoma is commonest
not all centre nodes ( extranodal tissue generarting lymphoma include mucosa- associated lymphoid tissue- eg gastric MALT)
what are the 2 types of non-Hodgkin’s lymphoma?
