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?
What are the causes of non-Hodkin’s lymphoma?
Complex process involving the accumulation of multiple genetic lesions
The changes in the genome in certain lymphoma subtypes have been associated with the introduction of foreign genes via oncogenic viruses (e.g. EBV and Burkitt’s lymphoma)
Radiotherapy
Immunosuppressive agents
Chemotherapy
HIV, HBV, HCV, HTL-V1
EBV and Burkitt’s
H pylori
Connective tissue disease (e.g. SLE)
Sjogren’s
Coeliac’s
Outline extranodal disease in non hodgkin’s lymphoma and give the symptoms related to this?
extranodal disease ( 50% ) **gut ( commonest)**
1) Gastric MALT- caused by H pylori -> symptoms same as gastric cancer
- MALT usually involved altrum, is multifocal and metastasises late
2) non- MALT gastric lymphomas ( 60% ) - usually diffuse large cell lymphomas- high grade and not responding well to H-pylori eradication
3) small- bowel lymphomas eg IPSID) or EATCL- presents with diarrhoea, vomiting, diarrhoea, vomiting, abdominal pain and decreased weigh- poor prognosis
skin ( second most common)
- Eg clonal T cells in mycosis fungoides
Oropharynx
- Waldeyer’s ring lymphoma causes sore throat, obstructed breathing
other sites- bone, CNS, lung
what are the symptoms of non- Hodgkin’s lymphoma?
Painless enlarging mass (in neck, axilla or groin) – superficial lymphadenopathy
Systemic Symptoms (occurs less frequently than in Hodgkin’s):
Fever
Fatigue/malaise
Night sweats
Weight loss > 10% body weight
Symptoms of hypercalcaemia
Symptoms related to organ involvement
Extranodal disease is MORE COMMON in NHL than in Hodgkin’s lymphoma
Skin rashes
Headache
Sore throat
SOB – pleural involvement
Cough
Headache/change in mental status – meningeal involvement
Abdominal discomfort
Testicular swelling
Dizziness and ataxia – CNS involvement
Bone and back pain – bone involvement
Jaundice – liver infiltration
What are the systemic symptoms of non-Hodgkin’s?
less common than in hodkin’s lymphoma and indicates
Fever
Fatigue/malaise
Night sweats
Weight loss > 10% body weight
Symptoms of hypercalcaemia
What are the signs of non-Hodkin’s lymphoma?
Painless firm rubbery lymphadenopathy
Skin rashes- Mycosis fungoides - pruritic cutaneous plaques - looks like a fungal infection but is in fact a cutaneous T-cell lymphoma
Abdominal mass
Hepatomegaly
signs of bone marrow involvement
- anaemia
- infections
- purpura
What are the appropriate investigations for non-Hodkins lymphoma?
bloods
blood film- lymphomas may be visible in some patients
bone marrow aspiration and biopsy
imaging- CT, CXR, PET
Lymph Node Biopsy - allows histopathological evaluation, immunophenotyping and cytogenetics
Staging - Ann-Arbor
What can be seen in the bloods when investigating a non-Hodkin’s lymphoma?
FBC
-anaemia
- lymphocytosis
- neutropenia
- thrombocytopenia
High ESR and CRP
Raised LDH
Renal and liver baseline test s
Calcium may be raised
HIV, HBV and HCV serology
summarise Hodkins lymphoma?
Hodgkin’s : B cell symp (systemic symp) + lymph N hurts with alcohol + pruritis + NT rubbery lymphadenopathy + reed stern burg cells , associated with EBV - high WCC, low Hb and low plts
summarise non-Hodkin’s lymphoma?
Non-Hodgkin’s : painless enlarging cervical lymph N + organ involvement (skin rashes, headache, hepatosplenomegaly + sore throat/ cough + BM fail signs) – associated with Sjogrens
Burkitts lymphoma: African, large N in jaw growing quick and starry sky appearance
summarise a typical presentation of Burkitt’s lymphoma?
subtype of NHL ( B cell)
- African child
- large lymph node in jaw ( fast growing)
- under microscopy- starry appearance
