Lymphoma

Question 1

What are lymphomas?

Answer 1

Neoplasms of lymphoid cells, originating in the lymph nodes or other lymphoid tissues
Arises from Mature B cells

Question 2

Hodgkins lymphomas account for what percentage of all lymphomas?

Answer 2

15%

Question 3

What histological feature is diagnostic for Hodgkins lymphoma?

Answer 3

Reed Sternberg cells

“OWL EYES”

Question 4

Describe the aetiology of Hodgkins lymphoma

Answer 4

UNKNOWN
Likely to be an environmental trigger in a genetically susceptible individual
EBV genome detected in 50% of Hodgkin’s lymphomas

Question 5

Give 2 risk factors for Hodgkins lymphoma

Answer 5

FHx

EBV

Question 6

Describe the epidemiology of Hodgkins lymphoma

Answer 6

Bimodal age distribution with peaks at 20-30yrs + > 50yrs

M > F

Question 7

List 3 symptoms of Hodgkins lymphoma

Answer 7

Pruritis
Cough
Dyspnoea

Question 8

List 3 B symptoms of Hodgkins lymphoma

Answer 8

Fever > 38 degrees: If cyclical = Pel-Ebstein fever
Night sweats
Weight loss > 10% body weight in 6 months

Question 9

Describe the mass in Hodgkins lymphoma

Answer 9

Painless enlarging mass
Rubbery, superficial
Most commonly in neck (Can also be in axilla or groin)
May become painful after alcohol ingestion

Question 10

List 7 signs of Hodgkins lymphoma

Answer 10

Non-tender firm rubbery lymphadenopathy (cervical, axillary or inguinal)
Splenomegaly (or sometimes, hepatosplenomegaly)
Skin excoriations
Signs of intrathoracic disease (e.g. pleural effusion, superior vena cava obstruction)
Cachexia
Tonsillar enlargement
Anaemia: Pallor

Question 11

Describe bloods in Hodgkins lymphoma

Answer 11

Anaemia of chronic disease (Low Hb, low platelets)
Leucocytosis (Lymphopaenia in advanced disease)
High neutrophils
High eosinophils
High ESR + CRP
High LDH (released in cell turnover)

Question 12

What is seen on lymph node biopsy in Hodgkins lymphoma?

Answer 12

Reed Sternberg Cells

Question 13

What imaging may be performed in Hodgkins lymphoma? Why?

Answer 13

CXR, CT, PET

May show mediastinal mass

Question 14

What system is used for staging in Hodgkins lymphoma?

Answer 14

Ann Arbor Staging

Question 15

Describe Ann Arbor Staging

Answer 15

I = single lymph node region  
II = 2+ lymph node regions on 1 side of the diaphragm 
III = lymph node regions on both sides of the diaphragm 
IV = extranodal involvement  
A = absence of B symptoms  
B = presence of B symptoms  
E = localised extranodal extension  
S = involvement of spleen

Question 16

Why may Bone Marrow Aspirate and Trephine Biopsy be performed in Hodgkins lymphoma?

Answer 16

Can spread to bone marrow in late stages