Lymphoma

Question 1

Define lymphoma (Hodkin’s and non-Hodgkin’s)

Answer 1

Malignancies of lymphoid cells originating in the lymph nodes or other lymphoid tissues

Hodgkin’s = Neoplasm of lymphoid cells

Non-Hodgkin’s = malignancy of lymphoid cells (85% B cell)

Question 2

Aetiology and risk factors of Hodgkin’s lymphoma

Answer 2

Unknown aet

Linked to EBV (50%)
Family history
Higher social class

Question 3

Aetiology and risk factors of Non-Hodgkin’s lymphoma

Answer 3

Accumulation of oncogene and tumour-suppressor gene lesions, may be due to alteration by oncogenic viruses

RF: viral infection, radio/chemotherapy, immunosuppression, SLE

Question 4

Which viruses are associated with the following lymphomas: Burkitt’s and AIDS-associated, Adult T cell, Body-cavity-based

Answer 4

Burkitt’s/AIDS-associated - EBV

Adult T cell (ATLL) - HTLV-1

Body-cavity-based - HHV-8

Question 5

Epidemiology of Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma

Answer 5

Makes up 15% of lymphomas
Bimodal age distribution
Males > females

Incidence increases with age
Males > females
More prevalent in the West

Question 6

Presenting symptoms of Hodgkin’s lymphoma

Answer 6

Painless enlarging mass, often on neck (also axilla and groin) which may become painful after alcohol and ingestion

Systemic: fever, night sweats, weight loss

Pruritus

Dry cough

Dyspnoea, cough, orthopnoea, oedema, neck vein dilation (Superior vena cava syndrome)

Question 7

Presenting symptoms of Non-Hodgkin’s lymphoma

Answer 7

Painless enlarging mass (neck/axilla/groin)

Systemic: fever, night sweats, weight loss

Hypercalcaemia (stones, thrones, abdominal groans, psych moans)

Extra-nodal: skin rash (Mycosis fungoides), headache, sore throat, testicular swelling, abdo discomfort

Bone marrow: anaemia, infections, purpura

Question 8

What is the following describing: well-defined indurated scaly plaque-like lesions with raised ulcerated nodules

Answer 8

Mycosis fungoides found in cutaneous T cell lymphoma and Sezary’s syndrome

Question 9

Signs of Hodgkin’s lymphoma

Answer 9

Lymphadenopathy (cervical/axillary/inguinal) - non-tender, firm, rubbery
Splenomegaly (EBV)
Hepatomegly

Question 10

Signs of Non-Hodgkin’s lymphoma

Answer 10

Lymphadenopathy - painless, firm, rubbery
May have oropharyngeal (Waldeyer’s ring or lymph nodes) involvement

Mycosis fungoides

Hepatosplenomegaly

Abdominal mass

Purpura

Question 11

Investigations for Hodgkin’s lymphoma

Answer 11

Lymph node biopsy - shows REED-STERNBERG CELLS (large cell with abundant pale cytoplasm + oval lobulated nuclei) -> Owl eye

FBC: microcytic anaemia, Raised WBC, lymphocytes, neutrophils, eosinophils
CRP/ESR: raised
LFTs: raised LDH

CXR: mediastinal mass
PET, CT CAP, Gallium scan: staging

Bone marrow aspirate and trephine biopsy: Presence of Hodgkin’s cells

Question 12

Investigations for Non-Hodgkin’s lymphoma

Answer 12

Lymph node biopsy
Bone marrow aspirate and trephine biopsy

FBC: anaemia with neutropenia and thrombocytopenia (bone marrow involvement)
U+Es: calcium raised
CRP/ESR: raised
LFTs: LDH raised
Serology: important for HIV, hBV and HCV
Blood film: lymphoma cells, nucleated RBCs and left shift

CXR, PET, CT CAP, Gallium scan: staging