Lymphoma Flashcards
State the causes of lymphadenopathy
Infection/inflammation Neoplasm Drugs/toxins Autoimmune Metabolic
Name the B symptoms
Fever
Night sweats
Weight loss - 10% over 6 months
On examination what patterns would suggest infectious cause?
Tender, firm, smooth nodes
On examination what patterns would suggest lymphoma?
Rubbery, soft, smooth, non-tender nodes
On examination what patterns would suggest metastatic disease?
Non-tender, hard, irregular tethered nodes
What investigations can be done in lymphadenopathy?
Full blood count Biochemical profile General investigations for non-malignant cause Biopsy - excision Imaging
Describe the morphology of Hodgkin lymphoma
Nodular appearance, darker areas surrounded by fibres/sclerosis
What is immunohistochemistry?
Confirm diagnosis and subclassify
Enzyme based assay looking at patterns of proteins on the surface/in cells
What do the colours of immunohistochemistry indicate?
Brown - positive
Blue - negative
Name a b cell marker
CD20
Name a hodgkin marker
CD30
What genetic techniques are used in lymphoma?
Chromosome analysis
FISH
PCR
Describe B cell development
- Lymphoid progenitor
- B cell progenitor
- Immature B cell
What happens to the immature B cell?
Naive B cell interacts with antigen
Travels to lymph node mantel cell
After the naive B cell interacts with antigen what happens
Short lived plasma cell producing antibodies
Lymphoblast
Describe the maturation of a lymphoblast
Centrocyte
Centroblast
Marginal/ memory cell or long lived plasma cel
Describe T cell development
- lymphoid progenitor
- T cell progenitor
- Thymus
- T cells
- effector T cells
- memory T cells
What T cells migrate to help in the lymph node?
Follicular helper T cell
What are the two key types of lymphoma?
Hodgkin
Non-hodgkin
Are most lymphomas B or T cells?
B
Name the risk factors for lymphoma
Immunosuppression Autoimmune disorders Infections Genetic predisposition Environment
Describe Ann Arbor staging
I - one node/extra lymph node area
II - 2 or more on one side of diaphragm
III - 2 or more on both sides of diaphragm
IV - disseminated/multiple extra nodal area
What biochemical marker can help prognosis?
Lactate dehydrogenase - marker of cell necrosis
What is the peak incidence of hodgkin lymphoma?
Third decade
What are typical cells in hodgkin lymphoma?
Reed Sternberg Cell
Describe Reed Sternberg Cell
Typical, binucleate appearance and associates with inflammatory cells
How is hodgkins lymphoma treated?
Multiagent chemotherapy +/- radiotherapy
Immunotherapy/stem cell transplantation
What chemotherapy can cause pneumonitis?
Bleomycin
What are the effects of lymphoma treatment?
Secondary cancer
Cardiovascular disease
Infertility
Name a common high grade NHL
Diffuse large B cell lymphoma
What subtypes of NHL are associated with extra nodal disease?
T cell
Burkitt
How is NHL treated?
Multi-agent chemotherapy +/- radiotherapy
Monoclonal antibody therapy + chemotherapy
Name two monoclonal antibody therapies
Rituximab
Brentuximab
What is the prognosis for NHL?
High grade - potentially curable
Low grade - treatment is disease control measure may live normal life span
In patients with NHL failing chemo what can be given?
High dose therapy with autologous stem cell rescue or CART therapy
What is the fastest growing humour tumour?
Burkitt
What disease is burkitt associated with?
EBV
HIV
Where does burkitt affect?
Jaw/abdomen Extranodal involvement (bone, CNS, testes)
What genetic change occurs in Burkitt?
c-myc translocation
How does tumour lysis present?
Hyperkalaemia Hypocalcaemia Hyperphosphataemia Hyperuricaemia Renal failure
Why can steroids be used in lymphoma treatment?
Lymphocytes are sensitive to steroids
When are steroids useful and how should they be used?
Useful in compressive symptoms - biopsy before steroids as cellular necrosis and distortion may occur
