Lymphoma

Question 1

State the causes of lymphadenopathy

Answer 1

Infection/inflammation 
Neoplasm 
Drugs/toxins 
Autoimmune 
Metabolic

Question 2

Name the B symptoms

Answer 2

Fever
Night sweats
Weight loss - 10% over 6 months

Question 3

On examination what patterns would suggest infectious cause?

Answer 3

Tender, firm, smooth nodes

Question 4

On examination what patterns would suggest lymphoma?

Answer 4

Rubbery, soft, smooth, non-tender nodes

Question 5

On examination what patterns would suggest metastatic disease?

Answer 5

Non-tender, hard, irregular tethered nodes

Question 6

What investigations can be done in lymphadenopathy?

Answer 6

Full blood count 
Biochemical profile 
General investigations for non-malignant cause 
Biopsy - excision 
Imaging

Question 7

Describe the morphology of Hodgkin lymphoma

Answer 7

Nodular appearance, darker areas surrounded by fibres/sclerosis

Question 8

What is immunohistochemistry?

Answer 8

Confirm diagnosis and subclassify

Enzyme based assay looking at patterns of proteins on the surface/in cells

Question 9

What do the colours of immunohistochemistry indicate?

Answer 9

Brown - positive

Blue - negative

Question 10

Name a b cell marker

Answer 10

CD20

Question 11

Name a hodgkin marker

Answer 11

CD30

Question 12

What genetic techniques are used in lymphoma?

Answer 12

Chromosome analysis
FISH
PCR

Question 13

Describe B cell development

Answer 13

1. Lymphoid progenitor
2. B cell progenitor
3. Immature B cell

Question 14

What happens to the immature B cell?

Answer 14

Naive B cell interacts with antigen

Travels to lymph node mantel cell

Question 15

After the naive B cell interacts with antigen what happens

Answer 15

Short lived plasma cell producing antibodies

Lymphoblast

Question 16

Describe the maturation of a lymphoblast

Answer 16

Centrocyte
Centroblast
Marginal/ memory cell or long lived plasma cel

Question 17

Describe T cell development

Answer 17

1. lymphoid progenitor
2. T cell progenitor
3. Thymus
   - T cells
   - effector T cells
   - memory T cells

Question 18

What T cells migrate to help in the lymph node?

Answer 18

Follicular helper T cell

Question 19

What are the two key types of lymphoma?

Answer 19

Hodgkin

Non-hodgkin

Question 20

Are most lymphomas B or T cells?

Answer 20

B

Question 21

Name the risk factors for lymphoma

Answer 21

Immunosuppression 
Autoimmune disorders 
Infections 
Genetic predisposition 
Environment

Question 22

Describe Ann Arbor staging

Answer 22

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

Question 23

What biochemical marker can help prognosis?

Answer 23

Lactate dehydrogenase - marker of cell necrosis

Question 24

What is the peak incidence of hodgkin lymphoma?

Answer 24

Third decade

Question 25

What are typical cells in hodgkin lymphoma?

Answer 25

Reed Sternberg Cell

Question 26

Describe Reed Sternberg Cell

Answer 26

Typical, binucleate appearance and associates with inflammatory cells

Question 27

How is hodgkins lymphoma treated?

Answer 27

Multiagent chemotherapy +/- radiotherapy | Immunotherapy/stem cell transplantation

Question 28

What chemotherapy can cause pneumonitis?

Answer 28

Bleomycin

Question 29

What are the effects of lymphoma treatment?

Answer 29

Secondary cancer Cardiovascular disease Infertility

Question 30

Name a common high grade NHL

Answer 30

Diffuse large B cell lymphoma

Question 31

What subtypes of NHL are associated with extra nodal disease?

Answer 31

T cell | Burkitt

Question 32

How is NHL treated?

Answer 32

Multi-agent chemotherapy +/- radiotherapy | Monoclonal antibody therapy + chemotherapy

Question 33

Name two monoclonal antibody therapies

Answer 33

Rituximab | Brentuximab

Question 34

What is the prognosis for NHL?

Answer 34

High grade - potentially curable | Low grade - treatment is disease control measure may live normal life span

Question 35

In patients with NHL failing chemo what can be given?

Answer 35

High dose therapy with autologous stem cell rescue or CART therapy

Question 36

What is the fastest growing humour tumour?

Answer 36

Burkitt

Question 37

What disease is burkitt associated with?

Answer 37

EBV | HIV

Question 38

Where does burkitt affect?

Answer 38

``` Jaw/abdomen Extranodal involvement (bone, CNS, testes) ```

Question 39

What genetic change occurs in Burkitt?

Answer 39

c-myc translocation

Question 40

How does tumour lysis present?

Answer 40

``` Hyperkalaemia Hypocalcaemia Hyperphosphataemia Hyperuricaemia Renal failure ```

Question 41

Why can steroids be used in lymphoma treatment?

Answer 41

Lymphocytes are sensitive to steroids

Question 42

When are steroids useful and how should they be used?

Answer 42

Useful in compressive symptoms - biopsy before steroids as cellular necrosis and distortion may occur