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Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

State the causes of lymphadenopathy

A 
Infection/inflammation 
Neoplasm 
Drugs/toxins 
Autoimmune 
Metabolic
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2
Q

Name the B symptoms

A

Fever
Night sweats
Weight loss - 10% over 6 months

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3
Q

On examination what patterns would suggest infectious cause?

A

Tender, firm, smooth nodes

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4
Q

On examination what patterns would suggest lymphoma?

A

Rubbery, soft, smooth, non-tender nodes

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5
Q

On examination what patterns would suggest metastatic disease?

A

Non-tender, hard, irregular tethered nodes

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6
Q

What investigations can be done in lymphadenopathy?

A 
Full blood count 
Biochemical profile 
General investigations for non-malignant cause 
Biopsy - excision 
Imaging
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7
Q

Describe the morphology of Hodgkin lymphoma

A

Nodular appearance, darker areas surrounded by fibres/sclerosis

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8
Q

What is immunohistochemistry?

A

Confirm diagnosis and subclassify

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

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9
Q

What do the colours of immunohistochemistry indicate?

A

Brown - positive

Blue - negative

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10
Q

Name a b cell marker

A

CD20

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11
Q

Name a hodgkin marker

A

CD30

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12
Q

What genetic techniques are used in lymphoma?

A

Chromosome analysis
FISH
PCR

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13
Q

Describe B cell development

A
  1. Lymphoid progenitor
  2. B cell progenitor
  3. Immature B cell
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14
Q

What happens to the immature B cell?

A

Naive B cell interacts with antigen

Travels to lymph node mantel cell

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15
Q

After the naive B cell interacts with antigen what happens

A

Short lived plasma cell producing antibodies

Lymphoblast

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16
Q

Describe the maturation of a lymphoblast

A

Centrocyte
Centroblast
Marginal/ memory cell or long lived plasma cel

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17
Q

Describe T cell development

A
  1. lymphoid progenitor
  2. T cell progenitor
  3. Thymus
    - T cells
    - effector T cells
    - memory T cells
18
Q

What T cells migrate to help in the lymph node?

A

Follicular helper T cell

19
Q

What are the two key types of lymphoma?

A

Hodgkin

Non-hodgkin

20
Q

Are most lymphomas B or T cells?

A

B

21
Q

Name the risk factors for lymphoma

A 
Immunosuppression 
Autoimmune disorders 
Infections 
Genetic predisposition 
Environment
22
Q

Describe Ann Arbor staging

A

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

23
Q

What biochemical marker can help prognosis?

A

Lactate dehydrogenase - marker of cell necrosis

24
Q

What is the peak incidence of hodgkin lymphoma?

A

Third decade

25
Q

What are typical cells in hodgkin lymphoma?

A

Reed Sternberg Cell

26
Q

Describe Reed Sternberg Cell

A

Typical, binucleate appearance and associates with inflammatory cells

27
Q

How is hodgkins lymphoma treated?

A

Multiagent chemotherapy +/- radiotherapy

Immunotherapy/stem cell transplantation

28
Q

What chemotherapy can cause pneumonitis?

A

Bleomycin

29
Q

What are the effects of lymphoma treatment?

A

Secondary cancer
Cardiovascular disease
Infertility

30
Q

Name a common high grade NHL

A

Diffuse large B cell lymphoma

31
Q

What subtypes of NHL are associated with extra nodal disease?

A

T cell

Burkitt

32
Q

How is NHL treated?

A

Multi-agent chemotherapy +/- radiotherapy

Monoclonal antibody therapy + chemotherapy

33
Q

Name two monoclonal antibody therapies

A

Rituximab

Brentuximab

34
Q

What is the prognosis for NHL?

A

High grade - potentially curable

Low grade - treatment is disease control measure may live normal life span

35
Q

In patients with NHL failing chemo what can be given?

A

High dose therapy with autologous stem cell rescue or CART therapy

36
Q

What is the fastest growing humour tumour?

A

Burkitt

37
Q

What disease is burkitt associated with?

A

EBV

HIV

38
Q

Where does burkitt affect?

A 
Jaw/abdomen 
Extranodal involvement (bone, CNS, testes)
39
Q

What genetic change occurs in Burkitt?

A

c-myc translocation

40
Q

How does tumour lysis present?

A 
Hyperkalaemia 
Hypocalcaemia
Hyperphosphataemia 
Hyperuricaemia 
Renal failure
41
Q

Why can steroids be used in lymphoma treatment?

A

Lymphocytes are sensitive to steroids

42
Q

When are steroids useful and how should they be used?

A

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

Haematology (18 decks)

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