Lymphoma and Myeloma

Question 1

What are the CRAB features?

Answer 1

Hypercalcaemia

Renal impairment

Anaemia

Lytic bone lesions

Question 2

In which type of myeloma are the bone lesions sclerotic?

Answer 2

Poems

Question 3

What is immunoparesis?

Answer 3

Relative deficiency in endogenous, protective Ig, that is replaced by pathological paraprotein

Question 4

What is lymphoma?

Answer 4

Malignant tumours of lymphoid tissue (not arising primarily from bone marrow)

Question 5

What are Reid-Sternberg cells?

Answer 5

Binucleated giant cells (owl eyed) typically seen in Hodgkin lymphoma

Question 6

How is treatment divided in Hodgkin lymphoma?

Answer 6

<2A - Local radiotherapy only

>2B - Local radiotherapy and chemotherapy

Question 7

Define CHOPR, define how it’s cycled

Answer 7

Cyclophosphamide - haemorrhage cytitis, and renal impairment

Hydroxydaunorubicin (adriamycin) - cardiac toxicity

Oncovin (vincintine) - peripheral neuropathy

Prednisolone

Rituximab

CHO on day one and P on day 1 to 5 is one cycle, do a cycle every 3 weeks or so depending on bone marrow response

Question 8

Which lymphoma would you expect in young patients?

Answer 8

Hodgkin lymphoma

Burkitt

Lymphoblastic

Anaplastic large cell

Question 9

Where does Hodgkin lymphoma typically present?

Answer 9

Neck and mediastinal nodes

Question 10

Which type of lymphoma is common in the groin?

Answer 10

T-cell lymphoma

Question 11

A polyclonal process is typical of benign or malignant lymphoma?

Answer 11

Benign

Question 12

A monoclonal process is typical of benign or malignant lymphoma?

Answer 12

Malignant

Question 13

Describe the light chain phenotype in malignant myeloma?

Answer 13

It is restricted to cappa or lambda

Question 14

Which lymphoma has a classic starry sky appearance on histopath?

Answer 14

Burkitt lymphoma

Question 15

How do nodes in Hodgkin lymphoma feel on palpation?

Answer 15

Rock hard

Question 16

What are the major side effects of each of the CHOPR drugs?

Answer 16

Cyclophosphamide - haemorrhage cytitis, and renal impairment

Hydroxydaunorubicin (adriamycin) - cardiac toxicity

Oncovin (vincintine) - peripheral neuropathy

Prednisolone

Rituximab - Lymphopenia

Question 17

What characteristic urine feature do you get in multiple myeloma? What is it?

Answer 17

Bence-Jones protein

Light chains

Question 18

What is MGUS? How is it significant?

Answer 18

Monoclonal gammopathy of undetermined significance - paraprotein is present in the absent of myeloma

People with it are at higher risk of developing myeloma

Question 19

Are Ix are specific for diagnosing MM?

Answer 19

Serum and urine electrophoresis

B-2 Microglobulin

Bone marrow examination

Xray skull, spine and long bones

Question 20

How is MM treated?

Answer 20

Melphalan

Cyclophosphamide

Thalidomide

Bone marrow transplant

Plasmapheresis to reduce paraprotein if causing symptoms

Bisphosphonates for bone

Question 21

What des MM look like on bone marrow biopsy?

Answer 21

>5% plasma cell

With irregular morphology - increase blue in cytoplasm

Question 22

When does MGUS become myeloma?

Answer 22

When there are

• CRAB symptoms
• Bone marrow >10% plasma cells

Question 23

When should you suspect MM?

Answer 23

Pathological fracture

Unexplained renal failure

Unexplained hypercalcaemia

Unexplained anaemia with rouleax (staking of RBCs)

High total protein despite low/normal albumin

Question 24

What do you see on low power views of Hodgkin lymphoma LNs?

Answer 24

Nodularity and sclerosis

Question 25

What is the name of the staging system in lymphoma?

Answer 25

Ann Arbor staging classification

Question 26

How does follicular lymphoma present?

Answer 26

Painless, slow growing lymphadenopathy

Question 27

What are the three classic Ix finding in Burkitt’s?

Answer 27

Vacuolated cytoplasm

High LDH

Starry sky pattern