Lymphoma case studies Flashcards
Lymphadenopathy can have many etiologies. What is the pneumonic to cover the bases?
MIAMI
- Malignancy
- Infectious
- Auto-immune
- Miscellaneous
- Iatrogenic
With Lymphadenopathy, a detailed ____ is important
Detailed history
With Lymphadenopathy, a comprehensive physical is necessary. What things should you be checking for at the lymph nodes?
- Diffuse or regional lymphadenopathy
- Painful or painless
- Fixed or mobile
- Soft or hard
Tender lymph nodes are often?
Benign
What laboratory test should be ordered if suspicious of lymphadenopathy?
Biopsy
Common symptoms of malignant lymph nodes
Supraclavicular location
Hard, fixed and greater than 4 cm in size
What are 3 biopsy types?
- Fine needle aspiration
- Needle biopsy
- Excisional biopsy
What is the best way to diagnose lymphomas?
Excisional biopsy
What is the only way to diagnose Hodgkin Lymphomas?
Excisional biopsy
A fine needle aspiration takes out a ____ sample. What is it good for?
Liquid sample
- Metastatic cells and flow cytometry
A needle biopsy takes out a _____. What is it good for?
Solid core of tissue
- Metastatic cells and flow cytometry
What can only diagnose Non-Hodgkin Lymphomas?
Fine needle aspiration
Best way to diagnose a lymphoma?
Excisional biopsy
Burkitt Lymphoma translocation
t(8;14) - IgH next to MYC
Burkitt lymphoma is a fast growing mass. What is the treatment for it, especially if there is CNS involvement?
Intrathecal chemotherapy
When treating Burkitt lymphoma (or any fast growing tumor) the patients urine output has decreased. What does this indicate?
Tumor Lysis Syndrome
Tumor Lysis Syndrome - when should you suspect it?
After starting chemotherapy and the urine output DECREASES while the BUN and Cr INCREASE
Tumor Lysis Syndrome is often seen with?
Fast growing malignancies
What are 4 electrolyte disturbances seen with Tumor Lysis Syndrome?
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
What are 4 electrolyte disturbances seen with Tumor Lysis Syndrome?
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
What is the initial treatment for Tumor Lysis Syndrome?
IV fluids and Allopurinol
Allopurinol can treat?
Tumor Lysis Syndrome
How does Allopurinol treat Tumor Lysis Syndrome?
Xanthine Oxidase inhibitor (decreases uric acid)
What can treat the hyperuricemia seen with Tumor Lysis Syndrome?
Rasburicase-urate oxidase
You should not give Rasburicase-urate oxidase to patients with?
G6PD deficiency
What can treat the hypocalcemia seen with Tumor Lysis Syndrome?
Calcium gluconate
If the initial treatment for Tumor Lysis Syndrome does not work, you should?
Treat the electrolyte disturbances
Common symptoms of Hodgkin Lymphoma?
Lymphadenopathy
B symptoms - fever, night sweats, weight loss
Mediastinal mass
B symptoms
Fever, night sweats, weight loss
- seen often with Hodgkin Lymphoma
What cells are seen with Hodgkin Lymphoma?
Reed Sternberg cells
What is the treatment for Hodgkin Lymphoma?
21 or 28 day chemotherapy
The prognosis for Hodgkin Lymphoma is?
Excellent
CLL/SLL contains lots of what on peripheral smear?
Mature, small lymphocytes
How does CLL/SLL present?
Usually asymptomatic or fatigued
If a diagnosis of CLL/SLL is made, what should you be concerned could happen?
Richter transformation
What is the Richter transformation?
CLL/SLL transitioning into an aggressive tumor
If CLL/SLL undergoes the Richter transformation, what are the signs?
- Going from asymptomatic or fatigued to:
= fever, night sweats, weight loss, lymphadenopathy
What is the treatment for CLL/SLL that underwent the Richter transformation?
Chemotherapy + Rituximab
Chemotherapy + Rituximab can treat?
CLL/SLL that underwent the Richter transformation
What is Rituximab?
Monoclonal antibody to CD20 receptors
