Lymphoma Cases Flashcards
What lymphoma is a medical emergency?
Burkitts Lymphoma! These kids die in days-weeks!!
What was the disease that created oncologists?
Hodgkin lymphoma!!
What are the four stages of lymphomas? (Ann Arbor Staging)
I. Single LN region
II. One side of diaphragm
III. Both sides of diaphragm
IV. Disseminated
What is the immunohistochemistry consistent with a Reed Sternberg cell?
CD15+, CD30+, EBER+, CD20-, CD79a-, CD45-
What must you do if you think something is lymphoma?
EXCISIONAL BIOPSY
What translocation is associated with follicular lymphoma?
t(14;18)
What is cyclin D1 positive in?
Mantle Cell Lymphoma
What is MALT lymphoma often associated with?
Helicobacter pylori - stomach
What is the treatment for PTLPD (post-transplant lymphoproliferative disorder)?
Backing off immune suppression (ex: anti-kidney rejection medication - treated with chemo)
What should you do if someone has hemolysis??
JUST TRANSFUSE THEM - don’t take time to blood type them
What should you do if some has a lot of anemia with heart trouble/ischemia?
Transfuse them
What are B symptoms?
> 10% weight loss, drenching night sweats, fever >38.5
What three side things should you check for with potential lymphoma?
- Hepatitis B (reactivation of chronic infection)
- Ask about fertility counseling - treatment may make them infertile
- HIV - much higher rates of lymphoma in HIV tests
What is important to remember about Hodgkin’s Lymphoma?
- Malignant cell is Reed Sternberg Cell (owl eyes)
- Now recognized as a B-cell, some are CD20+
- Bulk of tumor is reactive tissue
- Spreads contiguously from node to node
What are common hodgkin’s lymphoma symptoms?
It typically presents with enlarging, rubbery, but not tender lymphadenopathy. Typically in the NECK or CHEST. Can also have: -Fatigue -Fever -Weight loss -Nigh sweats -Pain with EtOH -Symptoms of cytopenias -Hepatosplenomegaly
HL is a rare cancer, but in . . .
. . .young people with cancer, its common
-Most cases occur 15-19 years or 70-74 years
What is the best treatment for Hodgkin lymphoma?
- ABVD - used since 1970s. - Adriamycin, Bleomycin, Vinblastine, Dacarbazine
- Autotransplant - can be curative - transplant for relapsed/refractory lymphoma
- Rituximab - Targeted therapy
What is the classification of HL by WHO?
- Classical HL (CD30+)
- –Nodular sclerosis (grades I and II)
- –Lymphocyte-rich classical
- –Mixed cellularity
- –Lymphocyte depleted
- Nodular lymphocyte predominant (CD20+)
What does E and S mean in the staging of lymphomas?
E- extralymphatic site
S- Splenic disease
What are four late (bad) effects of therapy?
- Second malignancy
- Solid tumors (risk continues to increase beyond 15 years)
- -Lung cancer most common (1/3 of all cancers)
- -Breast cancer
- Secondary leukemia (rare beyond 10-15 years) - Heart disease
- Distant third cause of death after HL and second malignancies
- Most common is acute MI secondary to CAD
- Associated with radiation to the mediastinum - Lung disease
- Acute interstitial pneumonitis - chronic lung injury
- Most common in bleomycin containing regimens, esp. when combined with chest radiation
- Significant complication in transplant patients - Impaired fertility
- - infections (herpes, sepsis)
Where does testicular cancer metastasize to?
Parasitical nodes
For non-hodgkin lymphoma, what do you use other than stage for diagnosis?
IPI Scoring System Prognostic factors: -Age over 60 -Stage III/IV -ECOG 3 (need help grocery shopping) or 4 (need help with everything) -Elevated LDH -Two or more extra nodal sties
What is the treatment for Diffuse Large B-cell lymphoma (non-hodgkin)?
R-CHOP (rituximab, adriamycin, cyclophosphamide, vincristine & prednisone), followed by field radiation
What are important things to remember about Diffuse Large B-cell Lymphoma?
- Prototype aggressive NHL
- Accounts for 40% of lymphomas
- Average age = 67
- 75.3% cases are over age 55
- Quickly fatal if left untreated
- Treated with CHOP and R (rituximab) - with rituximab we now cure about 50% with no added toxicity
What is the most common T-cell lymphoma on boards?
Usually cutaneous lymphoma, with mycosis fungicides as the prototype.
What are the general principles of T cell lymphomas?
Ex: mycosis fungicides
- Not curable
- Frequently relapse, but systemic involvement is uncommon
- Treatment is UV radiation, topical or systemic
What is the only lymphoma you don’t treat? (and it isn’t curable)
Non-Hodgkin Indolent Lymphoma (ex: follicular, MALT, marginal zone, SLL, etc.)
What are the aggressive non-hodgkin lymphomas?
DLBC, Mantle Cell
What are the very aggressive non-hodgkin lymphomas?
Lymphoblastic, Burkitt, AIDs related
How does PTLPD (post-transplant lymphoproliferative disorder) usually occur?
- Solid organ transplant patients, patients with immune suppression, particularly calcineurin inhibitors (tacrolimus & cyclosporine) or ATG, who develop lymphoma
- EBC induced, poly-clonal, expansion of B cells. It occurs bc suppression of T-cells lead to loss of suppression of B-cell proliferation
What to know about systemic T cell lymphoma?
These behave badly and don’t end well!!
- Again, CHOP is often first line treatment
- No rituximab
- CD30+, then brentuximab vedotiin as targeted therapy
