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Year 3 > Lymphoma (CH) > Flashcards

Lymphoma (CH) Flashcards

1
Q

What is a lymphoma?

A

Malignant proliferation of lymphocytes (B and T cells) which accumulate in lymph nodes or other organs

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2
Q

What are the two main types of lymphoma?

A
  • Hodgkin’s lymphoma
  • non-Hodgkin’s lymphoma
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3
Q

What is a Hodgkin’s lymphoma?

A

Malignant lymphoma of B-cell origin with no antibody expression

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4
Q

How common is Hodgkin’s lymphoma?

A

Uncommon

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5
Q

What is Hodgkin’s lymphoma characterised by?

A

Reed-Sternberg cells

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6
Q

What types of Hodgkin’s lymphoma are there? (4)

A
  • nodular sclerosing - associated with lacunar cells (most common)
  • mixed cellularity
  • lymphocyte predominant (best prognosis)
  • lymphocyte depleted (worst prognosis)
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7
Q

Describe the epidemiology of Hodgkin’s lymphoma.

A
  • M>F
  • bimodal age distribution:
    • 1st peak: 25-30 years
    • 2nd peak: 50-70 years
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8
Q

What is 50% of Hodgkin’s lymphoma associated with?

A

EBV - viral particles allow infected abnormal B cells to evade apoptosis and/or replicate in an uncontrolled manner

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9
Q

What conditions are associated with Hodgkin’s lymphoma? (3)

A
  • EBV (50%)
  • immunodeficiency
  • autoimmune diseases e.g. RA, sarcoidosis
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10
Q

What are some signs of poor prognosis of Hodgkin’s lymphoma? (4)

A
  • B-symptoms (fever, weight loss, night sweats)
  • male
  • increasing age
  • stage IV disease and lymphocyte depleted subtype
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11
Q

What is a non-Hodgkin’s lymphoma?

A

Every other type of lymphoma that is not Hodgkin’s lymphoma (no Reed-Sternberg cells)

May affect B or T cells: 85% B cell, 15% T cell and NK form

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12
Q

How common is non-Hodgkin’s lymphoma?

A

More common than HL

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13
Q

What does incidence of non-Hodgkin’s lymphoma increase with?

A

Age

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14
Q

What are some causes of non-Hodgkin’s lymphoma? (4)

A
  • chromosomal translocations
  • infections - EBV, HIV, H. pylori
  • autoimmune diseases
  • immunodeficiency
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15
Q

What are some subtypes of non-Hodgkin’s lymphoma? (3)

A
  • diffuse large B-cell lymphoma
  • Burkitt’s lymphoma
  • MALT lymphoma
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16
Q

What is the most common form of lymphoma in the UK?

A

Diffuse large cell B-lymphoma (type of non-Hodgkin’s lymphoma)

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17
Q

What is Burkitt’s lymphoma?

A

Rapidly proliferating B cell tumour - type of non-Hodgkin’s lymphoma

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18
Q

What would you see on microscopy in Burkitt’s lymphoma?

A

‘Starry sky’ appearance

(‘Sky’ due to densely packed malignant B cells which appear blue on H&E stain due to minimal cytoplasm; ‘starry’ due to fixation artefact derived from debris-filled macrophages)

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19
Q

Which patients is Burkitt’s lymphoma common in?

A

HIV patients (or generally immunosuppressed) and young patients

Associated with EBV

20
Q

How can Burkitt’s lymphoma present?

A

Unusual ways due to rapid proliferation e.g. nerve root compression due to mass effect of lesion

21
Q

What is a common complication of Burkitt’s lymphoma?

A

Tumour lysis syndrome (PUKe calcium)

22
Q

What is a gastric MALT lymphoma?

A
  • associated with H. pylori infection in 95% of cases
  • good prognosis
  • if low grade, 80% respond to H. pylori eradication
  • paraproteinaemia may be present
  • type of non-Hodgkin’s lymphoma
23
Q

What are the clinical features of Hodgkin’s lymphoma? (5)

A
  • painless lymphadenopathy - cervical / supraclavicular nodes
  • involvement of single group of lymph nodes
  • alcohol-induced pain (at sites of lymphadenopathy)
  • pruritus
  • B-symptoms - fever >38, weight loss (>10% in 6m), night sweats
24
Q

What are the clinical features of non-Hodgkin’s lymphoma? (6+3)

A
  • rubbery painless lymphadenopathy (associated with fatigue)
  • affects multiple nodes
    • Waldeyer’s ring - oropharyngeal involvement
  • splenomegaly + sometimes hepatomegaly
  • B-symptoms (less common vs HL)
  • fatigue and malaise
  • extranodal disease:
    • GI - dyspepsia, dysphagia, abdominal pain
    • bone marrow - bone pain
    • neurological - headache
25
Q

What systems can non-Hodgkin’s lymphoma affect? (3)

A
  • GI - dyspepsia, dysphagia, abdominal pain
  • bone marrow - bone pain
  • neurological - headache
26
Q

Which type of lymphoma has alcohol-induced pain?

A

Hodgkin’s lymphoma

27
Q

What are the B symptoms? (3)

A
  • unexplained fevers >38
  • unexplained weight loss >10% in 6 months
  • unexplained night sweats
28
Q

When do B symptoms occur in Hodgkin’s vs non-Hodgkin’s lymphoma?

A

Typically occur earlier in Hodgkin’s lymphoma

29
Q

What are some risk factors for lymphoma? (5)

A
  • age>50
  • male
  • viruses - EBV, HIV, hep C
  • autoimmune conditions - RA, Sjogren’s, Coeliac
  • hereditary immunodeficiency syndromes
30
Q

What are the first-line investigations for lymphoma? (4)

A
  • lymph node biopsy
  • PET/CT scan
  • PET scan
  • FBC with differential
31
Q

What does histology and biopsy show in Hodgkin’s lymphoma?

A

Reed-Sternberg cells:

  • binucleate lymphocytes
  • large multinucleate cells with eosinophilic nucleoli
  • mirror image nucleoli
32
Q

What does lymph node biopsy show in non-Hodgkin’s lymphoma?

A

Positive

33
Q

What does FBC show in lymphoma?

A

Lymphocytosis

34
Q

What is immunohistochemistry useful for in non-Hodgkin’s lymphoma?

A

Determines specific cell type and identifies specific markers

35
Q

When is ESR high in lymphoma?

A

Non-Hodgkin’s lymphoma - ESR high

Adverse prognostic factor: >50mm/hr without B symptoms or >30mm/hr with B symptoms

36
Q

What is PET-CT CAP used for in lymphoma?

A

Staging (Ann-Arbor staging)

36
Q

What might be seen in blood film in lymphoma?

A
  • lymphoma cells may be seen
  • nucleated RBCs, left-shift (WBC precursors) from bone marrow involvement
37
Q

What is the Ann-Arbor staging system for lymphoma?

A
  • stage I - 1 node affected
  • stage II - >1 node affected on same side of diaphragm
  • stage III - nodes affected on both sides of diaphragm
  • stage IV - extra-nodal involvement e.g. spleen, bone marrow, CNS
  • A - no B symptoms
  • B - B symptoms
  • X - bulky diseases (widening of mediastinum)
  • E - involvement of extra-nodal site
38
Q

What do we see on CXR in lymphoma? (2)

A
  • widened mediastinum
  • bilateral hilar lymphadenopathy
39
Q

What is elevated LDH an indicator of in lymphoma?

A

Poor prognosis

40
Q

What are some differential diagnoses for lymphoma? (10)

A
  • non-Hodgkin’s lymphoma (Waldeyer ring + extra-nodal sites)
  • Hodgkin’s lymphoma (Reed-Sternberg cells, alcohol-triggered pain)
  • CLL - peripheral blood lymphocytosis (precursors but not blasts), lymphadenopathy, hepatosplenomegaly
  • ALL - acute, purpura, bleeding, infection, blasts
  • infectious mononucleosis - pharyngitis, rash, myalgia, positive heterophile AB test
  • hepatitis C
  • CMV infection
  • TB
  • HIV infection
  • sarcoidosis
41
Q

What is the management plan for Hodgkin’s lymphoma?

A

Chemotherapy +/- adjuvant radiotherapy

42
Q

What specific chemotherapy drugs are taken for Hodgkin’s lymphoma?

A

ABVD

  • Adriamycin/doxorubicin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
43
Q

What is the management plan for non-Hodgkin’s lymphoma?

A

Chemotherapy +/- radiotherapy

44
Q

What specific chemotherapy drugs are taken for non-Hodgkin’s lymphoma?

A

R-CHOP-21

Rituximab + Cyclophosphamide, doxorubicin, vincristine, Prednisolone for 21 days

45
Q

What are some complications of lymphomas?

A
  • radiotherapy-related thyroid abnormalities (hypothyroidism most common)
  • chemotherapy and radiotherapy - secondary malignancies (AML, non-Hodgkin’s lymphoma)
  • chemotherapy and radiotherapy –> accelerated diseases e.g. CAD
  • immunosuppression, infections, myelosuppression, renal failure etc
46
Q

Which lymphoma has better prognosis?

A

Hodgkin’s lymphoma has better prognosis than non-Hodgkin’s lymphoma

Year 3 (169 decks)

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