Lymphoma: High/low grade, Hodgkin/Non-Hodgkin

Question 1

Define lymphoma?

Answer 1

Group of haematological malignancies of lymphocytes, which originates from the lymphatic system

Question 2

What is the main difference between lymphoma and lymphocytic leukaemia?

Answer 2

Lymphoma and lymphocytic leukaemia both are cancers of lymphocytes

But lymphoma originates from lymphatic system and leukaemia originates from bone marrow

Question 3

What is the usual initial clinical presentation of lymphoma?

Answer 3

Painless swelling of lymph node

Question 4

What 3 B symptoms can present in lymphoma, and are also red flags of other haematological malignancies?

Answer 4

Drenching night sweats

Unexplained fever

Weight loss over 6 months, that was unintentional and over 10% baseline weight

Question 5

Give the 2 main ways in which lymphoma can affect other organs, in terms of clinical presentation?

Answer 5

Splenomegaly

Presentation of symptoms due to lumps compressing other structures eg. shortness of breath due to lesion in lung, bowel movement changes

Question 6

Give examples of signs of BMF or anaemia commonly present in clinical presentation of lymphomas, and the underlying lab finding that causes these?

Answer 6

Cytopenias

Which cause eg. TATT, frequent infections, bleeding or bruising easily, pallor

Question 7

If a patient presents with pruritus, what can this signify when classifying the lymphoma?

Answer 7

Pruritus (widespread itching) is a common feature of Hodgkin lymphoma instead of Non-hodgkin lymphoma

Question 8

Describe the location of the lump that characteristically presents in Hodgkin’s lymphoma, and what is the anatomical term?

Answer 8

Lump in chest

Mediastinal mass

Question 9

Give one characteristic feature of Hodgkin’s lymphoma that presents when drinking?

Answer 9

Lymph node pain when drinking alcohol

Question 10

Which 2 age groups are most commonly affected by Hodgkin’s lymphoma?

Answer 10

Young adults

Over 60 yrs old

Question 11

Is Hodgkin’s lymphoma equally common in males and females?

Answer 11

More common in males

Question 12

What virus is Hodgkin’s lymphoma associated with, and is this a causative agent?

Answer 12

EBV

Not causative agent

Question 13

What lab investigation confirms the diagnosis of lymphomas, and why?

Answer 13

Lump biopsy (core biopsy or whole node excision)

Provides info about HL/NHL and grade

Question 14

Why is FNA of a lymph node not used to confirm lymphoma diagnosis?

Answer 14

FNA can give info about cellular tissue of lymph node but not about grade or HL/NHL

Question 15

Compare the history and onset of high grade (aggressive) and low grade (indolent) lymphomas?

Answer 15

High grade: Short history (symptomatic with rapid onset)

Low grade: Longer or no history (asymptomatic with insidious onset)

Question 16

Compare the general treatment of high grade (aggressive) and low grade (indolent) lymphomas?

Answer 16

High grade: Treated immediately with intensive chemotherapy

Low grade: Treated by watch and wait, until low intensity chemotherapy is needed

Question 17

Compare the prognosis of high grade (aggressive) and low grade (indolent) lymphomas?

Answer 17

High grade: Potentially curable with 1-2 chances (After relapse, second-line drug is used which can be successful)

Low grade: Lifelong illness that is treated with multiple chances, to relieve symptoms

Question 18

Why are low grade lymphomas rarely cured, and instead stay as lifelong illnesses?

Answer 18

Rarely cured because they often present at advanced stage

Question 19

Describe the classification of Burkitt lymphoma, its characteristic pathophysiology, onset and lab finding?

Answer 19

Very rapidly progressive subtype of high grade Non-Hodgkin lymphomas

Starry sky appearance: Characterised by large vacuolated cells

Caused by chromosome translocation (8;14): On chromosome 8 , C-MYC gene is a regulator of the cell cycle and plays a major role in the control of cell growth, differentiation, apoptosis and neoplastic transformation

Question 20

Describe the lab finding that confirms the diagnosis of Hodgkin lymphoma and Non-Hodgkin lymphoma?

Answer 20

Hodgkin lymphoma diagnosis: Microscopic imaging of biopsy shows presence of Reed-Sternberg cells

Non-Hodgkin lymphoma diagnosis: Microscopic imaging of biopsy shows absence of Reed-Sternberg cells

Question 21

Describe the appearance of Reed-Sternberg cells, and what cancer is this a hallmark of?

Answer 21

Large, abnormal lymphocyte with binucleated nucleus that resembles owl eyes

Hallmark of Hodgkin lymphoma

Question 22

What staging system is used to classify lymphomas, and how many stages are there?

Answer 22

Ann Arbor Staging

Stages 1 to 4

Question 23

How does lymphoma treatment change as the stage increases?

Answer 23

From stages 1 to 4, radiotherapy alone becomes less effective and chemotherapy is needed

Question 24

What do each of the stages of the Ann Arbor Staging system indicate about the spread of the lymphoma?

Answer 24

1. Localised disease
2. Disease in more than 1 lymph node, on the same side of diaphragm
3. Disease above and below diaphragm
4. Extranodal disease (outside lymph nodes and spleen)

Question 25

What is the meaning of the A/B suffixes also added to the numeral staging of lymphomas?

Answer 25

A: Absence of B symptoms

B: Presence of B symptoms

Question 26

What mode of radiological investigation is used to for lymphoma staging?

Answer 26

PET scan

Radio-tracer uptake (dark areas) show metabolically active areas (due to active malignancy) or normal physiological uptake (this is would be during remission)

Question 27

What is another characteristic finding of a Hodgkin lymphoma biopsy, apart from Reed-Sternberg cells?

Answer 27

Also shows many reactive myeloid cells eg. eosinophilia (causes pruritus)

Question 28

What type of Burkitt lymphoma is found in the UK?

Answer 28

Sporadic Burkitt lymphoma

Question 29

What type of Burkitt lymphoma is found in some parts of Africa?

Answer 29

Endemic Burkitt lymphoma