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A. MLA Map Oncology > Lymphoma - Hodgkin Lymphoma > Flashcards

Lymphoma - Hodgkin Lymphoma Flashcards

1
Q

Hodgkin lymphoma (HL) is essentially a tumour derived from lymphocytes, specifically B and T cells. What is the incidence of NHL?

1 - 3.3 / 100,000
2 - 3.3 / 10,000
3 - 3.3 / 1000
4 - 3.3 / 100

A

1 - 2.7 / 100,000
- males at increased risk
- accounts for 30% of all lymphomas

Slightly more common in males 1.3:1 ratio

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2
Q

Hodgkin lymphoma (HL) is essentially a tumour derived from lymphocytes, specifically B and T cells. What ages is most at risk of developing HL?

1 - 2-10 and >30
2 - 10-15 and >40
3 - 15-30 and >50
4 - 40-60 and >85

A

3 - 15-30 and >50

Bimodal in those it affects

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3
Q

Although the exact cause of Hodgkin Lymphoma (HL) is unknown, which 2 viruses have been associated with HL?

1 - HIV
2 - EBV
3 - HPV
4 - CMV

A

1 - HIV
2 - EBV

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4
Q

Although the exact cause of hodgkin lymphoma (HL) is unknown, which of the following immunosuppressive conditions is NOT associated with causing NHL?

1 - rheumatoid arthritis
2 - lupus
3 - type 2 diabetes
4 - Sjögren syndrome
5 - coeliac disease
6 - Hashimoto’s thyroiditis

A

3 - type 2 diabetes

5% is though to be familial as well

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5
Q

When comparing leukaemia and lymphoma, which is a solid and which is a liquid tumour?

A
  • leukaemia = liquid (blood)
  • lymphoma = solid (lymph nodes)
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6
Q

To distinguish between Non-hodgkin lymphoma (NHL) or Hodgkin lymphoma we use a specific cell, what is this cell?

1 - reed sternberg cells
2 - cytomegalovirus
3 - aeur rods on blood smears
4 - raised basophils

A

1 - reed sternberg cells

This is most commonly present in Hodgkin lymphoma

Look like owl eyes

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7
Q

Reed sternberg cells are what we can use to distinguish between Non-hodgkin lymphoma (NHL) or Hodgkin lymphoma. Which of the following is a characteristic of Reed sternberg cells?

1 - large multinucleated cells
2 - don’t produce antibodies
3 - surrounded by inflammatory cells (T cells that secrete cytokines)
4 - fibroblasts surround and become activated
5 - eosinophils are activated
6 - all of the above

A

6 - all of the above

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8
Q

There are 2 subcategories of Hodgkin lymphoma:

  • Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
  • Classical Hodgkin Lymphoma (cHL)

In cHL do the the B cells have CD45 and CD20 as normal B cells do?

A
  • no

Instead they have CD15 and CD30

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9
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • mixed cellularity cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL

Which of these is the most common form of cHL?

A
  • nodular sclerosis cHL

Given name because neoplastic cells and inflammatory cells get surrounded by collagen and from fibroblasts then then form nodules

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10
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • mixed cellularity cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL

Which of the subtypes is described below:

1 - tumour contains neoplastic lymphocyte Reed sternberg cells and immune cells
2 - neoplastic cells are surrounded by collagen and fibroblasts
3 - nodules are formed
4 - lacunar cells are present on histology

A
  • nodular sclerosis cHL

predominantly causes mediastinal lymphadenopathy in 80% of patients

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11
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL
  • mixed cellularity cHL

Which of the subtypes is described below:

1 - Reed sternberg cells and immune cells are present
2 - eosinophils, plasma cells, lymphocytes, neutrophils and histiocytes surround the Reed sternberg cell

A
  • mixed cellularity cHL

Called mixed because of the variety of cells surrounding the redd Sternberg cells

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12
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL
  • mixed cellularity cHL

Which of the subtypes is described below:

1 - Reed sternberg cells and immune cells are present
2 - Reed sternberg cell is surrounded by mostly lymphocytes
3 - best prognosis of hodgkin lymphoma subtypes

A
  • lymphocyte rich cHL

Most commonly has lymphocytes surrounding the reed sternberg cells

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13
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL
  • mixed cellularity cHL

Which of the subtypes is described below:

1 - Reed sternberg cells and immune cells are present
2 - no or very few lymphocytes
3 - lots of hodgin and Reed sternberg cells
4 - least common subtype of hodgkin lymphoma

A
  • lymphocyte depleted cHL

Most commonly has few lymphocytes surrounding the reed sternberg cells

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14
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL
  • mixed cellularity cHL

Which of the subtypes has the worse prognosis?

A
  • lymphocyte depleted cHL

Best prognosis is in the following order:
- nodular sclerosis cHL
- mixed cellularity cHL
- lymphocyte rich cHL
- lymphocyte depleted cHL

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15
Q

There are 2 subcategories of Hodgkin lymphoma:

  • Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
  • Classical Hodgkin Lymphoma (cHL)

In NLPHL do the the B cells have CD45 and CD20 as normal B cells do?

A
  • yes
  • they do not have CD15 or CD30

This is most common in men

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16
Q

There are 2 subcategories of Hodgkin lymphoma:

  • Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
  • Classical Hodgkin Lymphoma (cHL)

In NLPHL, what is present on histology?

1 - just Reed sternberg cells
2 - just lymhocytes
3 - lymphocyte predominant cells
4 - granulocytes only

A

3 - lymphocyte predominant cells

Contains a lobulated nucleus that looks like popcorn

Surrounded by nodules made from lymphocytes

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17
Q

All of the following are common in patients with Classical Hodgkin Lymphoma (cHL), what is the most commonly presenting symptom?

1 - enlarged, non-tender, rubbery lymph nodes
2 - night sweats, drenching
3 - fever, >38C
4 - weight loss and lethargy
5 - pruritus (itchy skin)
6 - alcohol induced Hodgkins

A

1 - enlarged, non-tender, rubbery lymph nodes

70% of patients have cervical
Axillary and groin are also common

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18
Q

All of the following are common in patients with Classical Hodgkin Lymphoma (cHL). Enlarged, non-tender, rubbery lymph nodes are present in 80% of patients. Which of the following describes the lymph nodes:

1 - painless and symmetrical
2 - panful and symmetrical
3 - painless and asymmetrical
4 - painful and asymmetrical

A

3 - painless and asymmetrical

May occur on just one side of the body

19
Q

Although not as common as non-Hodgkin Lymphoma, lymph nodes of all of the following can be observed, EXCEPT which one typically?

1 - spleen
2 - axillary
3 - tibial
4 - abdominal
5 - hilar
6 - inguinal-femoral

A

3 - tibial

20
Q

There are 4 subtypes of Classical Hodgkin Lymphoma (cHL) based on histology and the reactive background inflammatory cells and whether fibrosis is present:

  • nodular sclerosis cHL
  • lymphocyte rich cHL
  • lymphocyte depleted cHL
  • mixed cellularity cHL

Which of the subtypes above can cause mediastinal lymph node enlargement?

A
  • nodular sclerosis cHL
21
Q

Which of the following is NOT a B sign in Hodgkin Lymphoma?

1 - Fever >38ºC
2 - Night sweats
3 - Unintentional weight loss >10% over 6 months
4 - Bleeding
5 - Pruritus

A

4 - Bleeding

22
Q

You are in a GP and you perform a history and examine a patient and suspect classical Hodgkin lymphoma. Which of the following should you do?

1 - standard haematology referral
2 - prescribe corticosteroids and wait and see approach
3 - direct to A&E
4 - fast track referral to haematology

A

4 - fast track referral to haematology

23
Q

When performing a FBC in a patient with suspected Hodgkin lymphoma, which of the following is least likely to be present?

1 - anaemia
2 - thrombocytopenia
3 - lymphocytosis
4 - lymphopenic

A

3 - lymphocytosis

neutropenia and anaemia may occur, which also carry a poorer prognosis

24
Q

When trying to diagnose Hodgkin lymphoma, which 2 of the following are most likely to be elevated?

1 - CRP
2 - ESR
3 - LDH
4 - TFTs

A

2 - ESR
3 - LDH

25
Q

There are 2 subcategories of Hodgkin lymphoma:

  • Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
  • Classical Hodgkin Lymphoma (cHL)

Do both of these need to be treated immediately?

A
  • no
  • NLPHL is treated like a mild non-hodgkin lymphoma
  • essentially a monitor and see approach
26
Q

Mediastinal lymphadenopathy can be dangerous and is a medical emergency. Why can mediastinal lymphadenopathy cause a medical emergency?

1 - cardiomegaly
2 - obstruct pulmonary arteries
3 - superior vena cava obstruction
4 - increased afterload

A

3 - superior vena cava obstruction
- collateral veins are prominent to overcome blockage

27
Q

Superior vena cava obstruction (SVCO) can be a medical emergency in patients with mediastinal lymphadenopathy. Which of the following can occur due to SVCO?

1 - collateral veins are prominent to overcome blockage
2 - SOB and cough
3 - oedema (brain, neck, chest)
4 - headaches, confusion
5 - raised JVP
6 - facial plethora
7 - all of the above

A

7 - all of the above

28
Q

When trying to diagnose hodgkin and non-Hodgkin lymphoma, which of the following would NOT routinely be performed?

1 - FBC (Hb can be low)
2 - full lymph node examination
3 - renal/liver/bone profiles
4 - MRI
5 - lactate dehydrogenase
6 - Erythrocyte sedimentation rate (ESR) (typically raised)

A

4 - MRI
- typically perform a chest X-ray 1st to assess for mediastinal masses

  • LDH is a tumour marker in hodgkin lymphoma and cell turnover
29
Q

Which of the following is NOT a differential for lymphadenopathy, other than Hodgkin and non-Hodgkin lymphoma?

1 - infection (EBV, HIV, etc.)
2 - COPD
3 - tuberculosis
4 - lymphomas (HL and NHL)
5 - metastatic
6 - chronic lymphocytic leukaemia

A

2 - COPD

30
Q

What tests is used to make a definitive diagnosis in a patient with suspected Hodgkin lymphoma or nonHodgkin lymphoma?

1 - core nodal biopsy, or whole node
2 - CT scan
3 - tumour markers in blood
4 - blood smear

A

1 - nodal biopsy
- used to confirm the presence of reed-sternberg cells

A bone marrow biopsy would be considered if B symptoms and end stage disease

31
Q

Which imaging modality is typically 1st in a patient with suspected non-Hodgkin lymphoma?

1 - ultrasound
2 - whole body MRI
3 - chest X-ray
4 - whole body PET scan

A

3 - chest X-ray

Looking for mediastinal masses

MRI is neurological symptoms are present, especially of the spine and/or brain

32
Q

Once we have made the diagnosis of Hodgkin and non-Hodgkin lymphoma we need to stage this just like any other cancer. Which imaging modality is used to stage these types of cancers?

1 - FDG-PET/CT scan
2 - MRI
3 - X-ray
4 - ultrasound

A

1 - FDG-PET/CT scan

33
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage I?

1 - nodes on both sides of the diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

2 - 1 node or a group of adjacent nodes

A or B is given with the stage

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
34
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage I?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

> 2 nodal groups on the same side of the diaphragm

  • can also include bulky disease
  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
35
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage III?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
36
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage IV?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

3 - additional non-contagious extralymphatic involvement

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
37
Q

In patients with hodgin lymphoma which 2 of the following are the 1st line treatment?

1 - immune therapy
2 - chemotherapy
3 - radiotherapy
4 - targeted therapy

A

2 - chemotherapy
3 - radiotherapy

Depending on the severity, chemotherapy is given with or without radiotherapy, which can be neo-adjuvant (before) or adjuvant (after) the main treatment

  • if disease is more aggressive then more aggressive radiotherapy and chemotherapy is given
38
Q

In patients with Hodgkin lymphoma, the aim is to cure them using chemotherapy and radiotherapy. However, if they have their 1st relapse, what treatment are they offered?

1 - more chemotherapy with allogeneic stem cell transplant
2 - clinical trials or palliative care
3 - more chemotherapy with autologous stem cell transplant

A

3 - more chemotherapy with autologous stem cell transplant

  • autologous means cells have come from the recipient
39
Q

In patients with Hodgkin lymphoma, the aim is to cure them using chemotherapy and radiotherapy. However, if they have a 2nd relapse, what treatment are they offered?

1 - more chemotherapy with allogeneic stem cell transplant
2 - clinical trials or palliative care
3 - more chemotherapy with autologous stem cell transplant

A

1 - more chemotherapy with allogeneic stem cell transplant

  • allogeneic means that the cells for the transplant are coming from a donor
40
Q

In patients with Hodgkin lymphoma, the aim is to cure them using chemotherapy and radiotherapy. However, if they have a 3rd relapse, what treatment are they offered?

1 - more chemotherapy with allogeneic stem cell transplant
2 - clinical trials or palliative care
3 - more chemotherapy with autologous stem cell transplant

A

2 - clinical trials or palliative care

  • CAR-T may be an option as research develops
41
Q

Patients with Non-Hodgkins lymphoma will receive chemotherapy in an attempt to cure them. However, this can cause which of the following that is classed as a medical emergency?

1 - cardiogenic shock
2 - neutropneic sepsis
3 - hypovolaemic shock
4 - obstructive shock

A

2 - neutropneic sepsis
- chemotherapy wipes out all haemopoetic stem cells as well as the malignant cells
- essentially it leaves the body defenceless to infection and sepsis

42
Q

Neutropneic sepsis is a medical emergency in patients who may have received chemotherapy, such as Non-Hodgkins lymphoma. Are gram + or gram - most dangerous during neutropneic sepsis?

A
  • gram - bacteria
  • examples such as Escherichia coli, Klebsiella sp, Enterobacter sp, and Pseudomonas aeruginosa
43
Q

Neutropneic sepsis is a medical emergency in patients who may have received chemotherapy, such as Non-Hodgkins lymphoma. Gram - are the most dangerous during neutropneic sepsis. Which of the following should be implemented immediately in neutropneic sepsis?

1 - blood cultures
2 - fluid resuscitation
3 - broad spectrum antibiotics immediately
4 - inotropes based on ITU input
5 - all of the above

A

4 - inotropes based on ITU input
5 - all of the above

44
Q

The complications of hodgkin lymphoma are often associated with the chemotherapy. All of the following are complications of chemotherapy, but which 2 are often the most common?

1 - thyroid disease
2 - acute myeloid leukaemia
3 - paraneoplastic syndrome
4 - cardiac abnormalities (valves)
5 - pulmonary toxicity
6 - infertility
7 - infections

A

1 - thyroid disease
6 - infertility

Both occur in 50% of patients

A. MLA Map Oncology (27 decks)

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