Lymphoma - Hodgkin Lymphoma Flashcards by David Houghton

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

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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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

3 - 15-30 and >50

Bimodal in those it affects

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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

1 - HIV
2 - EBV

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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

3 - type 2 diabetes

5% is though to be familial as well

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

leukaemia = liquid (blood)
lymphoma = solid (lymph nodes)

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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

1 - reed sternberg cells

This is most commonly present in Hodgkin lymphoma

Look like owl eyes

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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

6 - all of the above

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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?

Instead they have CD15 and CD30

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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?

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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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

nodular sclerosis cHL

predominantly causes mediastinal lymphadenopathy in 80% of patients

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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

mixed cellularity cHL

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

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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

lymphocyte rich cHL

Most commonly has lymphocytes surrounding the reed sternberg cells

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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

lymphocyte depleted cHL

Most commonly has few lymphocytes surrounding the reed sternberg cells

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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?

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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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?

yes
they do not have CD15 or CD30

This is most common in men

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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

3 - lymphocyte predominant cells

Contains a lobulated nucleus that looks like popcorn

Surrounded by nodules made from lymphocytes

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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

1 - enlarged, non-tender, rubbery lymph nodes

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

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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

3 - painless and asymmetrical

May occur on just one side of the body

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

3 - tibial

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?

nodular sclerosis cHL

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

4 - Bleeding

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

4 - fast track referral to haematology

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

3 - lymphocytosis

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

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

2 - ESR
3 - LDH

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?

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

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

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

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

7 - all of the above

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)

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

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

2 - COPD

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

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

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

3 - chest X-ray Looking for mediastinal masses MRI is neurological symptoms are present, especially of the spine and/or brain

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

1 - FDG-PET/CT scan

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

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

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

>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

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

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

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

3 - additional non-contagious extralymphatic involvement - A = no symptoms - B = weight loss, fever and/or drenching night sweats

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

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

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

3 - more chemotherapy with autologous stem cell transplant - autologous means cells have come from the recipient

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

1 - more chemotherapy with allogeneic stem cell transplant - allogeneic means that the cells for the transplant are coming from a donor

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

2 - clinical trials or palliative care - CAR-T may be an option as research develops

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

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

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?

- gram - bacteria - examples such as Escherichia coli, Klebsiella sp, Enterobacter sp, and Pseudomonas aeruginosa

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

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

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

1 - thyroid disease 6 - infertility Both occur in 50% of patients