Lymphoma - Hodgkin, Non-Hodgkin

Question 1

Lymphoma generally
- pathophysiology
- types
- presentation
- diagnosis
- management

Answer 1

Genetic mutation in lymphocytes/HIV, EBV => cell division in LN/other tissues

Hodgkins - nodal lymphoma that spreads from node to node => treatment can be more targetted (better prognosis)
-Reed Sternberg cells

Non-Hodgkin - non contiguous spread

B symptoms

Confirmation, typing - LN biopsy
Stage - CT, PET

Chemo, stem cell transplant, RT

Question 2

Hodgkin lymphoma
- pathophysiology
-risk factors
- types
- presentation
- diagnosis
- management

Answer 2

B cells (Reed Sternberg cell - owl eyes due to 2 nuclei)

HIV, EBV

LN - cervical/supraclavicular
-painless, asymmetrical
-alcohol induced LN pain
B symptoms - early in disease
-weight loss, itch, night sweats, fever
Mediastinal mass => symptoms

FBC
-normocytic anemia
-eosinophilia
High LDH
DEFINITIVE - LN BIOPSY => owl eye/Reed Sternberg cells
LN biopsy - owl eye

Chemo
RT
Hematopoetic cell transplant
Rituximab (CD20) => apoptosisCD20) => apoptosis

Question 3

Metastatic spread

Answer 3

Liver
Lungs
Bone marrow

Question 4

Non-Hodgkin lymphoma
-what is it
-risk factors
- types
- presentation
- diagnosis
- management

Answer 4

B cell lymphoma - MOST COMMON
-t(14:18) BCL2 gene, EBV (Burkitt),
T cell lymphoma
-HTLV

Age
EBV
FHx
IC - HIV, DM, transplant

Painless LN
B symptoms - late disease
Extranodal GI - bowel obstruction
Extranodal BM - BM failure
Extranodal SC - motor/sensory deficit in legs

GOLD STANDARD - excisional node biopsy
CT CAP - staging
FBC - rule out leukemias

Rituximab (CD20) => apoptosis

Question 5

Referral guidelines for Hodgkin
-adults
-children

Answer 5

Adults in 2wks
Children in 48hrs

Both unexplained LN especially with
-fever
-night sweats
-SOB
-itch
-weight loss
-alcohol-induced LN pain

Question 6

Main differences between Non-Hodgkin and Hodgkin
-age
-commonality
-risk factors
-LN location
-LN spread
-other symptoms

Answer 6

NHL - 60s
HL - 15-25 and 60+

NHL - 6th most common adult cancer
HL - V rare

NHL - AI, HIV, IC after organ transplant
HL - EBV, FHx

NHL - anywhere in the body
HL - limited to upper body (neck, chest, axilla)

NHL - discontinuous spread
HL - continuous spread

NHL - extranodal disease uncommon
-systemic symptoms common
HL - extranodal disease common
-systemic symptoms not common