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Haematology > Lymphoma (Hodgkin's and non-Hodgkin's) > Flashcards

Lymphoma (Hodgkin's and non-Hodgkin's) Flashcards

1
Q

What is lymphoma.

A

Malignancy of the lymph system.
These malignancies arise from the lymphoid tissue.
It involves clonal expansion of B and T white blood cells.

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2
Q

How common is Hodgkin’s lymphoma. (2)

A

Rare.

4/100,000 new cases per year.

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3
Q

At what ages is it most common to get Hodgkin’s lymphoma. (2)

A

Between 20-35 years.

Between 50-60 years.

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4
Q

What are the clinical features of Hodgkin’s lymphoma. (9)

A

Painless rubbery lymphadenopathy - localized or generalized (usually in the neck or supraclavicular fossae).
Hepatosplenomegaly may be present.
Rarely large mediastinal masses may cause dry cough and breathlessness.
Cachexia.
There may be alcohol induced lymph node pain.
Constitutional or ‘B’ symptoms are experienced in up to 25% of patients:
Fever.
Weight loss (>10%).
Pruritus.
Sweats.

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5
Q

What lymph nodes are most commonly affected in Hodgkin’s lymphoma.

A

The cervical chain is the commonest site.

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6
Q

What is the staging system used for Hodgkin’s lymphoma.

A

ANN ARBOR.

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7
Q

What is a stage 1 Hodgkin’s lymphoma.

A

Confined to a single lymph node group.

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8
Q

What is a stage 2 Hodgkin’s lymphoma. (2)

A

Two or more lymph node groups.

Confined to one side of the diaphragm.

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9
Q

What is a stage 3 Hodgkin’s lymphoma. (2)

A

Two or more lymph node groups.

Involves both sides of the diaphragm.

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10
Q

What is a stage 4 Hodgkin’s lymphoma.

A

Involvement of the extralymphatic sites (eg bone marrow).

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11
Q

What other feature is included when staging a Hodgkin’s lymphoma.

A

Includes the absence (A) or presence (B) of systemic symptoms.

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12
Q

What is the 10 year survival rate for patients with Hodgkin’s lymphoma. (2)

A

Varies from 50% for stage 4 to 80% for stage 1A.

Between 50-70% with advanced disease can be cured.

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13
Q

How common is non-Hodgkin’s lymphoma.

A

It is 10 times more common than Hodgkin’s lymphoma.

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14
Q

What are the risk factors for developing Hodgkin’s lymphoma. (7)

A

Increases with age.
Slight male preponderance.
Geographical variation: Burkitt’s lymphoma is common in Africa.
Viruses are implicated, eg. EBV, HSV.
Immunosuppression is a risk factor (including HIV/AIDS).
SLE.
Obesity.

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15
Q

What are the two main types of non-Hodgkin’s lymphoma. (2)

A

B cell lymphoma (80% of cases).

T cell lymphoma (20% of cases).

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16
Q

How can non-Hodgkin’s lymphomas be classified. (3)

A

As low, intermediate, or high grade.

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17
Q

What are the clinical signs of non-Hodgkin’s lymphoma. (3)

A

Lymphadenopathy (60-70%).
Hepatosplenomegaly.
B symptoms.

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18
Q

How are non-Hodgkin’s lymphomas staged.

A

Using the ANN ARBOR staging system.

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19
Q

What is the 10 year survival rate for patients with Non-Hodgkin’s lymphoma. (2)

A

Varies from 35% for stage 4 to 80% for stage 1 disease.

There is a median survival of 10 years.

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20
Q

How are lymphomas classified. (2)

A

They are diagnosed from the pathological findings on biopsy as Hodgkin’s or non-Hodgkin’s lymphoma.
The majority are of B cell origin.

21
Q

How are non-Hodgkin’s lymphomas classified.

A

non-Hodgkin’s lymphomas are classified as low or high grade tumours on the basis of heir proliferation rate.

22
Q

What are high grade non-Hodgkin’s lymphomas. (3)

A

They are rapidly dividing.
They present for a matter of weeks before diagnosis.
They may be life-threatening.

23
Q

What are low grade non-Hodgkin’s lymphomas. (3)

A

They divide slowly.
They may be present for many months before diagnosis.
They typically present in an indolent fashion.

24
Q

What is the hallmark finding in Hodgkin’s lymphoma.

A

Reed-Sternberg cells.

25
Q

What are Reed-Sternberg cells.

A

These are large malignant lymphoid cells of B cell origin.

26
Q

How are Reed-Sternberg cells usually present in the bone marrow. (2)

A

They are present in small numbers.

They are surrounded by large numbers of reactive non-malignant T cells, plasma cells and eosinophils.

27
Q

What is the male:female ratio for Hodgkin’s lymphoma.

A

1.5:1.

28
Q

What is the age of diagnosis of Hodgkin’s lymphoma. (2)

A

Median age: 31.

First peak 20-35 years, second at 50-70 years.

29
Q

What are poor prognostic factors of Hodgkin’s lymphoma on blood test (4)

A

Normochromic.
Normocytic anaemia.
Lymphopenia.
Raised LDH.

30
Q

What may be seen on the blood tests of a patient with Hodgkin’s lymphoma. (5)

A

FBC may be normal, normochromic, normocytic anaemic or lymphopenic.
There may be eosinophillia or neutrophillia.
ESR may be raised.
Renal function tests are required before starting treatment.
LFTs may be abnormal (it may reflect hepatic infiltration).
LDH may be raised.

31
Q

What is the Hasenclever prognostic index for advanced Hodgkin’s lymphoma. (7)

A 
A score of 1 is given to each of the following:
Age>45. 
Male. 
Serum albumin 15.
Lymphopenia
32
Q

What is the incidence of non-Hodgkin’s lymphoma.

A

Incidence has increased since 1970 to 1:10,000.

33
Q

Who is at greater risk of developing non-Hodgkin’s lymphoma.

A

Slight male excess.

34
Q

What is the average age of onset of non-Hodgkin’s lymphoma.

A

65-71.

35
Q

What are the risk factors for developing non-Hodgkin’s lymphoma. (7)

A

No single causative abnormality has been found.
Lymphoma is a late manifestation of HIV infection.
Certain viruses are associated with lymphoma types (EBV, HHV8, HTLV).
Gastric lymphoma can be associated with H.pylori infection (with MALT tissue).
Congenital.
Some lymphomas are associated with specific chromosomal translocations: t(11;14).
Lymphoma may occur in congenital immunodeficiency states and in immunosuppressed patients after organ transplantation.

36
Q

Does Hodgkin’s lymphoma tend to spread beyond the lymph nodes.

A

It does not tend to spread beyond the lymphatic system.

37
Q

Does non-Hodgkin’s lymphoma tend to spread beyond the lymph nodes.

A

It is often widely disseminated at presentation.

38
Q

What are the symptoms of non-Hodgkin’s lymphoma. (10)

A 
Patients present with lymph node enlargement. 
May be associated with systemic upset:
Weight loss (less common than in Hodgkin's lymphoma and associated with disseminated disease). 
Sweats. 
Fever. 
Itching. 
Hepatosplenomegaly may be present. 
Compression syndromes may occur:
Gut obstruction. 
Ascites. 
Superior vena cava obstruction. 
Spinal cord compression.
39
Q

What are the typical extranodal sites that are involved in non-Hodgkin’s lymphoma. (9)

A 
Bone marrow. 
Gut. 
Small bowel (rare). 
Thyroid. 
Lung. 
Skin. 
Testis. 
Brain. 
Bone (rare).
40
Q

What investigations should be performed on non-Hodgkin’s lymphoma. (7)

A 
As for Hodgkin's lymphoma. 
In addition:
Bone marrow aspiration and trephine. 
Immunophenotyping of surface antigents to distinguish T from B cell tumours. 
Cytogenetic analysis. 
Immunoglobulin determination. 
Measurement of uric acid.
HIV testing.
41
Q

What are the main subtypes of Hodgkin’s lymphoma. (2)

A

Classical Hodgkin’s lymphoma.

Nodular lymphocyte predominant Hodgkin’s lymphoma.

42
Q

What other tests should be done in Hodgkin’s lymphoma. (2)

A

CT chest.

Chest X ray (to see if there is a mediastinal mass).

43
Q

What is Pel-Ebstein fever. (3)

A

It is associated with Hodgkin’s lymphoma.
It implies a cyclical fever with long periods (15-28days) of normal to low temperatures.
It is very rare.

44
Q

What is the cellular difference between Hodgkin’s and non-Hodgkin’s lymphomas. (2)

A

Hodgkin’s lymphomas have Reed-Sternberg cells on a blood film.
Non-Hodgkin’s lymphomas include all the lymphomas without Reed-Sternberg cells.

45
Q

What are the two subsets of presentation of non-Hodgkin’s lymphoma. (2)

A 
Nodal disease (75%). 
Extranodal disease (25%).
46
Q

What are the symptoms caused by bone marrow invovlement in non-Hodgkin’s lymphoma. (3)

A

Pancytopenia from marrow involvement:
Infection.
Anaemia.
Bleeding (due to low platelets).

47
Q

How is Hodgkin’s lymphoma usually staged. (2)

A

Via CT/PET of the thorax.

Lymph node excision biopsy if possible.

48
Q

How is non-Hodgkin’s lymphoma usually staged. (2)

A

Bone marrow and lymph node biopsy.

49
Q

What reduced the chances of a good prognosis in non-Hodgkin’s lymphoma. (5)

A 
If at presentation:
Age>60. 
Systemic symptoms. 
Bulky disease (abdominal mass >10cm). 
Increased LDH. 
Disseminated disease.

Haematology (17 decks)

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