Lymphoma - Non-Hodgkin's Lymphoma

Question 1

Give 3 types of Non-Hodgkin’s Lymphoma.

Answer 1

1. Burkitt lymphoma.
2. MALT Lymphoma (Mucosa-Associated Lymphoid Tissue in Stomach).
3. Diffuse Large B Cell Lymphoma.

Question 2

How does Diffuse Large B Cell Lymphoma usually present?

Answer 2

Rapidly growing painless mass in patients over the age of 65.

Question 3

Risk Factors of Non-Hodgkin’s Lymphoma (5*).

Answer 3

Same as Hodgkin’s Lymphoma Risk Factors +
3. H. Pylori (MALT Lymphoma).
2. Hepatitis B/C.
3. Exposure to Pesticides Trichloroethylene.
4. Age (1/3 above 75).
5. Caucasian.

Question 4

Clinical Presentation of Non-Hodgkin’s Lymphoma (+ Differences) (3).

Answer 4

Similar to Hodgkin’s Lymphoma but :
1. Alcohol-Induced Pain Lymphadenopathy in Hodgkin’s lymphoma.
2. B Symptoms earlier in Hodgkin’s lymphoma.
3. Extranodal Disease in commoner in Non-Hodgkin’s.

Question 5

Clinical Features of Non-Hodgkin’s Lymphoma (3).

Answer 5

1. Painless Lymphadenopathy - Non-Tender, Rubbery, Asymmetrical.
2. Constitutional Symptoms.
3. Extranodal Disease (commonest : gut and skin).

Question 6

How else does the Lymphadenopathy in Non-Hodgkin’s Lymphoma differ from that in Hodgkin’s lymphoma?

Answer 6

1. Symmetrical.
2. Multiple Sites.
3. Spread Discontinuously across Nodal Sites.

Question 7

Investigations of Non-Hodgkin’s Lymphoma (4).

Answer 7

1. Diagnostic Investigation of Choice - Excisional Node Biopsy.
2. Staging - CT CAP.
3. FBC & Blood Film : Normocytic Anaemia.
4. Prognostic Indicators : ESR and LDH.

Question 8

What appearance does Burkitt’s Lymphoma have on Biopsy?

Answer 8

Starry Sky.

Question 9

Management of Non-Hodgkin’s Lymphoma (5).

Answer 9

1. Watchful Waiting.
2. Chemotherapy - Monoclonal Antibodies e.g. Rituximab / Radiotherapy.
3. Stem Cell Transplantation.
4. Flu/Pneumococcal Vaccines.
5. Neutropenia - Antibiotic Prophylaxis.

Question 10

Complications of Non-Hodgkin’s Lymphoma (5).

Answer 10

1. Bone Marrow Infiltration (Anaemia, Neutropenia, Thrombocytopenia).
2. SVC Obstruction.
3. Metastasis.
4. Spinal Cord Compression.
5. Adverse Effects of Treatment.