Lymphomas

Question 1

Hodgkin vs non-Hodgkin lymphoma spread

Answer 1

Hodgkin: single/chain of nodes —> contiguous
Non: extranodal —> unpredictable spread

Question 2

What are Reed-Sternberg cells?

Answer 2

B cells with crippled Ig gene

Question 3

EBV relates to more than 50% of ______ lymphomas

Answer 3

Hodgkin’s

Question 4

Hodgkin lymphoma main age + sex group

Answer 4

Young adults or 60+
Male 2:1

Question 5

Nodes affected in Hodgkin lymphoma

Answer 5

• Cervical 60-70%
• Axillary 10-15%
• InguinalL 6-12%

Question 6

Which lymphoma gives pain when drinking alcohol?

Answer 6

Hodgkin lymphoma

Question 7

Hodgkin lymphoma lab findings
(RBC, neutrophils, eosinophils, platelets, ESR, CRP, initial, later)

Answer 7

• Normo normo anemia
• Neutrophilia
• Eosinophilia
• Platelets normal or elevated
• Increased ESR and CRP

Initial: high LDH
Later: lymphopenia and thrombocytopenia

Question 8

RS cell markers

Answer 8

CD30+ CD15+ B- CD45-

Question 9

RS cell function

Answer 9

Attract MQ, lymphocytes and granulocytes

Question 10

Unfavorable marker in Hodgkin lymphoma

Answer 10

CD86, indicates MQ

Question 11

Hodgkin lymphoma signs & symptoms (3)

Answer 11

Nodes: painless, asymmetrical, firm, discrete, rubbery, large
- Hepatosplenomegaly
- Constitutional

Question 12

Hodgkin lymphoma pathogenesis

Answer 12

EBV —> NF-kB activation —> rescues B cells without Ig from apoptosis = RS cells

Question 13

Mediators produced by RS cells

Answer 13

IL-5, IL-10, M-CSF, chemokines

Question 14

Hodgkin lymphoma subtypes (5)

Answer 14

1. Nodular sclerosis (lacunar RS)
2. Mixed cellularity (mononuclear)
3. Lymphocyte rich = best prognosis
4. Lymphocyte deletion (rare, worst)
5. Lymphocyte predominance

Question 15

Ann-Arbour staging for lymphomas

Answer 15

I (cervical) - IV (extranodal)
A = abscence of 38oC, night sweats, body weight increase
B = presence

E = Extension of nodes
S = splenic involvement

Question 16

Hodgkin lymphoma red flag

Answer 16

Bulky
Wide mediastinum by 1/3
Mass more than 10 cm

Question 17

Hodgkin lymphoma treatment and cureability

Answer 17

Radiotherapy or chemotherapy
85% curability

Question 18

Non-Hodgkin lymphoma most common extranodal location

Answer 18

GI tract

Question 19

Grades of Non-Hodgkin lymphoma

Answer 19

Low: indolent, respond to chemo, difficult cure

High: aggressive, urgent, CUREABLE

Question 20

Causes of Non-Hodgkin lymphoma

Answer 20

• HTLV-1 = T cell
• EBV = Burkitt
• HHV-8
• HIV
• Hep C
• H. Pylori = MALT
• Malaria = Burkitt

Question 21

Non-Hodgkin lymphoma clinical features (8)

Answer 21

• Superficial lymphadenopathy - asymmetric, painless
• Constitutional
• Bowel obstruction
• Anemia
• Neutropenia
• Purpura
• AI cytopenia
• Hepatosplenomegaly

Question 22

Non-Hodgkin lymphoma lab findings (LDH, otro)

Answer 22

Increased:
- LDH
- Uric acid

Question 23

Non-Hodgkin lymphoma mutations

Answer 23

t(14;18) = follicular, DLBCL

t(8;14) = Burkitt

MYC genes

Question 24

Follicular lymphoma
- markers
- mutation
- age group
- cells
- more info

Answer 24

• Bcl2, CD10, Ig, Bcl6 = no apoptosis
• t(14;18)
• Middle age
• Cleaved centrocytes, fDC, MQ, T
• Indolent/slow

Question 25

DLBCL
- markers
- mutation
- age group
- cells
- more info

Answer 25

• CD10, Ig, rare Bcl6
• MYC mutation
• Elder, males
• Large nuclei, prominent nucleoli
• Can be immunodeficiency, aggressive

Question 26

Burkitt lymphoma
- markers
- mutation
- age group
- cells
- more info

Answer 26

• CD10, Bcl6, IgM
• MYC mutation or EBV or t(8;14)
• Children
• Mitotic, apoptotic cells
• “starry sky”

Question 27

Most common Non-Hodgkin

Answer 27

Diffuse large B cell