Lymphomas Flashcards
What is a lymphoma?
What are common sites of presentation of lymphomas
Lymphoma = neoplasm of lymphoid cells
Usually found in
1. Lymphatic system (lymph nodes, BM or blood)
2. Lymhpoid organy: Spleen or gut associated lymphoid tissue
3. Skin (often T-cell lymphomas)
- Rarely: anywher else in the body
What is the incidence of lymphomas in the UK?
Are hodgkin or non-hodgkin’s lymphomas more common?
Around 200/1.000.000 new diagnosis per year
Non-Hodgkin’s 80%
Hodgekins 20%
What is usually the first step of classifying Lymphomas?
Classification into
1. Hodgkin lymphoma (20%)
2. Non-Hodgkin lymphomas (80%)
What are the characterisics of Hodgekin Lymphomas?
Historical + histological difference to NHL
Malignant Lymphoma usually of B-cell origin, with the presence of Reed-Sternbeg cells (picture below) or the presence of Hodgekin cells
Clinical: single/ localised in one group of lymph nodes
What is the epidemiology of Hodgekin Lymphmas?
Bimodal age disribution
1st peak: 25-30 years
2nd peak: 50-70 years (EBV association)
In paediatrics: male dominance
How is Hodgekin’s lymphoma sub-classified?
Classified into
1. Classical HL (95%) –> focus of future flashcards
2. nodular lymphocyte predominant HL (5%) (similar presentation to B cell -NHL)
A paient presents with the following cell on lymph node biopsy: What is the diagnosis?
Cell: Reed- Sternberg cell –> Large binucleaed or polylobaed cells with large nucleoli (malignant B-cells)
–> owel eye appearance
Pathonognomic for Hodgekin lymphomas
What is a Hodgkin cell? What is its significance in the diagnosis of Hodgekin lymphomas?
Large mononuclear cells with large nucleoli of B-cell origin
Can be present in HL, but pathonognomic cell for diagnoss and more commonly present is Reed-sernber cell
What are risk factors associaed with the devleopment of Hodgekin Lymphomas?
- Strong association with Epstein-Barr virus (EBV)
- Immunodeficiency: HIV, transplant, immunosuppression
- Autoimmune diseases (e.g., rheumatoid arthritis, sarcoidosis)
What is the clinical presentation of Hodgekin lymphoma?
- B-symptoms
- Painless lymphadenopathy (if in mediastinum: might only be cough) –> usually single-group of lymph nodes above the mediastinum
- Pruritus
- Lymph node pain associated with alcohol (rare but v.specific)
How is Hodgekin lymphoma diagnosed (what investigations + respective findings) ?
Mainly history + Lymph node biopsy
1. Bloods
FBC: can be normal, high or low WCC, anaemia, eosinophilia
LDH: increased
calcium: can be increased if paraneoplastic syndrome
- Biopsy
Reed-Sternberg cells (don’t express normal B-cell markers (CD20 and 45 but do expressed CD 15)
Potential inflammation + granuloma formation - Imaging: disease spread (CT/ PET)
How is Hodgekin Lymphoma staged?
Staged by using Ann Arbor system with reference to the diaphragm
+ A for no constitutional symptoms
+ B for constitutional symptoms
What is the prognosis of Hodgekin Lymphoma?
Generally good (80-90% 5 year survival), especially in young
–> Curative approach of treatment, regardless of stage
What is the approach to treatment of Hodgekin Lymphoma?
Stage 1+2: Combination Chemo + Radiotherapy (very high risk of breast cancer in female)
Stage 3-4: Chemotherapy with radiotherapy in selected cases
If fails or in remission: Stem-cell transplnat (usually autologous)
What is a typical chemotherapy regime used in the treatment of Hodgekin’s lymphoma?
ABVD
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
What are the 2 main categories in which non-Hodgekin Lymphomas are sub-classified?
Which one is more common?
Non-Hodgekin Lymphomas then classfied into
1. B-cell 85% and
2. T-cell
3. (NK cells very rare)
How are non-Hodgekin lymphomas staged?
Same staging as HL: Ann Arbor + A and B
+ A for no constitutional symptoms
+ B for constitutional symptoms
You have esablished that a patient has a
1. Non- Hodgekin Lymphoma of
2. B-cell origin
How can it be further sub-classified?
By maturity of cells
1. Mature
2. Immature (much closer to ALL)
If mature: by aggressiveness of disease
1. Aggressiveness
2. Indolent
3. Other
What is the most common B-cell NHL?
What is the malignant cells that are present in it?
Diffuse large B-cell lymphoma
(40% of all NHL)
–> Mature Large B-cells
What are the histological findings of Large B-cell lymphomas?
Sheets of large lymphoid cells
What is the 2nd most common sub-type of NHL after diffuse Large B-cell lymphoma?
Follicular lymphoma (25% of NHL lymphomas)
What is the characteristic cell+ typical histological findings of Follicular lymphoma on Lympho node biopsy?
Mature B-cells related to follicle centre and show follicular growth pattern + nodular appearance on histology
with small cells with cleft nuclei (someimes can also be seen on film)
What genetic mutation is associated with Follicular Lymphoma?
Follicular lymphoma associated with
t(14:18) translocation –> formation of BCL-2 gene (can be tesed for diagnosis)
What type of Lymphoma is Burkittt’s lymphoma?
What is the epidemiology ?
Burkitt’s = Very Agressive, mature B-cell NHL
Most commonly occurs in children (except for HIV associated Burkitt’s lymphoma)
How is Burkitt’s lymphoma diagnosed?
- Haematology (lymhoma cells with strongly basophilic vacuolated cytoplasm)
- Lymph node biopts: Starry sky appearance (lymph nodes infilrate tissue but macrophages stand out –> starry sky)
What are common clinical presentaions of T-cell non-Hodgekins lyphomas?
Variable as verry differnet disease
Generally incureable
Site:
if skin involvement, usually T-cell
Others: lymph nodes, Splee, GI tract (e.g. in Coeliac )
Otherwise typical lymphoma symptoms
What sub-type of lymphomas are caused by chonic antigen stimmulation with H.pylii, autoimmune conditions, esp. Sjögrens etc. associated with?
Extra nodal Marginal Zone lymphomas (MZL)/ MALT
Mature B-cell lymphoma
H.pylori: Gastric
Sjögrens: parotic lymphoma
