Lymphomas Flashcards
What is the clinical difference between Hodgekins and non-Hodgekins lymphoma?
HL: painful after alcohol
NHL: not painful after alcohol
What are the types of HL?
- Nodular sclerosing HL
- Mixed cellularity HL
- Lymphocyte rich HL
- Lymphocyte depleated HL
(5. Nodular lymphocyte-predominant HL)
What is the microscopy of nodular sclerosing HL?
- LARGE Reed Sternberg cells
- Nodular fibrosis
What is the microscopy of lymphocyte rich HL?
- Scattered Reed Sternberg cells
- Lots of lymphocytes
What is the microscopy of lyphocyte depleated HL?
- Reed sternberg cells
- Paucity of lymphocytes
What is the microscopy of mixed cellularity HL?
- Reed Sternberg cells
- Eosinophils, plasma cells, histiocytes etc
What is the microscopy of nodular lymphocyte-predominant HL?
- NO REED STERNBERG
- Popcorn cells (histiocytes with nuclei resembling exploded popcorn kernels)
Non-classical with lymphocytes and histiocytes = NLPHL
Treated in a different way
What are the investigations for HL?
- CT/PET
- Tissue diagnosis: LN/BM biopsy (cells stain with CD15 & CD30)
- Reed-Sternberg cell (bi-nucleate/multinucleate (‘owl eyed’) cell on background of lymphocytes & reactive cells)
What is the treatment for HL?
Combination chemo (used in most cases)
- ABVD: Adriamycin, bleomycin, vinblastine and dacarbazine
- 2-4 cycles in stage 1/2, 6 cycles in stage ¾
- Usually have interim PET (guides rx)
What are the NHLs?
B cell:
- Follicular
- Marginal zone
- Diffuse large B cell lymphoma
- Mantle cell lymphoma
- Burkitt’s lymphoma
T cell:
- Adult T-cell leukaemia/ lymphoma
What is the histo of follicular lymphoma?
- Follicular pattern
- Nodular appearance
- Centroblasts LN biopsy
What is the mutation in follicular NHL?
T(14;18) fusion of BCL2 gene
Management of follicular NHL?
Watchful waiting unless high burden of disease
Rituximab/ obinutuzumab + chemo
Prognosis of follicular NHL?
Mostly incurable; median survival 12-15 years
Indolent (slow growing)
What is the most common high grade NHL?
Diffuse Large B-Cell Lymphoma
Presentation DLBCL?
- Middle-aged/ elderly
- Aggressive
- Associated with EBV
(Can be transformed from low-grade lymphoma like follicular)
Histo of DLBCL?
Sheets of large lymphoid cells
Management of DLBCL?
Rituximab-CHOP
C: cyclophosphamide
H: doxorubicin hydrochloride
O: oncovin (vincristine sulfate)
P: prednisolone
Relapse of DLBCL?
Auto-SCT/CAR-T
(Chimeric antigen receptor T-cell therapy)
Features of high grade NHLs?
- Lymphadenopathy & B sx
- May have BM involvement
- TLS risk with treatment
Clinical presentation of mantle cell lymphoma?
- Middle aged
- M>F
- Aggressive (if disseminated at presentation, median survival 3-5yrs)
High grade lymphoma
Mutation mantle cell?
T(11;14) Cyclin D1 dysregulation
Histo mantle cell lymphoma?
Angular/ clefted nuclei
Management mantle cell?
R-CHOP & high dose cytarabine
Relapse mantle cell?
Auto-SCT
Presentation Burkitt’s lymphoma?
Endemic
- Most common malignancy equatorial Africa
- EBV associated
- Jaw involvement
- Abdo masses
Sporadic
- Outside Africa
- EBV associated
Immunodeficiency
- NON-EBV ASSOCIATED
- HIV/post-transplant
Burkitt’s histology?
Starry sky appearance
Mutation in Burkitt’s?
T(8;14) Cellular myelocytomatosis oncogene (c-myc) overexpression
Burkitt’s management?
Chemo (rituximab) & secondary CNS prophylaxis
What are the MALT lymphomas?
Marginal zone NHL
- H.pylori (gastric MALT)
- Sjorgren’s (parotid lymphoma)
Management Marginal zone NHLs?
Remove stimulus eg. H.pylori triple therapy
Chemo
How do cutaneous T cell lymphomas present (NHL)?
Weird rashes
Features of adult t-cell leukaemia (NHL)?
- Far east (Carribbean & Japanese)
- Associated with HTLV-1
- Aggressive
Histology of adult t-cell lymphoma/leukaemia?
Flower cells blood film
Features of anaplastic large cell leukaemia?
- Children/ young adults
- Aggressive
Gene mutation anaplastic large cell lymphoma?
T(2;5)
Alk-1 protein expression
Features of peripheral T cell lymphoma?
- Middle aged and elderly
- Aggressive
Histology of peripheral T cell lymphoma?
Large T cells
Features of enteropathy associated t cell lymphoma?
Long standing coeliac disease
Features of cutaneous t cell lymphoma?
Associated with mycosis fungoides
Where are lymph nodes in HL usually inflammed?
Mediastinum
(+ anywhere else)
What is the prognosis of HL?
Mostly curable
What causes the starry sky appearance in Burkitt’s lymphoma?
Large numbers of lymphocytes and a significant number of macrophages containing phagocytosed lymphocytes
Which lymphoma is most common in >40 year olds?
Diffuse large B cell lymphoma
Which lymphoma is most common in 15-40 year olds?
Hodgkin’s lymphoma
Which lymphoma is most common in <15 year olds?
Burkitt’s lymphoma
What is the term given to describe the transformation of chronic lymphocytic leukaemia into diffuse large B cell lymphoma?
Richter’s transformation
What medication can be given to reduce the risk of TLS?
IV Rasburicase/ allopurinol
