lymphomas Flashcards
most lymphomas arise from where
85% of lymphomas arise from B-cells whereas 10-15% arise from T-cells.
Germinal B center > any mutation here leads to
follicular lymphoma,
diffuse large B cell lymphoma
hodgkin’s lymphoma
Each subtype originates from a specific place in the lymph node, so let’s see what’s the structure of lymp node
1- Capsule
2- Lymph and blood vessels
3- Cortex >has follicles
Mantle zone > naïve mature B cells, any mutation that happens here=
mantle zone lymphoma
what is a diagnostic method for lymphomas
Lymph node excisional biopsy (NOT FNA)
where does hodgkin lymphoma arise from
germinal center of B cells
what CD is found in hodgkin
Cd 15,30 characteristic of reed sternberg cell
what age is in hodgkin
Bimodal age distribution — 15 to 30 years old and >50 of age
four subtypes in hodgkin according to histology
o Lymphocyte predominance (5%) — few Reed-Sternberg cells & many B-cells- best prognosis
o Nodular sclerosis (70%) — more in women: bands of collagen envelope Reed- Sternberg cells
o Mixed cellularity (25%) — large numbers of Reed-Sternberg cells in a pleomorphic background
o Lymphocytic depletion (<1%) — worst prognosis
ann arbor staging system 4 stages
• Stage 1: Single LN region
• Stage 2: Two or more LN regions on the same side of diaphragm, above or below the diaphragm
• Stage 3: LN regions both above and below diaphragm
• Stage 4: Widespread involvement of one or more organs (liver, spleen, bone marrow, lung) +/- LN involvement
Ex: Patient with one group of LN and constitutional symptoms = stage ?
1B
Suffix A: No symptoms
Suffix B: Constitutional: fever, weight loss, night sweats (worse prognosis)
signs anf symptoms of hodgkin lymphoma
• Painless cervical lymphadenopathy —most common presentation
• Supraclavicular, cervical, axillary, mediastinal lymph nodes — spreads by continuity from one to adjacent. Has rubbery consistency on examination.
• +/- hepatosplenomegaly, B symptoms (fever, night sweats,and weight loss), pruritis, and cough (secondary to mediastinal involvement)
• less commonly, alcohol related pain at site of LN.
main risk factors of hodgkin
• HIV, EBV, infectious mononucleosis (CD15, CD30)
• Benzene (also RF for acute leukemia)
in biopsy what is seen in hodgkin
Reed Sternberg on LN biopsy (binucleate or multinucleate malignant B-lymphocytes)
tx of hodgkin
• Stage 1A and 2A: Local radiation + small course of chemo
•Stage 3 and 4: (or any B-symptoms): Chemo ABVD
o A = Adriamycin (doxorubicin)
o B = Bleomycin
o V = Vinblastine
o D = Dacarbazine
non hodgkin lymphoma
a group of blood cancers that originate from lymphocytes (B cells or T cells) in the lymphatic system. It is more common than Hodgkin lymphoma and has many subtypes, ranging from slow-growing (indolent) to aggressive.
risk factors of non hodgkin
• Older age (Most common in 60s-70s)
• Weakened immune system (HIV/AIDS, organ transplant, autoimmune diseases)
• Viral infections (EBV, HTLV-1, Hepatitis C)
• Chronic inflammation or infections (H. pylori → MALT lymphoma)
• Exposure to chemicals (pesticides, herbicides, chemotherapy, radiation)
symptoms of non hodgkin
Mnemonic: “B-Symptoms + Lymph Nodes”
1. Painless swollen lymph nodes (neck, armpits, groin)
2. B-Symptoms (Seen in aggressive cases)less common than in hodgkin
• Fever (>38°C/100.4°F)
• Drenching night sweats
• Unintentional weight loss (>10% in 6 months)
Extranodal involvement is more common than Hodgkin:
o Hepatosplenomegaly, abdominal pain or fullness
o BM infiltration: anemia, infections, bleeding
o Skin (in T-cell): mycosis fungoides, Sezary syndrome
types of non hodgkin lymphoma
- B-Cell Lymphomas (Most Common, ~85%)
• Diffuse Large B-Cell Lymphoma (DLBCL) → Most common, aggressive
• Follicular Lymphoma → Slow-growing, indolent
• Burkitt Lymphoma → Highly aggressive, associated with EBV
• Mantle Cell Lymphoma → Rare, aggressive
• Marginal Zone Lymphoma (MALT lymphoma) → Linked to chronic infections (e.g., H. pylori in the stomach)
tx of of NHL indolent
• Watchful waiting (if asymptomatic)
• Rituximab (Anti-CD20 antibody) ± Chemotherapy
• Radiation therapy (for localized disease)
tx of Aggressive NHL (e.g., DLBCL, Burkitt)
Chemotherapy (CHOP regimen)
• Cyclophosphamide
• Hydroxydaunorubicin (Doxorubicin)
• Oncovin (Vincristine)
• Prednisone
• Rituximab (Anti-CD20, for B-cell NHL)
Stem cell transplant (for refractory or relapsed cases)
what type of non hodgkin lymphoma is associated with EBV presents with a mass in jaw and GI involvement and mmostly in childhood most aggressive
burkitts lymphoma
histology of burkitts lymphoma
starry night appearance
