Lymphomas

Question 1

What is Lymphoma?

Answer 1

Lymphomas are cancers that begin by the “malignant transformation” of a lymphocyte in the lymphatic system

Many lymphomas are known to be due to specific genetic mutations

Follicular lymphoma due to overexpression of BCL-2 (gene that blocks programmed cell death)

Question 2

Multipotential myeloid cells differentiate into

Answer 2

red cells basophils
neutrophils monocytes
eosinophils platelets

Question 3

Multipotential lymphocytic cells differentiate into

Answer 3

T lymphocytes
B lymphocytes
Natural Killer Cells

Question 4

Stage 1 of Lymphoma(Ann Arbor Staging System)

Answer 4

Single LN region or extra lymphatic organ or site

Question 5

Stage 2 of Lymphoma(Ann Arbor Staging System)

Answer 5

Cancer in 2 or more LN groups on the SAME side of the diaphragm

Question 6

Stage 3 of Lymphoma(Ann Arbor Staging System)

Answer 6

Cancer in groups on BOTH sides of both above and below the diaphragm

Question 7

Stage 4 of Lymphoma(Ann Arbor Staging System)

Answer 7

Cancer has spread to one or more organ or tissues

Question 8

Sub-stages of Lymphoma A

Answer 8

No systemic symptoms present at diagnosis (B-Symptoms absent)

Question 9

Sub-stages of Lymphoma B

Answer 9

B-symptoms are present (fever, night sweats, weight loss)

Question 10

Sub-stages of Lymphoma E

Answer 10

Cancer in an area or organ other than LN or spread to tissues outside the lymphatic system

Question 11

Sub-stages of Lymphoma S

Answer 11

Cancer spread present in the spleen

Question 12

Grading Low

Answer 12

slow growing, incurable. Follicular, small lymphocytic, Waldenstrom’s

Question 13

Grading Intermediate

Answer 13

rapid growing, potentially curable.

Diffuse large B cell, mantle cell, anapestic large (T cell) NHL

Question 14

Grading High

Answer 14

fastest growing, potentially curable.

Burkitt’s lymphoma, lymphoblastic lymphoma

Question 15

Grading Indolent

Answer 15

Grow very slowly, need little or no treatment until symptoms appear. Tend to reoccur after treatment

Question 16

Grading Aggressive

Answer 16

Grow quickly, symptomatic and treatment required immediately. Can be treated with intense chemotherapy.

Question 17

Hodgkin’s Lymphoma Clinical Features

Answer 17

Asymptomatic lymphadenopathy (70%)
Splenomegaly
Systemic symptoms: B symptoms – fever, pruritus, night sweats
Non-specific: alcohol induced pain in nodes, nephrotic syndrome
Disease spread in contiguity with lymphatic system

Question 18

NON-HODGKIN’S LYMPHOMA

Answer 18

Malignant proliferation of lymphoid cells of progenitor or mature B/T cells

Most common hematological cancer

85 % of all NHL are B-cell lymphomas
Distinguished from HL by proliferation of only malignant B-cells (rarely, T-cells)

Question 19

Lymphoma Take home points

Answer 19

To diagnose lymphoma, a lymph node biopsy is required

Hodgkin’s is distinguished from non-Hodgkin’s lymphoma by the presence of Reed-Sternberg cells

Classical presentation of HL: painless, non-tender, firm, rubbery enlargement of superficial LN, most often in cervical nodes.

NHL associated conditions: Immunodeficiency (e.g. HIV), Autoimmune disease (e.g. SLE), infections (e.g. EBV)

Tx of HL depends on stage; treatment of NHL depends on histological sub-type