Lymphomas

Question 1

What is a lymphoma?

Answer 1

Neoplastic tumour of lymphoid cells; may arise in a lymph node or an extranodal tissue.

Question 2

Characteristic cells of hodgkin’s lymphoma?

Answer 2

REED-STERNBURG CELLS- bi-nucleate/multinucleate OWL EYED cell on a background of lymphocytes and reactive cells.

Question 3

B symptoms of hodgkin’s lymphoma?

Answer 3

Fever >38
Drenching night sweats
Chills
Weight loss

Question 4

Staging of hodgkin’s lymphoma?

Answer 4

Stage 1- one LN region (LN region can include spleen)
Stage 2: 2 or more LN regions on the SAME side of the diaphragm
Stage 3: 2 or more LN regions on OPPOSITE sides of the diaphragm
Stage 4: extranodal sites (liver, Bone marrow)

A: no constitutional symptoms
B: constitutional symptoms

Question 5

Clinical presentation of hodgkins lymphoma?

Answer 5

Affects young people
Asymmetrical painless lymphadenopathy- frequently mediastinal
Pain in affected nodes after alcohol

REED STERNBURG CELLS ARE DIAGNOSTIC

Question 6

Treatment and prognosis of hodgkin’s lymphoma?

Answer 6

Prognosis excellent especially in young
Treatment is with ABVD chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine)
Most patients have a good chance of cure
Stem cell transplants for rare cases who fail treatment.

Question 7

Features of follicular lymphoma?

Answer 7

Most common ‘indolent’ lymphoma- low grade
T(14;18) causes fusion of BCL2 gene
Histology: “follicular pattern” “nodular appearance”
Large number of centroblasts on lymph node biopsy.
Treatment is watchful waiting.

Question 8

Features of mantle cell lymphoma?

Answer 8

High grade, aggressive
T(11;14) causes overexpression of CYCLIN D1
Treatment is chemotherapy- Rituximab-CHOP, auto-SCT for relapse
“Angular nuclei” on histology

Question 9

Features of diffuse large b cell lymphoma?

Answer 9

Most common high grade lymphoma, aggressive
Treatment is rituximab-CHOP chemotherapy
“Sheets of large lymphoid cells on histology

Question 10

Features of burkitt’s lymphoma?

Answer 10

Very aggressive, fast growing
T(8;14)
STARRY SKY APPEARANCE ON HISTOLOGY
Treatment with chemotherapy
Associated with EBV + HIV
Large fast growing lymph nodes in neck/elsewhere

Question 11

Features of Adult t cell leukaemia/lymphoma?

Answer 11

Associated with HTLV-1 infection, aggressive
Flower cells on blood film
CARIBBEAN AND JAPANESE

Question 12

What is cutaneous t cell lymphoma associated with?

Answer 12

Mycosis fungoides