Lymphomas Flashcards
Features of cervical lymphadenitis due to lymphoma include all except:
A. Discharging sinus.
B. Longer duration.
C. No pain.
D. Weight loss.
E. Other enlarge lymph nodes in the body.
A
Discharge from lymph node is a feature of tuberculous lymphadenitis.
Syed/MCQ
Regarding undifferentiated lymphoma, which one is not correct?
A. It is variety of non-Hodgkin lymphoma.
B. It develops from B cells.
C. Burkitt’s lymphoma is its one variety.
D. The majority of these present as thymic or mediastinal masses.
E. Chemotherapy is primary modality of treatment.
D.
Ninety per cent of these present as abdominal tumours.
Syed/MCQ
Regarding lymphoblastic lymphoma which one of the following statements is false?
A. It is a variety of non-Hodgkin lymphoma.
B. It originates from T cells.
C. Non-Burkitt lymphoma is one of the varieties.
D. The majority of these present as thymic or mediastinal masses.
E. Chemotherapy is the primary modality of treatment.
C
Both Burkitt’s and non-Burkitt’s lymphoma are varieties of undifferentiated lymphoma.
Syed/MCQ
Which of the following develops from posterior mediastinum?
A. Thymoma.
B. Lymphoma.
C. Neuroblastoma.
D. Teratoma.
E. Dermoid cyst.
C
Neuroblastoma develops from posterior mediastinum.
Other mediastinal masses developing from posterior mediastinum include bronchogenic and enteric duplication cyst.
Thymoma, teratoma, dermoid cyst and germ cell tumours develop in anterior mediastinum.
Syed/MCQ
Which one is the commonest mediastinal mass?
A. Neurogenic tumour, such as neuroblastoma and others.
B. Lymphoma.
C. Germ cell tumour.
D. Mesenchymal tumour.
E. Thymic lesion.
B
Lymphoma is most common.
The incidence is like lymphoma 41 percent, neurogenic tumour 33 percent, germ cell tumour 7 percent, mesenchymal tumour 7 percent, cystic lesion (such as pericardial, bronchogenic and enteric) 7 percent, and thymic lesion 2.5 percent.
Syed/MCQ
Regarding diagnosis and management of mediastinal masses, which of the following statements is not true?
A. CT is superior with ability to define to define calcification within the mass.
B. Oesophagogram is indicated in foregut duplication.
C. Urinary catecholamine for anterior mediastinal masses.
D. Pre-operative alpha fetoprotein and beta HCG particularly for anterior mediastinal masses.
E. Common approach for anterior mediastinal masses is median sternotomy.
C
Urinary catecholamine measurement is indicated in posterior mediastinal masses.
Syed/MCQ
With regard to lymphoma, what is false?
A. It is a variety of small blue cell tumour.
B. C-myc proto-oncogene translocation between chromosomes number 14 and 18 is associated with Burkitt’s lymphoma.
C. Almost all intestinal lymphoma are non-Hodgkin’s type.
D. Lymphoblastic lymphoma occurs in predominantly in anterior mediastinum.
E. It is associated with increases serum alpha-fetoprotein.
E
None of the small, round cell tumours are associated with increased serum alpha-fetoprotein level.
Syed/MCQ
Small round cell tumours include all except:
A. Lymphoma.
B. Primary neuroectodermal tumour.
C. Rhabdomyosarcoma.
D. Hepatoblastoma.
E. Ewing’s sarcoma.
D
Hepatoblastoma is not a small blue cell tumour.
In addition to A, B, C and E, other blue cell tumours include neuroblastoma.
Syed/MCQ
In Hodgkin’s lymphoma, Reed–Sternberg cells are usually derived from:
A granulocytes
B B-lymphocytes
C T-lymphocytes
D plasma cells
E histiocytes.
B
Reed–Sternberg cells in classic Hodgkin’s lymphoma are large cells that have a characteristic ‘owl’s eye’ nucleus.
These cells express CD15 and CD30 and are negative for CD45.
Reed–Sternberg cells harbour clonal immunoglobulin rearrangements identifying them as being derived from germinal centre B-lymphocytes.
Reed–Sternberg cells make up less than 2% of the cellular content of the tumour and are found among a background of inflammatory cells that typically include B- and T-lymphocytes, granulocytes, histiocytes, plasma cells and eosinophils.
SPSE 1
The most frequent histological subtype of Hodgkin’s lymphoma seen in children is:
A nodular sclerosing
B mixed cellularity
C lymphocyte rich
D lymphocyte depleted
E nodular lymphocyte predominant.
A
Hodgkin’s lymphoma is divided into two main histological types: classic and nodular lymphocyte predominant.
Classic Hodgkin’s lymphoma is further divided into four subtypes: nodular sclerosing, mixed cellularity, lymphocyte rich and lymphocyte depleted.
The nodular-sclerosing subtype comprises 40% of childhood Hodgkin’s lymphoma and is more commonly diagnosed in adolescents.
The mixed-cellularity subtype is seen in 30% of cases.
It occurs more frequently in children less than 10 years of age and often presents with extranodal involvement.
The nodular-lymphocyte-predominant subtype is seen in 10%–15% of cases.
lymphocyte-rich and lymphocyte-depleted subtypes are uncommon in children.
SPSE 1
The most common site of extralymphatic spread for Hodgkin’s lymphoma is:
A bone marrow
B lung
C central nervous system (CNS)
D liver
E skin.
D
The liver is the most common site for extralymphatic spread in Hodgkin’s lymphoma.
Central nervous system disease is extremely rare, and sampling of cerebrospinal fluid is not routinely practised.
Bone marrow disease is seen in 4%–14% of patients with Hodgkin’s disease and should be evaluated in all patients with the exception of those with localised disease and no systemic symptoms.
SPSE 1
Diagnostic staging of patients with Hodgkin’s lymphoma should include all of the following except:
A complete blood count
B CT scan of neck, chest, abdomen and pelvis
C chest X-ray
D lymph node biopsy
E splenectomy.
E
Although historically, exploratory laparotomy and splenectomy were a routine part of staging for Hodgkin’s lymphoma, improved imaging modalities and changes in treatment strategies (with a larger emphasis on chemotherapy) have made these procedures unnecessary.
Splenectomy in patients who are treated for Hodgkin’s lymphoma results in an increased risk of sepsis during treatment and increases the incidence of secondary leukaemia as a long-term complication.
lymph node biopsy is used to establish a diagnosis and identify the histological subtype of disease. All patients should have a chest X-ray and CT scan of the chest, abdomen and pelvis to assess the extent of disease and number of involved lymph nodes.
A complete blood count is used to screen for bone marrow disease and to detect other haematological abnormalities that may be associated with Hodgkin’s lymphoma.
SPSE 1
Important long-term side effects that are caused by chemotherapy for Hodgkin’s lymphoma include all of the following except:
A ototoxicity
B infertility
C secondary leukaemia
D cardiotoxicity
E restrictive lung disease.
A
With the current high cure rates seen for patients diagnosed with Hodgkin’s lymphoma using intensive, multimodal treatments, the avoidance of long-term side effects has become increasingly important.
Chemotherapy is associated with some significant long-term side effects that include cardiomyopathy (following treatment with anthracyclines), restrictive lung disease (bleomycin), infertility (alkylating agents such as nitrogen mustard, procarbazine and cyclophosphamide), and secondary leukaemias (nitrogen mustard, procarbazine, cyclophosphamide and etoposide).
Platinum compounds, which can cause highfrequency hearing loss, are not routinely used in Hodgkin’s lymphoma treatment protocols.
SPSE 1
Important long-term side effects that are caused by radiation therapy in Hodgkin’s lymphoma include all of the following except:
A cosmetic defects
B growth retardation
C hyperthyroidism
D coronary artery disease
E secondary malignancies.
C
Radiation therapy in Hodgkin’s lymphoma has several long-term side effects that often do not manifest until many years following treatment.
Cosmetic defects can occur due to decreases in the growth of bone and/or soft tissues exposed to radiation, and this is more common in younger patients.
The clavicles and vertebrae are the most commonly affected, due to their presence within the most commonly applied radiation field.
Hypothyroidism is commonly diagnosed after radiation to the neck.
Secondary malignancies within the radiation field are not uncommon, and the relative risk following radiation is as much as 10 times that seen in the general population.
Breast cancer is a particularly common secondary cancer in irradiated females. mediastinal irradiation increases the risk for coronary artery disease and survivors of Hodgkin’s lymphoma have an increased incidence of cardiac death.
SPSE 1
A translocation involving chromosomes 8 and 14 is characteristic of:
A Burkitt’s lymphoma
B Hodgkin’s lymphoma
C lymphoblastic lymphoma
D diffuse large B-cell lymphoma
E anaplastic large cell lymphoma.
A
The majority of Burkitt’s lymphoma is characterised by a translocation between the c-Myc oncogene, found on chromosome 8q24 and the immunoglobulin heavy chain gene found on chromosome 14q32.
In a smaller number of cases, the c-Myc gene can occur as a part of other translocations involving the immunoglobulin light chain gene.
This translocation is thought to mediate tumourogenesis through the dysregulation of c-Myc signalling, which normally controls cell cycle progression through G 1 into the S phase.
SPSE 1
