Lymphomas

Question 1

True or false. The incidence of NHL is nearly 10x the incidence of Hodgkins Lymphoma.

Answer 1

True

Question 2

True or false. Patients with both primary and secondary immunodeficiency states are predisposed to developing non-NHL.

Answer 2

True

Question 3

____ is stronly associated with the occurence of extranodal nasal NK/Tcell lymphomas in Asia and South America.

Answer 3

EBV infection

Question 4

This infectious agent is associated with gastric MALT lymphoma.

Answer 4

Helicobacter pylori

Question 5

This infectious agent is associated with primary effision lymphoma and Multicentric Castleman’s disease.

Answer 5

Human herpesvirus 8

Question 6

HIV is associated with these lymphoid malignancies.

Answer 6

• Diffuse large B-cell lymphoma

- Burkitt’s Lymphoma

Question 7

True or false. About 90% of all lymphomas are of B-cell origin.

Answer 7

True

Question 8

These are important independent prognostic factors in NHL.

Answer 8

1. Serum B-2 microglobulin level

2. Serum LDH

Question 9

True or false.
Since HIV and Hepatitis B and C infection can be risk factors for developing NHL, and since treatment for some NHL can result in the potentially life threatening reactivation of Hepatitis B, patients with newly diagnosed NHL should be screened for these viruses as well.

Answer 9

True

Question 10

This is useful to detect aggressiveness of lymphomas.

Answer 10

FDG PET.

The intensity of FDG avidity, or SUV, correlates with histologic aggressiveness.

Question 11

PET should only be used for DLBCL and Hodgkins lymphoma, that scanning during therapy should only be done as part of clinical trials, and that end-of-treatment scan should not be done before ___ weeks, but preferably ___ weeks after chemotherapy and ___ weeks after radiation or chemoradiatiotherapy.

Answer 11

should not be done before 3weeks, but preferably 6-8weeks after chemotherapy and 8-12 weeks after radiation or chemoradiatiotherapy

Question 12

What is the Ann Arbor Stage?

Involvement of a single LN or single extranodal site.

Answer 12

I

Question 13

What is the Ann Arbor Stage?
Involvement of two or more LN regions or lymphatic structures on the SAME SIDE OF THE DIAPHRAGM alone or with involvement of limited, contiguous, extralymphatic organ or tissue.

Answer 13

II

Question 14

What is the Ann Arbor Stage?
Involvement of LN regions on BOTH SIDES OF THE DIAPHRAGM, which may include spleen, or limited, contiguous, extralymphatic organ or tissue, or both.

Answer 14

III

Question 15

What is the Ann Arbor Stage?
Diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues, with or without associated lymphatic involvement.

Answer 15

IV

Question 16

What are the five clinical risk factors included in the International Prognostic Index for NHL?

Answer 16

1. Age >60 years
2. Serum LDH elevated
3. ECOG >=2 or Karnofsky <=70
4. Ann Arbor Stage III or IV
5. > 1 site of extranodal involvement

Question 17

These are malignanct cells in HL.

Answer 17

Reed Sternberg Cells

Question 18

This is one of the fastest growing neoplasms, with a doubling time of <24 hours. It has male preponderance, often <35 years old.

Answer 18

Burkitts Lymphoma

Question 19

This form of Burkitts Lymphoma presents as a jaw or facial bone tumor that spreads to extranodal sites, usually EBV positive.

Answer 19

Endemic (African) form

Question 20

This form of Burkitts Lymphoma usuallt has abdominal presentation with massive ascites and renal and testis/ovarian involvement, and also spreads to bone marrow and CNS, usually EBV negative.

Answer 20

Non-endemic form

Question 21

True or false. Burkitts Lymphoma is chemosensitive.

Answer 21

True. All regimens incorprate high doses of cyclophosphamide.

Question 22

This is the most common histologic subtype of NHL; with median age of 64 years.

Answer 22

Diffuse large B-cell lymphoma

Question 23

Composition of R-CHOP

Answer 23

Rituximab+ cyclophosphamide, doxorubicin, vincristine, prednisone

Question 24

This is the 2nd leading NHL; most common presentation is new, painless lymphadenopathy of multiple sites; elevated LDH and B symptoms are UNCOMMON

Answer 24

Follicular lymphoma

Question 25

This NHL is associated with monoclonal IgM paraprotein. Patients with high levels of circulating IgM paraproteins constitute a specific entity known as ___, which have symptoms of hyperviscosity.

Answer 25

Lymphoplasmacytic Lymphoma NHL is associated with monoclonal IgM paraprotein. Patients with high levels of circulating IgM paraproteins constitute a specific entity known as Waldenstrom Macroglobulinemia, which have symptoms of hyperviscosity.

Question 26

This is also known as cutaenous T-cell lymphoma.mit presents with several years lf eczematous or dermatitic skin lesions. Patients may develop generalized erythroderma and circulating tumor cells, called Sezary Syndrome.

Answer 26

Mycosis Fungoides

Question 27

This NHL is a neoplasm driven by HTLV1, often contracted through breast milk of infected mothers. Aferage age at diagnosis is 60 years, with long latency.

Answer 27

Acute T-Cell Leukemia/Lymphoma

Question 28

True or false. Hodgkin Lymphomas present with B symptoms and palpable nontender lymphadenopathy- neck, supraclavicular, axilla; more than half will have mediastinal adenopathy.

Answer 28

True

Question 29

This is fever pattern that persists for days to weeks, followed by afebrile intervals and recurrence of the fever.

Answer 29

Pel Ebstein Fever