Lymphomas and Multiple Myeloma Flashcards
____ are dense collections of
immune cells that filter antigens from extracellular fluid passing through
Lymph nodes
_____: disease of a lymph node
Lymphadenopathy
Lymphadenopathy:
disease of a lymph node
○ It reflects disease secondary to an increase in normal lymphocytes and macrophages in response to an antigen
Enlarged Lymph Node causes
● Lymphadenopathy
● Most often due to benign, self-limited conditions, such as viral
infections
● Other causes include accumulation of cells in response to an infection in the node itself (lymphadenitis), metastatic malignancy, or neoplastic
lymphocytes (lymphoma)
Tenderness of lymph nodes suggests _____
acute inflammation, the kind that
comes with localized or acute infections
If your patient reports lymphadenopathy of a few days or even a couple of weeks, it is appropriate to _____
wait for 3-4 weeks to see if it
resolves before arranging further workup
f your patient comes in reporting a swollen lymph node
that is _____, assess for signs concerning for malignancy
non-tender and has been present for a couple of
weeks
Lymph nodes ____ cm or greater are more concerning for malignancy
2
Good initial imaging for lymphadenopathy
Ultrasound
Types of biopsy on lymphadenopathy if malignancy is possible
○ Fine Needle Aspiration Biopsy: Less invasive but has the potential to miss the pathology within the node itself
○ Excisional Biopsy: Most ENT and General Surgeons prefer to remove the entire node to establish a more certain diagnosis
The lymphomas are often referred to as the “wet cancers” because ____
they can infiltrate any tissue
Lymphomas are generally categorized as
● Hodgkin Lymphoma: A specific type of cancer
● Non-Hodgkin Lymphomas: A large group of several types of Lymphoma
Hodgkin Lymphoma age distribution
bimodal age distribution: 20s and 50s
About 85% of children who develop Hodgkin’s are ____
male
Inheritance pattern of hodgkins?
No consistent chromosomal or hereditary pattern of inheritance
has been established
Also called “Hodgkin’s Disease”
Hodgkin Lymphoma Pathophysiology
● A malignant disease of the lymph tissue (lymph cancer)
● Characterized by the presence of
Reed-Sternberg cells
● The disease tends to start in a localized region of lymph nodes and then spreads in an orderly, predictable fashion to adjacent sites
of lymph tissues
S/S of hodgkins lymphoma
● Painless lump in neck area
● Fevers/chills
● Night sweats
● Weight loss
● Anorexia
● General malaise
● Intermittent pruritus
Some people with Hodgkin will experience pain/soreness at lymph node with ____ ingestion
ETOH (alcohol)
Pel-Ebstein pattern is sometimes seen with
Hodgkin lymphoma
Days or weeks of febrile period alternating with days or weeks of afebrile period
Excisional biopsy is
____ over FNA for diagnosis of _____
preferred; hodgkin lymphoma
Laboratory tests in hodgkin lymphoma may show:
○ Normocytic anemia (if bone marrow infiltration)
○ Elevated erythrocyte sedimentation rate (ESR)
○ Mild leukocytosis with decreased lymphocytes
Other imaging for hodgkin lymphoma
● Chest X-ray may show mediastinal lymphadenopathy
● CT chest/abdomen/pelvis required for staging
○ PET scan often used in the initial staging too
Hodgkin lympoma treatment
● General surgeon or ENT surgeon for biopsy
● If diagnosis is established, contact oncology right away to set up
consultation
● Treatment could include chemotherapy, chemo and radiation combo, and possible stem cell transplant
Ann arbor staging
○ Stage I - one nodal area/region
○ Stage II - two areas on one side of diaphragm
○ Stage III - both sides of diaphragm
○ Stage IV - disseminated; disease within bone marrow or liver
○ Addition of A - lacks constitutional symptoms
○ B- 10% weight loss over 6 months, fever, and night sweats
General treatment guidelines and prognosis by stage for Hodgkin lymphoma
■ Stages I, II, and IIIA - Radiation therapy
■ Stages IIIB, IV - Combination chemo, with or without
radiation therapy
■ 5 year survival rate for Stage I is >95%
● For Stage IV, about 65%
Non-Hodgkin Lymphomas (NHLs)
A group of dozens of forms of Lymphoma all
classified as Non-Hodgkin Lymphomas
(Non-Hodgkin’s Disease)
○ Classified functionally as B-cell or T-cell
Median age of diagnosis for NHLs
Median age at diagnosis is 50 years of age
○ Does occur fairly often in pediatric
population
○ Incidence possibly increases with age as well
Non-Hodgkin is much ____
common than Hodgkin
more
S/S NHLs
painless, peripheral lymphadenopathy
○ Unlike Hodgkin’s, NHL
lymphadenopathy seems to be more generalized rather than localized to one region
○ ⅔ have retroperitoneal, mesenteric, or pelvic nodal involvement
● Extranodal involvement can occur (GI, skin, CNS, etc)
Constitutional symptoms (fever, chills, night sweats, weight loss)
can occur, but are much ____ common in NHL
less
Non-Hodgkin Lymphoma diagnosis
● Tissue biopsy is required for definitive diagnosis
● Peripheral blood smear is usually normal, even with extensive bone
marrow involvement
● Disease is usually already disseminated at time of diagnosis
Plasma Cells are specialized Lymphocytes that simply excrete large amounts of ____ at their activation
whatever antibody they were programmed to create
When a B-Lymphocyte is activated, it differentiates into a
_____
more specialized, mature version of B-Lymphocyte
Multiple Myeloma
● MM is malignant proliferation of a
single clone of Plasma Cell
○ Resulting in excess monoclonal
paraproteins (M protein)
MM epidemiology
● Most commonly seen in older adults
○ Most are in their 60s or 70s
● More common in men than women
● Exposure to radiation, benzene, and pesticides may play a role based on recent research
Multiple Myeloma pathophysiology
● One rogue Plasma Cell starts it off
The malignant cells secrete
● Osteoclast Activating Factor (OAF) which stimulates inappropriate bone breakdown
● The cells also secrete excessive amounts of monoclonal Immunoglobulin protein (M-Protein), and these sometimes form chains that block glomeruli, causing kidney injury
Common triad of MM
○ Bone pain
○ Anemia
○ Kidney injury
Skull or other X-rays may show
punched out lytic lesions in
Multiple myeloma
Occasionally, clumps of Plasma Cells aggregate in various locations
and become a _____ in ___
Plasmacytoma; MM
S/S of Multiple Myeloma
● Bone pain - 70%
○ Can develop pathologic fractures
● Normocytic anemia
● Thrombocytopenia
● Leukopenia
● Osteopenia
● Hypercalcemia
● Fatigue
● Recurrent Infection
BREAK mnemonic for S/S of Multiple Myeloma
○ Bone pain: Osteolytic destruction
○ Recurrent infections: From the leukopenia
○ Elevated calcium
○ Anemia
○ Kidney failure
Multiple Myeloma on CBC
shows normocytic anemia in 80-90% of cases
MM CMP findings
shows hypercalcemia, possibly elevated BUN/Creatinine,
and elevated total protein
○ High protein because of excess immunoglobulin circulating in
serum
Serum Protein Electrophoresis (SPEP) and Urine Protein
Electrophoresis (UPEP) findings for MM
show monoclonal protein spike
(M-spike) - Classic, essentially pathognomonic
Bone marrow biopsy findings with MM
Shows 20-30% Plasma Cells
Multiple Myeloma PBS findings
may show Rouleaux formation (coin-stacking formation), but not always
24 hour urine electrophoresis findings for MM
May show Bence-Jones Proteins
(excess free light chains;
M-proteins)
Multiple Myeloma Treatment
● Although MM is presently incurable, treatment often involves
immunomodulatory agents, chemotherapy, autologous stem cell
transplant, and/or radiation
● Supportive treatments (i.e. Bisphosphonates) have shown some
improvement in delaying skeletal disease and improving bone pain
Median survival of Multiple Myeloma
● Median survival is 7 years after diagnosis
○ Eventual bone marrow failure
