Lymphomas Foundations

Question 1

what is a lymphoma?

Answer 1

a malignant tumor that usually begins in lymph nodes but can also affect other organs such as the thymus, bone marrow, and spleen

lymphomas are composed of malignant lymphocytes of different kinds and at different stages of maturation

Question 2

how does lymphoma differ from leukemia?

Answer 2

leukemias are malignant disorders of myeloid cells or lymphoid cells that begin in the bone marrow

lymphomas, on the other hand, are malignant disorders of lymphoid cells (not myeloid cells), and they typically typically begin in lymph nodes

but both leukemias and lymphomas can spread to other areas of the body as the disease progresses

Question 3

where does lymphoma spread to?

Answer 3

lymphomas can eventually involve the bone marrow and blood

Question 4

where does leukemia spread to?

Answer 4

leukemias can progress to involve the lymph nodes

Question 5

what’s the clinical presentation of lymphoma?

Answer 5

most commonly presents with painless lymphadenopathy = enlarged lymph nodes

can also present with other generalized and nonspecific symptoms such as persistent fatigue, weakness, unexplained or unintentional weight loss, anorexia, fever, chills, and night sweats

Question 6

what is Pel-Ebstein fever?

Answer 6

an unusual pattern of cyclic fevers that come and go every week or two

it’s called Pel-Ebstein fever when its present in Hodgkin lymphoma

Question 7

what’s the specific symptom for Burkitt lymphoma?

Answer 7

abdominal mass and bowel obstruction

Question 8

what’s the specific symptom for mycosis fungoides/Sézary syndrome?

Answer 8

it’s a type of lymphoma targets the skin

presenting with flat erythematous skin patches that progress to plaques and finally to nodules

Question 9

what are the two types of lymphomas?

Answer 9

Hodgkin lymphoma (HL)

non-Hodgkin lymphoma (NHL)

Question 10

is HL or NHL better? why?

Answer 10

clinically, patients with HL tend to do better overall than patients with NHL

part of the reason for this is the pattern of spread in each type of lymphoma

HL tends to spread in a contiguous fashion, from one node to adjacent nodes, while NHL tends to skip around, starting in a node and then showing up in the bone marrow or a faraway node

Question 11

what’s the main morphological difference between NHL and HL?

Answer 11

HL is distinguished by a characteristic, giant, multinucleated cell called the Reed-Sternberg cell,

NHL has a huge range of morphologic appearances and no single type of diagnostic cell

HL can be distinguished from NHL by its characteristic malignant Reed- Sternberg cell

Question 12

what are the 5 types of Hodgkin lymphoma?

Answer 12

1. Nodular sclerosis
2. Lymphocyte rich
3. Mixed cellularity
4. Lymphocyte depleted
5. Nodular lymphocyte predominant

Question 13

what are Reed-Sternberg cells?

Answer 13

characteristic of NL

Reed-Sternberg cells are huge cells with two big nuclei containing prominent nucleoli.

the nuclei give the cell an “owl-eye” appearance

Question 14

how do you classify the types of NHL?

Answer 14

the World Health Organization (WHO) divides NHL into two big groups by immunophenotype: B cell origin and T cell/NK-cell origin

Question 15

what markers do NHLs of B cell origin express?

Answer 15

CD19, CD20, CD22, and surface immunoglobulins

Question 16

what markers do NHLs of T cell origin express?

Answer 16

CD3, CD4, CD7, CD8, and T cell receptors

Question 17

are B cell or T cell lymphomas more common?

Answer 17

B cell lymphomas are far more common than T cell lymphomas

Question 18

which lymphomas are B cell origin NHLs?

Answer 18

Burkitt lymphoma

Diffuse large B-cell lymphoma

Mucosa-associated lymphatic tissue (MALT) lymphoma

Follicular lymphoma

Mantle cell lymphoma

Question 19

which lymphomas are T cell/NK cell origin NHLs?

Answer 19

Adult T-cell lymphoma/leukemia (human T- lymphotrophic virus [HTLV] 1+)

Mycosis fungoides/Sézary syndrome

Question 20

How does the WHO classify non-Hodgkin lymphomas?

Answer 20

by immunophenotype: B cell origin and T/NK cell origin

Question 21

what is the prognosis of a lymphoma?

Answer 21

prognosis of lymphomas depends vastly on the subtype, stage, and age of the patient

Question 22

how are NHLs classified for prognostic purposes?

Answer 22

NHLs are classified as indolent or aggressive

Question 23

indolent vs. agressive?

Answer 23

indolent means slow-growing

aggressive refers to fast-growing

Question 24

are indolent NHLs curable?

Answer 24

indolent tumors are often curable when caught at an early stage

unfortunately, this is rare as indolent lymphomas are often asymptomatic at an early stage

even with treatment, indolent tumors have high recurrence rates

Question 25

what’s the most common indolent lymphoma?

Answer 25

follicular lymphoma

Question 26

what are aggressive lymphomas?

Answer 26

fast-growing

tend to present with symptoms early on and can be treated with chemotherapy

Question 27

what is a common aggressive lymphoma?

Answer 27

diffuse large B cell lymphoma

Question 28

which characteristics of NHL are predictors of poor prognosis?

Answer 28

1. age greater than 60
2. co-morbid medical conditions
3. advanced stage lymphoma
4. elevated LDH

Question 29

which characteristics of HL are predictors of poor prognosis?

Answer 29

1. age greater than 45
2. advanced stage lymphoma
3. relapses despite treatment

Question 30

A 75-year-old male presented with complaints of fatigue, weight loss, fevers, and night chills for the past 3 months. He also described a strange phenomenon where 2 weeks ago, he developed a temperature of 100.4°F that increased to 103.5°F over several days and then decreased back to normal and then increased again to 102.7°F and then decreased back to normal. What type of lymphoma is
associated
with this phenomenon?

Answer 30

Hodgkin lymphoma

the phenomenon described in the patient’s cyclic fever course is called Pel-Ebstein fever

Question 31

A 72-year-old female presented to the clinic with complaints of fatigue, weight loss, loss of appetite, itchiness, fevers, night chills, and generalized lymphadenopathy for the past 7 months. The physician had a strong suspicion for lymphoma and biopsy of an affected lymph node revealed occasional large cells with two nuclei and an owl-eye appearance. Which of the following is the most likely diagnosis?

Answer 31

Hodgkin lymphoma

the main defining feature for the distinguishing Hodgkin lymphoma from NHL is the Reed-Sternberg cell.