Lymphomas Foundations Flashcards
what is a lymphoma?
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
how does lymphoma differ from leukemia?
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
where does lymphoma spread to?
lymphomas can eventually involve the bone marrow and blood
where does leukemia spread to?
leukemias can progress to involve the lymph nodes
what’s the clinical presentation of lymphoma?
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
what is Pel-Ebstein fever?
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
what’s the specific symptom for Burkitt lymphoma?
abdominal mass and bowel obstruction
what’s the specific symptom for mycosis fungoides/Sézary syndrome?
it’s a type of lymphoma targets the skin
presenting with flat erythematous skin patches that progress to plaques and finally to nodules
what are the two types of lymphomas?
Hodgkin lymphoma (HL)
non-Hodgkin lymphoma (NHL)
is HL or NHL better? why?
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
what’s the main morphological difference between NHL and HL?
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
what are the 5 types of Hodgkin lymphoma?
- Nodular sclerosis
- Lymphocyte rich
- Mixed cellularity
- Lymphocyte depleted
- Nodular lymphocyte predominant
what are Reed-Sternberg cells?
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
how do you classify the types of NHL?
the World Health Organization (WHO) divides NHL into two big groups by immunophenotype: B cell origin and T cell/NK-cell origin
what markers do NHLs of B cell origin express?
CD19, CD20, CD22, and surface immunoglobulins
what markers do NHLs of T cell origin express?
CD3, CD4, CD7, CD8, and T cell receptors
are B cell or T cell lymphomas more common?
B cell lymphomas are far more common than T cell lymphomas
which lymphomas are B cell origin NHLs?
Burkitt lymphoma
Diffuse large B-cell lymphoma
Mucosa-associated lymphatic tissue (MALT) lymphoma
Follicular lymphoma
Mantle cell lymphoma
which lymphomas are T cell/NK cell origin NHLs?
Adult T-cell lymphoma/leukemia (human T- lymphotrophic virus [HTLV] 1+)
Mycosis fungoides/Sézary syndrome
How does the WHO classify non-Hodgkin lymphomas?
by immunophenotype: B cell origin and T/NK cell origin
what is the prognosis of a lymphoma?
prognosis of lymphomas depends vastly on the subtype, stage, and age of the patient
how are NHLs classified for prognostic purposes?
NHLs are classified as indolent or aggressive
indolent vs. agressive?
indolent means slow-growing
aggressive refers to fast-growing
are indolent NHLs curable?
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
what’s the most common indolent lymphoma?
follicular lymphoma
what are aggressive lymphomas?
fast-growing
tend to present with symptoms early on and can be treated with chemotherapy
what is a common aggressive lymphoma?
diffuse large B cell lymphoma
which characteristics of NHL are predictors of poor prognosis?
- age greater than 60
- co-morbid medical conditions
- advanced stage lymphoma
- elevated LDH
which characteristics of HL are predictors of poor prognosis?
- age greater than 45
- advanced stage lymphoma
- relapses despite treatment
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?
Hodgkin lymphoma
the phenomenon described in the patient’s cyclic fever course is called Pel-Ebstein fever
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?
Hodgkin lymphoma
the main defining feature for the distinguishing Hodgkin lymphoma from NHL is the Reed-Sternberg cell.
