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Haematology > Lymphomas - Hodgkin's Lymphoma > Flashcards

Lymphomas - Hodgkin's Lymphoma Flashcards

1
Q

What is the definition of lymphoma?

A

Malignancies of the lymphoid system and hence may arise at any site where lymphoid tissue is present, including:

  • Lymphadenopathy
  • Extranodal
  • Bone marrow
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2
Q

What are the main types of lymphoma?

A
  • Hodgkin’s lymphoma
  • Non-hodgkin’s lymphoma
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3
Q

What age group does Hodgkin’s Lymphoma normally occur in?

A

Bimodal age curve (Between ages 16 and 65):

  • 15-35y - first peak
  • 2nd peak later in life
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4
Q

What are the main lymphoid tissues?

A
  • Lymph glands
  • Adenoids
  • Palatine tonsils
  • Thymus
  • Spleen
  • Liver
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5
Q

What does Hodgkin’s lymphoma have an asscoiation with?

A

EBV - up to 40% have increased EBV antibody titres at the time of diagnosis and EBV DNA has been demonstrated in tissue from patients with HL

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6
Q

What are the subclassifications of Hodgkin’s Lymphoma?

A
  • Classical Hodgkin’s lymphoma (cHL) - 90-95% of cases
  • Nodular lymphocyte predominant HL (NLPHL)
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7
Q

What are the characteristic cells found in classical Hodgkin’s Lymphoma?

A

Reed-Sternberg Cells

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8
Q

What are the characteristic cells found in Nodular lymphocyte predominant HL?

A

Popcorn Cells

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9
Q

What are the following?

A

Reed-Sternberg Cells - malignant binucleate cells

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10
Q

What are the main groups of causes of cervical lymphadenopathy?

A
  • Infection
  • Autoimmune disease
  • Drug reactions
  • Primary malignancy
  • Secondary Malignancy
  • Miscellaneous
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11
Q

Why can Hodgkin’s Lymphoma produce an inflammatory picture on FBC?

A

Reed-Sternberg cells produce cytokines, which attracts inflammatory cells and creates an inflammatory environment

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12
Q

What are acute infections which can cause cervical lymphadenopathy?

A
  • Pyogenic infections
  • EBV
  • CMV
  • Cat Scratch fever
  • Infected Eczema
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13
Q

What are chronic infections that can cause cervical lymphadenopathy?

A
  • TB
  • Syphilis
  • HIV
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14
Q

What are autoimmune causes of cervical lymphadenopathy?

A
  • Rheumatoid Arthritis
  • Sarcoidosis
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15
Q

What can increase the risk of someone developing Hodgkin’s Lymphoma?

A
  • Affected sibling
  • EBV
  • SLE
  • Post-transplantation
  • Obesity
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16
Q

What drug reactions can cause cervical lymphadenopathy?

A

Phenytoin

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17
Q

What primary malignancies can cause cervical lymphadenopathy?

A
  • Hodgkin’s Lymphoma
  • Non-Hodgkin’s Lymphoma
  • CLL
  • ALL
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18
Q

What secondary malignancies can cause cervical lymphadenopathy?

A
  • Thyoid
  • Laryngeal
  • Lung
  • Melanoma
  • Breast
  • Stomach
  • Nasopharyngeal/Oropharyngeal
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19
Q

What mnemonic can you use to help you remember groups of causes for lymphadenopathy in general?

A
  • Malignancy
  • Infection
  • Autoimmune
  • Miscellaneous
  • Iatrogenic
20
Q

What are miscellaneous causes of cervical lymphadenopathy?

A
  • Kawasaki disease
  • Sarcoidosis
21
Q

What are symptoms of Hodgkin’s Lymphoma?

A
  • Swellings
  • Fever
  • Weight loss
  • Night Sweats
  • Pruritis
  • Lethargy
22
Q

What is characteristic of the swellings seen in Hodgkin’s Lymphoma?

A
  • Painless
  • Non-Tender
  • Rubbery
  • Superficial
23
Q

Where does lymphadenopathy most commonly occur in Hodgkin’s Lymphoma?

A
  • Cervical
  • Axilla
  • Inguinal nodes
24
Q

What are signs of Hodgkin’s Lymphoma?

A
  • Lymphadenopathy
  • Cachexia
  • Anaemia
  • Splenomegaly
  • Hepatomegaly
25
Q

Why might someone with Hodgkin’s Lymphoma present with a cough?

A

Mediastinal lymphadenopathy

26
Q

What can happen if someone with Hodgkin’s Lymphoma drinks alcohol?

A

Alcohol-induced lymph node pain

27
Q

What is Pel-Ebstein fever?

A

Cyclical fever with long periods of normal or low temperature

28
Q

How would you investigate if you suspected Hodgkin’s Lymphoma?

A

Investigations for diagnosis

  • Bloods - FBC, Blood Film, ESR
  • CXR
  • CT Chest, Abdo, pelvis, neck
  • PET +/- Bone Scan
  • Fine Needle Aspiration - core biopsy
29
Q

Why would you do a CXR when investigating suspected Lymphoma?

A

Look for mediastinal widening

30
Q

What investigations would you do to prepare for treating lymphoma?

A
  • Bloods - LFTs, U+E’s, Serum Biochemistry, Urate, LDH
  • Virology - HIV, HBV, HCV
  • Consider Cardiorespiratory Function Testing
  • Consider Fertility testing
31
Q

Why would you do a serum urate in someone with lymphoma?

A

Serum uric acid is helpful, particularly in those lymphomas in which there is risk of tumour lysis syndrome

32
Q

Why is Serum LDH raised in Hodgkin’s lymphoma?

A

It is released during cell turnover

33
Q

How would you manage someone with Hodgkin’s Lymphoma?

A

Based on staging

  • Stage IA + IIA - radiotherapy and short courses of chemo
  • Other Staging - longer courses of chemo

In relapsed disease

  • High-dose chemo + Stem cell transplant
34
Q

What chemotherapeutic regimen is most commonly used in Hodgkin’s Lymphoma?

A

ABVD

  • Adreomycin (doxorubicin)
  • Bleomycin
  • Vinblastine
  • Dacarbazine

2-4 cycles of ABVD in early/low risk disease + radiotherapy

6-8 cycles of ABVD in advanced disease + radiotherapy

35
Q

What percentage of those treated with ‘ABVD’ are cured?

A

Approximately 80%

36
Q

What staging system is used to stage Hodgkin’s Lymphoma?

A

Ann Arbor System

37
Q

What would class as a stage I hodgkin’s lymphoma?

A

Confined to a single lymph node

38
Q

What would class as Stage II hodgkin’s lymphoma?

A

Involvement of two or more nodal areas on the same side of the diaphragm

39
Q

What would class as stage III Hodgkin’s Lymphoma?

A

Involvement of nodes on both sides of the diaphragm

40
Q

What would class as stage IV Hodgkin’s Lymphoma?

A

Spread beyond the lymph nodes - e.g. liver, bone

41
Q

What are complications of treatment of Hodgkin’s Lymphoma?

A
  • Second malignancy - lung, breast, melanoma, sarcoma, stomach, thyroid
  • Ischaemic heart disease
  • Hypothyroidism
  • Lung fibrosis
  • Peipheral neuropathy
42
Q

What are side effects to chemotherapy?

A
  • Myelosuppression
  • Nausea
  • Alopecia
  • Infection
  • AML
  • Non-hodgkin’s Lymphoma
  • Infertility
43
Q

What are emergency presentations that can occur in Hodgkin’s lymphoma?

A
  • Infection
  • SVC obstruction
44
Q

What are features of SVC obstruction?

A
  • Increased JVP
  • Sensation of fullness in the head
  • Dyspnoea
  • Blackouts
  • Facial Oedema
45
Q

When staging hodgkin’s Lymphoma, what do A and B stand for?

A
  • A - no systemic symptoms
  • B - presence of b symptoms
46
Q

What are B symptoms?

A
  • Weight loss > 10% in last 6 months
  • Unexplained fever > 38oC
  • Neight sweats (needing change of clothes)
  • Pruritis
47
Q

What classification of Classcial hodgkin’s lymphoma has a poor prognosis?

A

Lymphocyte deplete classical hodgkin’s lymphoma

Haematology (34 decks)

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