malignant lymphomas

Question 1

location?

Answer 1

Malignant Lymphomas
Neoplasms of lymphoid origin But can present: with enlarged lymph nodes OR extranodal involvement OR bone marrow involvement

Question 2

two things to assess what and where

Answer 2

biopsy: bone marrow aspirate or lymph node biopsy = WHAT

clinical ex + imaging = WHERE

Question 3

pathology of lymphomas

Answer 3

naive B lymphocytes proliferation + Differentiate within GERMINAL CENTRES within lymph nodes

• lots of genetic rearrangement + division - to produce suitable Ab
• vulnerable to genetic mutation involving other genes that can be potent stimulators for malignant change

Question 4

B symptoms for lymphoma

Answer 4

• night sweats, drenching mattress
• fever
• weight loss - extreme 10% in 6 months
• pruritus
• fatigue

Question 5

commonest leukaemia in the west?

Answer 5

CLL - chronic lymphocytic

leukaemia

Question 6

typically PC age and gender and race of CLL

Answer 6

> 65 yo
male
W > B

Question 7

PC of CLL

Answer 7

lymphadenopathy
splenomegaly
hepatomegaly

Question 8

stage of majority when they present CLL

Answer 8

stage A - same survival as matched controls (Binet’s staging)

Question 9

CLL diagnosis - bloods, markers?

Answer 9

¥ Blood > 5 x 109/L lymphocytes
¥ Bone marrow > 30% lymphocytes
¥ Characteristic immunophenotyping

B-cell markers (CD 19, 20, 23) & CD5 positive

Question 10

indications for tx in CLL

Answer 10

progressive bone marrow failure

massive lymphadenopathy

systemic symptoms

Question 11

tx for CLL

Answer 11

supportive - a/bs
cytotoxic chemo - fludarabine

monoclonal Abs: rituximab

TKIs ibrutinib

Question 12

NHL or HL association with EBV

Answer 12

hodgkin lymphoma - strong association with EBV - and therefore has a bimodal peak incidence curve

Question 13

PC age of HL

Answer 13

3rd decade

and after 5th decade

Question 14

PC of HL

Answer 14

lymphadenopathy - neck, arm,groin

Question 15

DDx if lymphadenopathy

• localised + painful

Answer 15

bacterial infection

tonsillitus

Question 16

DDx if lymphadenopathy

localised painless

Answer 16

met

lymphoma - rubbery

Question 17

DDx if lymphadenopathy

generalised and painful

Answer 17

viral infections EBV CMV hep HIV

Question 18

DDx if lymphadenopathy

generalised and painless

Answer 18

lymphoma
leukaemia
drugs

Question 19

tests for lymphoma

Answer 19

biopsies from:
lymph nodes
bone aspirate
bone marrow trephine (niche)

Question 20

staging for lymphoma

Answer 20

stage 1 - single side
stage 2 - one of diaphragm
stage 3 - both sides
stage 4 - extra nodal (organ infiltration)

Question 21

lymphoma A

Answer 21

absence of any B symptoms?

Question 22

expression of what in HL

Answer 22

CD15 CD30

Question 23

NHL age of PC

Answer 23

55-80+ yo

Question 24

Typical PC of NHL

Answer 24

60% upper body lymph node involvement

40% extra nodal

Question 25

two types of NHL

Answer 25

high and low grade

Question 26

Treatment for high grade NHL

Answer 26

fast growing aggressive cells - easy to pick up + destroy with chemo: potentially curable but due to high grade - commonly fatal
- give combination chemo

Question 27

low grade NHL tx

Answer 27

proliferation slow - similar to normal cells therefore harder to eradicate and pick up with chemo

• recurrence more common
• more commonly incurable
• but lower fatality rate

Question 28

2 types of specific disease entities in NHL

Answer 28

• Diffuse large B-cell lymphoma: COMMONEST LYMPHOMA, high grade
• Follicular lymphoma: 2nd commonest, low grade