manifestation of hamtolyoid neoplasm Flashcards
malignancy in nodes :
1. —- tumour
– Carcinoma - Commonest
– Melanoma
– Sarcoma - Rare
– Other rare tumours e.g. Germ cell
2. — malignancy which refers to cancer of any if the formed elements in the blood which can be classified by:
– Lymphomas
* — vs. — Lymphoma
– Leukaemias
* – vs. –
AND
* – vs. –
metastatic
haemotologic
Hopkins vs nonhodgkins
acute vs chronic
amyloid vs lymphoid
- malignant haemoposis is monoclonal :
- Monoclonal cells are defined as a group of cells that are derived from a — ancestral cell by — cellular replication
- In malignancy these cells divide “ – ” due to cell cycle dysregulation
- These cells can be said to form a single “ – ”
- manifestation of lymphoma:
- Painless lymphadenopathy
- Abdominal distention, ascites
- Shortness of breath, pleural effusion
- Fatigue
- Fever
- Night sweats
- Weight loss
- Neurological symptoms – CNS disease
single
repeated
unchecked
clone
ANN arbor staging:
I – — lymph node region
II – – side of diaphragm
III – – sides of diaphragm
IV – —
A – No – symptoms
B – fever , night sweats weight loss
what tissue might pathologist receive in investigation of an enlarged node;
* Fine Needle Aspirate (FNA)
* Incisional Bx of Node (cores of tissue)
* Excision of Whole Lymph Node
single
oe
both
disseminated
systemic
-lymphoma: malignant proliferation of — which can be — lymphoma and is 85% or — which is 15%
- why classify lymphoma:
* Provide – criteria.
* Allow correct –
* Provide – data
* Allow — of treatment trials
( classification should be reproducible)
lymphoid cells
non hodgkin HNL ( b cell 90% m T cell 10%)
hodgkin lymphoma hl ( classical 95% , non classical 5%)
diagnostic
treatment
prognostic
comparison
classification by the book:
WHO 2012 – focus on cell of origin
New WHO classification in 2016 (latest update 2024)
* Precursor Lymphoid Neoplasms = – -Grade B and T cell
* Mature Lymphoid Neoplasms = – -grade B and T cell
* Hodgkin Lymphoma
so basically lymphomas clinical behaviour can be — or –
high grade
low grade
high or low grade
diagnostic work for lymphoma - what is CD marker:
* Cell surface markers
– Cells at – stages of differentiation express– which can be used as a – of that cell type.
– CD = —-
– CD molecules can act in a number of different ways – — , — ,— molecules
– CD markers provide targets for — facilitating diagnosis of haematological malignancy as they delineate
benign from malignant phenotypes
different
surface proteins
signature
classification determinant
receptors ligands and adhesion molecules
immunophenotyping
- Neoplasm of — – large
pleomorphic prominent nucleolus in a halo - Hodgkin cells - Reed-Sternberg cell – — Hodgkin
cell with – appearance - Classification:
1. — Hodgkin
*Nodular sclerosis
*Mixed cellularity
*Lymphocyte rich classical
*Lymphocyte depleted
2. — : Nodular
lymphocyte Predominant
B lymphocytes
binucleate
owl eye
classical
non classical
Hodgkins Diases :
age: peaks — and –
clinical features:
* — firm node (often cervical)
* Fever
* Night Sweats
* Weight loss
* Pain After Alcohol
* Pruritis
- Hodgkins reed Sternberg cells:
* HRS cells – NB express – and often —
* Rest of node:
— Cells – –
cells, – Cells, —
* Management aims to
strike a balance
between disease control
and minimising early
and late treatment-
related toxicities
20 , 30s (60-70%)
enlarged
CD30 , CD15
inflammatory T cells plasma cells and macrophages
staging of lymphoma :
- CXR
- CT
- MRI
- PET-CT
- Bone Aspirate
- Bone Trephine
- Presence or absence of B symptoms
- LDH level
- Performance index
non Hopkins lymphoma:
1- b cells : — -Grade
* Burkitt’s Lymphoma
* Diffuse Large B-Cell Lymphoma
* Mantle Cell Lymphoma – more
intermediate
– -Grade
* Follicular
* Marginal Zone Lymphoma
* Lymphoplasmacytic Lymphoma
2- T cells:
Most Behave as High-Grade
* Peripheral T-Cell Lymphoma
(PTCL)
* Angioimmunoblastic T-cell
Lymphoma (AITL)
* Anaplastic Large Cell Lymphoma
(ALK+/ALK-)
* Enteropathy-associated T-cell NHL
(EATL)
* Mycosis Fungoides
* Sezary Syndrome
high
low
b cell lymphoma high grade diffuse —- and —- as well as —
- Diffuse Large Cell B cell lymphoma.
- Lymphoblastic B cell lymphoma
- Burkitt’s Lymphoma.
burritts lymphoma is a type of — lymphoma :
* — grade B cell
* Lymphoblastic
* Requires very aggressive — so
Pathologist must recognise it
* — associated, — translocation
present
* Common in Africa
* PC: Mass in Jaws, GIT, Gonads
* Children & Adolescents
* Very rare in Europe
* Translocation affecting – gene with— of c-Myc function
* Usually t(— ) translocation
* “— ” appearance on histogical section of marrow
b
high
chemo
EBV and c-myc
c-myc
deregulation
(8:14)
starry sky
Peripheral T Cell Lymphoma
Enteropathy associated T Cell Lymphoma
T Lymphoblastic lymphoma
T Adult T cell leukaemia/lymphoma
are all examples of –
high grade T cell lymphoma
EATL
Enteropathy Associated T Cell Lymphoma
This is a complication of — , It occurs in the — and is commoner in those with poor — control.
coeliac disease
small bowel
dietry
- CD 20 and CD 79 B Cell Lymphomas
- CD 3 T Cell lymphomas
- BCL2 and CD 10 Follicular lymphoma
- CD 5 and CD23 Small cell lymphocytic Lymphoma
- Cyclin D 1 Mantle cell lymphoma
are all —
markers used in low grade lymphoma diagnostic work up ( low grade lymphoma as all are small lymphocyte )
follicular lymphoma:
* Origin — , —/–
* Contain – follicles
* – grade
* One of the – lymphomas
* Age 50+
* 60% stage – or – at presentation – Why?
* Rarely get cure but indolent disease
-Translocation chromosome – and other chromosome, usually –
Over expression –
(anti apoptotic gene).
follicle, centrocyte/centroblast
neoplastic
low
commonest
iii and iv
14
14:18
BCL2
BCL2 is – in follicles in follicular lymphoma but – in benign follicular hyperplasia which is an important marker
- follicular lymphoma are – but — and 70% – year survival and 20% transform to —
positive
negative
indolent but progressive
5 years
high grade
mantle cell lymphoma :
- diffuse replacemnt of node by malignant mantle cells
* – grade B cell
* < 5% of lymphomas
* Peak 60-70
* Often – stage at presentation
* — positive
* t(—) translocation
* 20-40% – year survival (Despite being low grade)
- morphology: usually small cells w — appearance , blasted variant has more – course, occurs in adults more in — and median survival is —
- immuo: has CD20+ CD79a
low
high
cyclin d1
11:14
5
centrocyte like
aggressive
males
3-4 years
interpreting g a pathology report:
- Check it is the correct report for your patient – name,
DOB, patient unique identifier – know what you are
actually looking at - Check pathology site and biopsy type – was the correct
site biopsied? - Did you provide the correct information to the surgeon,
radiologist/pathologist? - Discuss at Lymphoma MDT – clinical correlation, newly
diagnosed vs. relapsed - Read the report end to end
– Know terminology – malignant, clonal, CD markers, grade,
prognostic features e.g. MIB index – what does this mean?
– Do you understand the diagnosis?
BREAKING BAD NEWS: - As a doctor you will be required to interpret the report of cancer biopsies
and then break the news of cancer to patients and their families - Read the report alone first without the patient present – be sure you know
the meaning of the report and the MDT outcome - Take into account cultural, ethical, special needs of the patient
- Relate the results in plain language that the patient can understand – do not
use medical jargon – important to actually verbalise the word “cancer” and
not leave the patient guessing - Give the patient time to digest the information you have told them – this may
require several visits - Give time for the patient to ask any questions
- Arrange follow up – this is not a once off meeting, the patient needs a plan
and a place to go with queries
