Module 10.2 - Lymphomas

Question 1

What are some characteristics of Hodgkin’s Lymphoma?

Answer 1

• A malignant lymphoma first characterized by Thomas Hodgkin in 1832
• HL progresses from one (1) group of LNs to another and includes the development of systemic symptoms and the presence of B cells called Reed-Sternberg (RS) cells
• Incidence of HL is higher in males with median age of 64 at diagnosis
• Incidence greater in Caucasians
• HL peaks at two (2) different ages: early in life (2nd & 3rd decade) and later in life (6th & 7th decade)

Question 2

Describe the pathophysiology associated with Hodgkin’s Lymphoma

Answer 2

• Reed-Sternberg (RS) cells represent the malignant transformed lymphocytes and are the HALLMARK of HL and are necessary for the diagnosis of HL
• The triggering mechanism for malignant transformation of cells remains unknown.
• Classic HL appears to be derived from a B cell in the germinal center that has not undergone successful immunoglobulin gene rearrangement and would normally be induced to undergo apoptosis.
• Survival of this cell may be linked to infection with EBV.
• Studies have linked HL with EBV infection and EBV DNA.
• The RS cells secrete and release cytokines that result in the accumulation of inflammatory cells that produces local and systemic effects.

HL is subcategorized into two (2) main types:

1. Classic Hodgkin’s – which is further subcategorized into four (4) types
2. Nodular lymphocyte predominant Hodgkin’s

Question 3

What are the Symptoms/Physical Exam findings associated with Hodgkin’s Lymphoma?

Answer 3

• Enlarged, painless LN in neck(classic presenting sign)
• Discovering of mediastinal mass on routine chest x-ray- asymptomatic
• Cervical, axillary, inguinal and retroperitoneal LNs commonly affected in HL
• Fever, weight loss, night sweats
• Pruritus

Question 4

What are the laboratory findings associated with Hodgkin’s Lymphoma?

Answer 4

• Presence of Reed-Sternberg (RS) cells on lymph node biopsy
• Thrombocytosis
• Leukocytosis
• Eosinophilia
• Elevated ESR
• Elevated alkaline phosphatase
• Paraneoplastic syndrome

Question 5

What is Burkitt’s Lymphoma?

Answer 5

• It is a rare but highly aggressive B-cell Non-Hodgkin’s Lymphoma.
• Translocation of a gene called MYC is a HALLMARK of Burkitt lymphoma
• In adults, Burkitt Lymphoma is often indistinguishable from diffuse Large B cell Lymphoma- another aggressive B cell lymphoma
• Endemic Burkitt lymphoma originates in Africa and is associated with the Epstein-Barr virus (ON TEST); its incidence rate is about 50 times higher in equatorial Africa and New Guinea than in the U.S.

Question 6

What are the symptoms associated with Non-Hodgkin’s Lymphoma?

Answer 6

• Lymphadenopathy- painless, widespread or isolated
• Patients may be asymptomatic
• Fever
• Night sweats
• Weight loss
• Abdominal fullness- with Burkitt lymphoma may have bowel obstruction
• Splenomegaly
• Hepatomegaly
• Extra-nodal sites of disease- skin ulcers