Non-Hodgkin’s / Hodgkin’s Lymphoma Flashcards
What is NHL?
Heterogenous group of cancers which occurs from the malignant proliferation of lymphocytes
What cells is NHL derived from?
B cells
T cells
NK cells
Occurs at any stage of B or T cell maturation
What mechanisms can cause lymphoma? 4 points
Gene mutation, amplification, deletion, and chromosomal translocation
How has WHO classified NHL? 3 points
Mature B-cell neoplasms
Mature T-cell
NK-cell neoplasms
How else (apart from WHO classification) can NHL be classified? What are their prognoses?
Low-grade NHL - relatively good prognosis but once advanced, it is incurable
High-grade NHL - progresses quickly but chemotherapy is more effective in these types
What percentage of NHL originate from B-cells? What is the most common types of lymphoma?
90%
Follicular lymphoma - commonest indolent form of NHL (35% of all NHL)
Diffuse large B-cell lymphoma - commonest type of aggressive NHL (30-58% nhl AND 30-40% B-cell lymphoma)
What are the precursor B-cell types?
Precursor B-acute lymphoblastic leukaemia / lymphoblastic lymphoma
What are the types of peripheral B-cell neoplasms?
- B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma
- B-cell prolymphocytic leukaemia
- Lymphoplasmacytic lymphoma/immunocytoma
- Mantle cell lymphoma
- Follicular lymphoma
- Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue (MALT) type
- Nodal marginal zone B-cell lymphoma (± monocytoid B-cells)
- Splenic marginal zone lymphoma (± villous lymphocytes)
- Hairy cell leukemia
- Plasmacytoma/plasma cell myeloma
- Diffuse large B-cell lymphoma
- Burkitt lymphoma
What are the precursor T-cell types?
Precursor T-acute lymphoblastic leukaemia/lymphoblastic lymphoma
What are the precursor T-cell and NK-cell types?
- T-cell chronic lymphocytic leukaemia/prolymphocytic leukaemia
- T-cell granular lymphocytic leukaemia
- Mycosis fungoides/Sezary syndrome
- Peripheral T-cell lymphoma, not otherwise characterized
- Hepatosplenic gamma/delta T-cell lymphoma
- Subcutaneous panniculitis-like T-cell lymphoma
- Angioimmunoblastic T-cell lymphoma
- Extranodal T-/NK-cell lymphoma, nasal type
- Enteropathy-type intestinal T-cell lymphoma
- Adult T-cell lymphoma/leukaemia (human T-lymphotrophic virus [HTLV] 1+)
- Anaplastic large cell lymphoma, primary systemic type
- Anaplastic large cell lymphoma, primary cutaneous type
- Aggressive NK-cell leukaemia
What are the clinical features of NHL?
B symptoms (worse prognosis) - weight loss >10%, night sweats and pyrexia >38 degrees celsius
Painless lymphadenopathy
Extranodal involvement - common sites include GI tract, skin and bone marrow
Bone marrow infiltration - cytopenia (anaemia, infections or purpura)
Enlarging lymph nodes causing symptoms e.g. SVC / biliary tree / ureters / bowel obstruction etc.
What are some specific manifestations of NHL?
Mycosis fungoides
Lymphoblastic lymphoma - mediastinal mass, SVC syndrome and meningeal disease with cranial nerve palsies
Burkitt’s lymphoma - abdominal mass > obstruction
Adult T-cell leukaemia
Anaplastic large cell lymphoma
What investigations to order for suspected NHL?
FBC, U+E, LDH, BBVS, beta-microglobulin, CXR, MRI brain (if neuro symptoms present)
Biopsy - excisional biopsy if easily accesible, core needle biopsy for lung or abdomen
Immunophenotyping - FISH (identify MYC)
CT TAP
FDG PET CT to confirm staging
Who should FDG-PET-CT be offered to?
Patients with:
Stage I diffuse large B-cell lymphoma by clinical and CT criteria
Stage I or localised stage II follicular lymphoma
Stage I or II Burkitt lymphoma with other low-risk features
What criteria is used for lymphoma staging?
Lugano classification
