Non Hodgkin's Lymphoma

Question 1

What is Non Hodgkin’s Lymphoma?

Answer 1

All lymphomas without Reed-Sternberg cells (binucleate cells).
Diverse group consisting of:
85% B cell
15% T cell and NK cell forms

Question 2

Describe the nature of Non Hodgkin’s Lymphoma

Answer 2

Ranges from stable, indolent disease to aggressive disease

Question 3

Describe the aetiology of Non Hodgkin’s Lymphoma

Answer 3

Complex process involving accumulation of multiple genetic lesions
Changes in the genome in certain lymphoma subtypes have been associated with introduction of foreign genes via oncogenic viruses (e.g. EBV + Burkitt’s lymphoma)

Question 4

List 5 risk factors of Non Hodgkin’s Lymphoma

Answer 4

Radiotherapy  
Immunosuppressive agents  
Chemotherapy  
HIV, HBV, HCV 
Connective tissue disease (e.g. SLE)

Question 5

Describe the epidemiology of Non Hodgkin’s Lymphoma

Answer 5

Incidence increases with age
M > F
More common in the WESTERN WORLD

Question 6

List 5 systemic symptoms of Non Hodgkin’s Lymphoma

Answer 6

Fever  
Night sweats  
Fatigue
Weight loss > 10% body weight  
Symptoms of hypercalcaemia

Question 7

List 8 symptoms related to organ involvement in Non Hodgkin’s Lymphoma

Answer 7

Headache  
Sore throat  
SOB
Cough 
Dizziness
Bone pain
Abdominal discomfort  
Testicular swelling

Question 8

Describe the mass in Non Hodgkin’s Lymphoma

Answer 8

Painless enlarging mass (in neck, axilla or groin)

Question 9

List 4 signs of Non Hodgkin’s Lymphoma

Answer 9

Painless firm rubbery lymphadenopathy
Mycosis fungoides: looks like a fungal infection but is a cutaneous T-cell lymphoma
Abdominal mass
Hepatosplenomegaly

Question 10

List 3 signs of bone marrow involvement in Non Hodgkin’s Lymphoma

Answer 10

Anaemia (Pallor)
Infections
Purpura

Question 11

What bloods are seen in Non Hodgkin’s Lymphoma?

Answer 11

Anaemia  
Neutropaenia 
Thrombocytopaenia  
High ESR + CRP  
Calcium may be raised

Question 12

What serology should be tested in Non Hodgkin’s Lymphoma?

Answer 12

HIV
HBV
HCV

Question 13

What other investigations should be performed in Non Hodgkin’s Lymphoma?

Answer 13

Blood Film: Lymphoma cells visible in some
Bone Marrow Aspiration + Biopsy
Imaging: CXR, CT, PET
Lymph Node Biopsy: histopathological evaluation, immunophenotyping + cytogenetics
Staging: Ann-Arbor

Question 14

Is extra nodal involvement more common in Hodgkins or non Hodgkins lymphoma?

Answer 14

Non Hodgkins Lymphoma

Question 15

Are systemic symptoms more common in Hodgkins or non Hodgkins lymphoma?

Answer 15

Hodgkins