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House Hemat > NON HODGKINS LYMPHOMA > Flashcards

NON HODGKINS LYMPHOMA Flashcards

1
Q

Lymphomas are ______geneous solid tumours of lymphoid tissues and may arise from ___,______,______, or ______ cells lineages.

A

hetero

B-, T-, non-B/T, or NK-

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2
Q

Lymphomas

The tumours are more often seen in regions of the body with high concentration of _______: the _______,______,________, and _______; and less frequently, extra nodal tissues of the _____,_____,______,________ and the central nervous system (CNS).

A

lymphoid tissues

lymph nodes, Waldeyer ring , spleen and bone marrow

skin, bone, lungs, liver

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3
Q

Waldeyer ring (_____,_______,_________,_____)

A

Palatine tonsil, , tubal tonsil, lingual tonsil and pharyngeal tonsil

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4
Q

Lymphomas are the _____ and ______ most frequent cancers in Nigerian males and females, respectively.

A

second and third

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5
Q

Lymphoma incidence has increased by 2-13 folds across sub-Saharan African countries since the _____________

A
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6
Q

AIDS-related lymphomas are generally very (indolent or aggressive?) , the poor risk HL (mixed cellularity, lymphocyte depleted), the _____ and the ______ , NHL (with predilection for extranodal sites such as the primary CNS lymphoma).

A

Aggressive

Burkitt

non-Burkitt

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7
Q

The incidence of all lymphoma variants in all age groups is higher in (males or females ?) than it is in (males or females?) , ratio = 2-3:1

A

Males

Females

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8
Q

The WHO Classification
• B-cell neoplasms

__________ neoplasm
_________ neoplasms

A

Precursor B-cell

Mature B-cell

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9
Q

The WHO Classification

Mature B-cell neoplasms
•______/_______
•______
• _______ lymphoma
•______ lymphoma
•_______ lymphoma
•___________

A

CLL/smalllymphocyticlymphoma

PLL

Mantle cell

Follicular

Burkitt’s

Plasmacytoma

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10
Q

The WHO Classification
• T- and Putative NK- cell neoplasms

______T-cell neoplasm
_______T-cell and ____ cell neoplasms

A

Precursor

Mature

NK

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11
Q

The WHO Classification
• T- and Putative NK- cell neoplasms

Precursor T-cell neoplasm
•____________ lymphoma/leukaemia

A

T-lymphoblastic

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12
Q

The WHO Classification
• T- and Putative NK- cell neoplasms

Mature T-cell and NK cell neoplasms

•T-cell ____
• T-cellgranularlymphocyticleukaemia
•_________ cell leukaemia
•___________
• Sezary syndrome
•__________ lymphoma/leukaemia
• Primary cutaneous anaplastic large cell lymphoma

A

PLL

Aggressive NK

Mycosisfungoides

Adult T-cell

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13
Q

(1) B-cell lineage lymphomas:
__________________________

(2) T-cell lineage lymphomas:
______________________

(3) N/K-cell lymphomas:
__________________________

A

Burkitt lymphoma
• Hodgkin lymphoma (HL)
• Non-Hodgkin lymphomas (NHL)

• Non-Hodgkin lymphomas (NHL)

Non-Hodgkin lymphomas (NHL)

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14
Q

HL was found predominantly in children and early adults

T/F

A

T

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15
Q

only 10% of cases of HL occurred after the age of _____ years. The M:F ratio was 1.2:1.

A

50

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16
Q

(Generalized or Localized?) disease and (indolent or aggressive?) lymphomas are rare in children.

A

Localized

indolent

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17
Q

Most lymphomas in children are of (indolent or aggressive?) histology that requires ______-like therapy.

A

Aggressive

ALL

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18
Q

In sub-Saharan tropical Africa, _____-associated ______ lymphoma,accounts for over ____% of childhood tumours.

A

EBV; Burkitt

60

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19
Q

Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

• Epstein-B Virus (EBV) and endemic ______ lymphoma and _______ lymphomas
• Human herpesvirus-8 (HHV8) and _____ lymphoma;
• Human T-cell lymphotropic virus 1 and __________ leukaemia/lymphoma

A

Burkitt; Hodgkin

primary effusion

adult T-cell

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20
Q

Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

• Helicobacter pylori and ___________ lymphoma of the ______.
• Hepatitis-C Virus and _______ lymphoma

A

mucosa-associated lymphoid tissue (MALT) ; stomach

plasmacytoid

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21
Q

Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

•__________ and endemic Burkitt lymphoma and Hodgkin lymphomas
• _______________ and primary effusion lymphoma;
•________________ virus 1 and adult T-cell leukaemia/lymphoma;
and

A

Epstein-B Virus (EBV)

Human herpesvirus-8 (HHV8)

Human T-cell lymphotropic

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22
Q

Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

•___________ and mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach.
•__________ Virus and plasmacytoid lymphoma

A

Helicobacter pylori

Hepatitis-C

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23
Q

Investigations of Lymphomas Patients 1

_____________ biopsy: very useful in Burkitt lymphoma; it is best complimented with histochemistry Ki67, BCL6 and BCL2

A

Fine needle aspiration

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24
Q

Investigations of Lymphomas Patients 1

• Positive cytology with at least 90% _____ and negative _____ staining reaction is confirmatory of BKT (Ajibade, 2015)

A

Ki67; BCL2

25
Q

Investigations of Lymphomas Patients

• _______ of _________________ biopsy (most reliable diagnostic approach for all lymphomas)

A

Histology of whole tumour tissue

26
Q

Investigations of Lymphomas

characterisation of tumour cells by Immunophenotyping using the following monoclonals:

• CD3 (___-cells) (______)
• CD20 (____-cells) (____________)
• CD30/CD15 (___________),
• CD45 (__-cells) (___________)

A

T; T-NHL

B; NLPHL, B-NHL, including BL

HL

leucocyte; NLPHL, NHL

27
Q

Investigations of Lymphomas Patients 3
characterisation of tumour cells by Cytogenetics:

• Burkitt lymphoma:T(__;__),t(__;__),t(__;__)

• Small cleaved cell lymphoma, follicular lymphoma: T(__;___)

• Small cell lymphocytic lymphoma: T(__;__)

A

8;14

2;8

8;22

14;18

11;14

28
Q

Investigations of Lymphomas

characterisation of tumour cells by Cytogenetics:

•_________ cell lymphoma: T(14;18)

A

Small cleaved

29
Q

Investigations of Lymphomas Patients 3
characterisation of tumour cells by Cytogenetics:

_______ lymphoma:T(14;18)

A

follicular

30
Q

Investigations of Lymphomas Patients 3
characterisation of tumour cells by Cytogenetics:

_____________ lymphoma: T(11;14)

A

Small cell lymphocytic

31
Q

Investigations of Lymphoma

Pretherapy Work Up Investigations:

•____ with blood film examination;

•___________ rate

•_______________ test;

A

CBC

Erythrocyte sedimentation

Direct antihuman globulin

32
Q

Investigations of Lymphoma
Pretherapy Work Up Investigations:

•________ and __________ biopsy are mandatory for staging of other lymphomas

•_________ and or biopsy of the _____

•_______ aspiration as part of diagnostic work (e.g., in BL);

A

Bone marrow aspiration and trephine

Fine needle aspiration ; of the liver

Splenic

33
Q

CLINICAL FEATURES of NHL

•_________ (most common manifestation)

• Fevers, night sweats, weight loss, and fatigue
• Symptoms related to ______ effect

• Document ______ of symptoms and ____ of progression

A

Lymphadenopathy

mass

duration; pace

34
Q

CLINICAL FEATURES of NHL

• Possibility that waxing and waning lymphadenopathy may be due to ______.

A

lymphoma

35
Q

NHL

Spontaneous remission, have been documented in some patients with lymphoma

T/F

A

T

Spontaneous remission, have been documented in some patients with lymphoma especially in low grade lymphoma

36
Q

PHYSICAL/SIGNS
• There may be (low or high?) fever, ____cardia and respiratory distress.

•______ (_____)

• Purpura, petechae or ecchymosis (thrombo_________)

A

high; tachy

Pallor (anaemia)

cytopenia

37
Q

PHYSICAL/SIGNS of NHL

• Examine all lymph node bearing areas as well as assessing _______ and _______

• Pharyngeal involvement, a thyroid mass, pleural effusion, abdominal mass, testicular mass and cutaneous lesions are findings that might direct further investigations and subsequent therapy.
• A neurological examination is vital at diagnosis.

A

hepatomegaly and splenomegaly.

38
Q

25% of patients with Waldeyer ring involvement also have involvement of the ________ and vice versa especially in _______ cell lymphoma.

A

gastro intestinal tract

mantle

39
Q

Patients with paranasal sinus involvement,______ involvement and ______ lymphoma are particularly prone to have ________ involvement and thus requires a diagnostic ______ puncture.

A

testicular; epidural; meningeal; lumbar

40
Q

• One quarter of patients with _________ involvement by large cell lymphoma also have CNS disease.

A

bone marrow

41
Q

• Patients with one testicle involved are likely to relapse in the ___________

A

contralateral testis.

42
Q

In NHL,

If pathological proof of involvement of 1 or more extralymphatic sites has been documented, the symbol for the site of involvement followed by a plus (+) sign is listed.

T/F

A

T

43
Q

Treatment of NHLs depend on the pathological classification, the clinical stage, the age of the patient and their general health.m

T/F

A

T

44
Q

Choice of Treatment for NHL

• Conventionally, it is convenient to categorize the pathological entities into:
•________
•_________ or
•_________

A

Indolent

Aggressive

Highly aggressive.

45
Q

Choice of Treatment for NHL: Indolent NHL
• Usually treated ___tively

• Runs a (shortened or prolonged?) courses and is (often or rarely?) cured;

•Local RT is useful for early stage disease

A

pallia; prolonged; rarely

46
Q

Choice of Treatment for NHL: Indolent NHL

• CT with alkylating agents, ______ analogues

• Interferon, _________ and high dose therapy with __________ transplant.

• Median survival is ____-____ years

A

purine; monclonal antibodies

autologous stem cell

8 – 10

47
Q

• Aggressive NHLs ( _________________ is the commonest type)

A

Diffuse large cell lymphoma

48
Q

Choice of Treatment for NHL
• Aggressive NHLs :

•___ (_______,_______,_____,______); ___ days is the conventional therapy.

A

CHOP

cyclophosphamide, adriamycin, oncovin and prednisolone

21

49
Q

Choice of Treatment for NHL

•______ may help to identify patients who will benefit from more aggressive strategies

A

IPS

50
Q

Treatment
• Principles of antilymphoma therapy

  1. Radiation therapy
    - Plays limited role because most patients with B-cell lymphomas often have _________ disease
  • Has a role as ______ therapy in _____ lymphomas that respond to ______.
  • In the management of some of the complications (eg ________ syndrome, ___ involvement with lymphoma with impending pathological fracture.
A

disseminated

consolidated; aggressive

chemotherapy; superior vena cava ; bone

51
Q

• The use of “second” or “third” generation regimens in aggressive NHLs have met with large success..

T/F

A

F

Little success

52
Q

Treatment
• Principles of antilymphoma therapy

Chemotherapy
- forms the _____ of therapy in lymphoma

A

cornerstone

53
Q

In lymphomas, Chemotherapy has just a palliative role.

A

F

Chemotherapy has a curative, as well as a palliative role.

54
Q

Treatment
• Principles of antilymphoma therapy

Biologic Therapy
- Comprised of _____ therapy and _________.

A

interferon

monoclonal antibodies

55
Q

Treatment
• Principles of antilymphoma therapy

Biologic Therapy

  • Interferon widely used in ____ for the treatment of (indolent or aggressive?) lymphoma, but seldon used in the ___.
A

Europe

Indolent

US

56
Q

Principles of antilymphoma therapy

Biologic Therapy

  • Recent studies show no overall significant difference in overall survival in patients treated with interferon against those treated with combination chemotherapy alone.

T/F

A

T

57
Q

Treatment
• Principles of antilymphoma therapy

Biologic Therapy

  • Interferon maintenance therapy suggest ________________ survival but no ___________________ benefit.
A

prolonged disease – free

consistent overall survival

58
Q

Treatment
• Principles of antilymphoma therapy

Biologic Therapy

-____________ – latest in the treatment against B-cell lymphoma.

A

Monoclonal antibodies

59
Q

BEFORE INITIATING THERAPY
• Confirm ______ diagnosis
• Establish ______ (disease ____)
• Confirm tumour _________
• Confirm tumour ________
• Assess ___________

A

histologic

tumour burden

staging

immunophenotype

cytogenetics

Prognostic indices

House Hemat (29 decks)

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