NON HODGKINS LYMPHOMA Flashcards
Lymphomas are ______geneous solid tumours of lymphoid tissues and may arise from ___,______,______, or ______ cells lineages.
hetero
B-, T-, non-B/T, or NK-
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).
lymphoid tissues
lymph nodes, Waldeyer ring , spleen and bone marrow
skin, bone, lungs, liver
Waldeyer ring (_____,_______,_________,_____)
Palatine tonsil, , tubal tonsil, lingual tonsil and pharyngeal tonsil
Lymphomas are the _____ and ______ most frequent cancers in Nigerian males and females, respectively.
second and third
Lymphoma incidence has increased by 2-13 folds across sub-Saharan African countries since the _____________
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).
Aggressive
Burkitt
non-Burkitt
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
Males
Females
The WHO Classification
• B-cell neoplasms
__________ neoplasm
_________ neoplasms
Precursor B-cell
Mature B-cell
The WHO Classification
Mature B-cell neoplasms
•______/_______
•______
• _______ lymphoma
•______ lymphoma
•_______ lymphoma
•___________
CLL/smalllymphocyticlymphoma
PLL
Mantle cell
Follicular
Burkitt’s
Plasmacytoma
The WHO Classification
• T- and Putative NK- cell neoplasms
______T-cell neoplasm
_______T-cell and ____ cell neoplasms
Precursor
Mature
NK
The WHO Classification
• T- and Putative NK- cell neoplasms
Precursor T-cell neoplasm
•____________ lymphoma/leukaemia
T-lymphoblastic
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
PLL
Aggressive NK
Mycosisfungoides
Adult T-cell
(1) B-cell lineage lymphomas:
__________________________
(2) T-cell lineage lymphomas:
______________________
(3) N/K-cell lymphomas:
__________________________
Burkitt lymphoma
• Hodgkin lymphoma (HL)
• Non-Hodgkin lymphomas (NHL)
• Non-Hodgkin lymphomas (NHL)
Non-Hodgkin lymphomas (NHL)
HL was found predominantly in children and early adults
T/F
T
only 10% of cases of HL occurred after the age of _____ years. The M:F ratio was 1.2:1.
50
(Generalized or Localized?) disease and (indolent or aggressive?) lymphomas are rare in children.
Localized
indolent
Most lymphomas in children are of (indolent or aggressive?) histology that requires ______-like therapy.
Aggressive
ALL
In sub-Saharan tropical Africa, _____-associated ______ lymphoma,accounts for over ____% of childhood tumours.
EBV; Burkitt
60
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
Burkitt; Hodgkin
primary effusion
adult T-cell
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
mucosa-associated lymphoid tissue (MALT) ; stomach
plasmacytoid
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
Epstein-B Virus (EBV)
Human herpesvirus-8 (HHV8)
Human T-cell lymphotropic
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
Helicobacter pylori
Hepatitis-C
Investigations of Lymphomas Patients 1
_____________ biopsy: very useful in Burkitt lymphoma; it is best complimented with histochemistry Ki67, BCL6 and BCL2
Fine needle aspiration
Investigations of Lymphomas Patients 1
• Positive cytology with at least 90% _____ and negative _____ staining reaction is confirmatory of BKT (Ajibade, 2015)
Ki67; BCL2
Investigations of Lymphomas Patients
• _______ of _________________ biopsy (most reliable diagnostic approach for all lymphomas)
Histology of whole tumour tissue
Investigations of Lymphomas
characterisation of tumour cells by Immunophenotyping using the following monoclonals:
• CD3 (___-cells) (______)
• CD20 (____-cells) (____________)
• CD30/CD15 (___________),
• CD45 (__-cells) (___________)
T; T-NHL
B; NLPHL, B-NHL, including BL
HL
leucocyte; NLPHL, NHL
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(__;__)
8;14
2;8
8;22
14;18
11;14
Investigations of Lymphomas
characterisation of tumour cells by Cytogenetics:
•_________ cell lymphoma: T(14;18)
Small cleaved
Investigations of Lymphomas Patients 3
characterisation of tumour cells by Cytogenetics:
_______ lymphoma:T(14;18)
follicular
Investigations of Lymphomas Patients 3
characterisation of tumour cells by Cytogenetics:
_____________ lymphoma: T(11;14)
Small cell lymphocytic
Investigations of Lymphoma
Pretherapy Work Up Investigations:
•____ with blood film examination;
•___________ rate
•_______________ test;
CBC
Erythrocyte sedimentation
Direct antihuman globulin
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);
Bone marrow aspiration and trephine
Fine needle aspiration ; of the liver
Splenic
CLINICAL FEATURES of NHL
•_________ (most common manifestation)
• Fevers, night sweats, weight loss, and fatigue
• Symptoms related to ______ effect
• Document ______ of symptoms and ____ of progression
Lymphadenopathy
mass
duration; pace
CLINICAL FEATURES of NHL
• Possibility that waxing and waning lymphadenopathy may be due to ______.
lymphoma
NHL
Spontaneous remission, have been documented in some patients with lymphoma
T/F
T
Spontaneous remission, have been documented in some patients with lymphoma especially in low grade lymphoma
PHYSICAL/SIGNS
• There may be (low or high?) fever, ____cardia and respiratory distress.
•______ (_____)
• Purpura, petechae or ecchymosis (thrombo_________)
high; tachy
Pallor (anaemia)
cytopenia
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.
hepatomegaly and splenomegaly.
25% of patients with Waldeyer ring involvement also have involvement of the ________ and vice versa especially in _______ cell lymphoma.
gastro intestinal tract
mantle
Patients with paranasal sinus involvement,______ involvement and ______ lymphoma are particularly prone to have ________ involvement and thus requires a diagnostic ______ puncture.
testicular; epidural; meningeal; lumbar
• One quarter of patients with _________ involvement by large cell lymphoma also have CNS disease.
bone marrow
• Patients with one testicle involved are likely to relapse in the ___________
contralateral testis.
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
T
Treatment of NHLs depend on the pathological classification, the clinical stage, the age of the patient and their general health.m
T/F
T
Choice of Treatment for NHL
• Conventionally, it is convenient to categorize the pathological entities into:
•________
•_________ or
•_________
Indolent
Aggressive
Highly aggressive.
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
pallia; prolonged; rarely
Choice of Treatment for NHL: Indolent NHL
• CT with alkylating agents, ______ analogues
• Interferon, _________ and high dose therapy with __________ transplant.
• Median survival is ____-____ years
purine; monclonal antibodies
autologous stem cell
8 – 10
• Aggressive NHLs ( _________________ is the commonest type)
Diffuse large cell lymphoma
Choice of Treatment for NHL
• Aggressive NHLs :
•___ (_______,_______,_____,______); ___ days is the conventional therapy.
CHOP
cyclophosphamide, adriamycin, oncovin and prednisolone
21
Choice of Treatment for NHL
•______ may help to identify patients who will benefit from more aggressive strategies
IPS
Treatment
• Principles of antilymphoma therapy
- 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.
disseminated
consolidated; aggressive
chemotherapy; superior vena cava ; bone
• The use of “second” or “third” generation regimens in aggressive NHLs have met with large success..
T/F
F
Little success
Treatment
• Principles of antilymphoma therapy
Chemotherapy
- forms the _____ of therapy in lymphoma
cornerstone
In lymphomas, Chemotherapy has just a palliative role.
F
Chemotherapy has a curative, as well as a palliative role.
Treatment
• Principles of antilymphoma therapy
Biologic Therapy
- Comprised of _____ therapy and _________.
interferon
monoclonal antibodies
Treatment
• Principles of antilymphoma therapy
Biologic Therapy
- Interferon widely used in ____ for the treatment of (indolent or aggressive?) lymphoma, but seldon used in the ___.
Europe
Indolent
US
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
T
Treatment
• Principles of antilymphoma therapy
Biologic Therapy
- Interferon maintenance therapy suggest ________________ survival but no ___________________ benefit.
prolonged disease – free
consistent overall survival
Treatment
• Principles of antilymphoma therapy
Biologic Therapy
-____________ – latest in the treatment against B-cell lymphoma.
Monoclonal antibodies
BEFORE INITIATING THERAPY
• Confirm ______ diagnosis
• Establish ______ (disease ____)
• Confirm tumour _________
• Confirm tumour ________
• Assess ___________
histologic
tumour burden
staging
immunophenotype
cytogenetics
Prognostic indices
