Non Hodgkins Lymphoma

Question 1

What is Non Hodgkins lymphoma(NHL)?

Answer 1

Malignancies of lymphocytes( B cell origin 90-85%, T cell origin 10-15%)
Common
Highly variable presentations and courses
Associated with HIV, EBV, H. Pylori
More common in men

Question 2

What are the NHL of B cell origin?

Answer 2

CLL/small lymphocytic
Mantle cell
Follicular 
Diffuse large cell
Burkitts lymphoma

Question 3

What are NHL of T cell origin ?

Answer 3

Lymphoblastic lymphoma
Peripheral T cell NHL
Mycosis fungoides

Question 4

How is NHL diagnosed?

Answer 4

Diagnosis always made by experience pathologist with an adequate sample
Node biopsy is preferred
Extranodal tissue can be adequate
Involves flow cytometry and cytogenetic analysis

Question 5

What are the adverse factors in the IPI?

Answer 5

PS greater or equal to 2
LDH greater than normal
Extranodal site greater or equal to 2
Age greater than 60
Ann Arbor stage 3 or 4

Question 6

What are the characteristics of small lymphocytic lymphoma (SLL/CLL)?

Answer 6

Slow paced and asymptomatic
Usually present in advanced stages
Highly treatable but incurable
Therapy is CHOP-R

Question 7

What are the characteristics of follicular lymphoma ?

Answer 7

Translocation 14:18- codes for Bcl-2
Present with painless waxing and waning lymphadenopathy
Indolent

Question 8

What are the characteristics of cutaneous T cell lymphoma ?

Answer 8

Aka Mycoses fungoides
Malignancy of helper T cells
Blacks have 2X higher incidence
Long pre diagnosis phase (years)
Pigmentation->plaques->tumors
Treatable not curable
Sezary cells present

Question 9

What are the characteristics of extranodal lymphoma ?

Answer 9

MALT lymphoma
Small lymphocytes (B cells)
Associated with H pylori infection
Indolent

Question 10

What are the characteristics of diffuse large cell?

Answer 10

Only intermediate grade 
Very common 
Typical varied presentation 
CHOP-R therapy
Curable 55%

Question 11

What are the characteristics of lymphoblastic lymphoma?

Answer 11

Highly aggressive T cell
Can progress to leukemia 
40% of childhood lymphoma 
Treated like ALL ( induction, maintenance)
Curable (30-40%)

Question 12

What are the characteristics of Adult T cell lymphoma/leukemia?

Answer 12

Agressive
Caused by HTLV
Associated with hypercalcemia and lytic bone lesions
Typically occurs in people from Japan, West Africa and the Caribbean
Rarely seen in the USA

Question 13

What are the characteristics of Mantle cell lymphoma?

Answer 13

Affects elderly men
Present with diffuse adenopathy, + marrow, splenomegaly
Over express cyclin D1
Translocation 11:14
Agressive course outside the mantle with indolent histology

Question 14

What are the characteristics of Burkitt’s lymphoma?

Answer 14

Highly aggressive B cell
Associated with t8:14 genetic mutation (c-myc gene)
Associated with EBV
Agressive chemotherapy needed
Curable (50%)

Question 15

What is Sezary syndrome?

Answer 15

T cell lymphoma
More aggressive form than mycoses fungoides
Systemic spread