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Non-Hodgkin and Hodgkin Lymphoma > Notecards > Flashcards

Notecards Flashcards

1
Q

What is the definition of lymphoma?

A

Malignant proliferation of abnormal lymphocytes in lymph nodes and/or lymphoid tissue of other organs (extranodal)Lymph node architecture is gone and lymphoma cells take over

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2
Q

What is the differential diagnosis for lymphadenopathy?

A

Most cases of lymphadenopathy are not malignantBacterial infectionViral (EBV common, HIV)FungalMycobacterial (TB)SpirochetalProtozoanImmunological diseaseGranulomatous diseaseMalignancy

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3
Q

What is the clinical presentation of lymphomas in general?

A

Painless lymphadenopathyFever, malaise, night sweats, and weight lossExtranodal involvement more common in Non-Hodgkin than HodgkinBone marrow involvement is rare at presentation in HD in contrast to NHL

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4
Q

What determines treatment in NHL and HD?

A

NHL = histology + stageHD = stage

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5
Q

What is stage I?

A

Single lymph node involvement or extralymphatic organ

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6
Q

What is stage II?

A

Involvement of 2+ lymph node regions on the same side of the diaphragm (above or below)

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7
Q

What is stage III?

A

Involvement of lymph node regions on both sides of the diaphragm

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8
Q

What is stage IV?

A

Disseminated disease in extralymphatic organs with or without lymph node enlargement

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9
Q

What is A staging?

A

No systemic symptoms

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10
Q

What is B staging?

A

Unexplained weight lossUnexplained feverNight sweats

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11
Q

What type of cell is this?

A

Reed-SternbergOwl eye appearanceCharacteristic of Hodgkin lymphoma

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12
Q

What is the epidemiology of Hodgkin disease?

A

No direct cause/effect relationship knownViral infectionEBV but not a direct associationHereditary predisposition (common HLA types)

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13
Q

What are the WHO categories for Hodgkin lymphoma?Which lymphomas are included in the classical Hodgkin lymphoma group?

A

Classical Hodgkin lymphoma and nodular lymphoma predominant Hodgkin lymphomaClassical Hodgkin lymphoma:Nodular sclerosis (most common)Lymphocyte-rich (best prognosis)Lymphocyte-depleted (worse prognosis)Mixed cellularity

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14
Q

What is the clinical presentation for Hodgkin lymphoma?

A

Painless lymphadenopathy (cervical or supraclavicular)Pruritis (itchy)Back painDyspnea because of enlarged mediastinal lymph nodeB symptoms (weight loss, fever, and night sweats)

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15
Q

What are the most common lymph nodes involved in Hodgkin lymphoma?

A

CervicalSupraclavicularMediastinal

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16
Q

What would a lymph node biopsy look like for Hodgkin lymphoma?

A

Few malignant Reed-Sternberg cells with the majority of cells being benign reactive cells (trying to contain Reed-Sternberg cells)

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17
Q

What are the unfavorable factors for Hodgkin lymphoma?

A

Bulky disease (large mass)ESR (erythrocyte sedimentation rate)elevated> 3 sites of diseaseB symptoms> 2 extranodal sites

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18
Q

What is the treatment for Hodgkin lymphoma?

A

Early stage disease: radiationLate stage disease: chemotherapy

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19
Q

What is the salvage treatment for Hodgkin lymphoma?

A

Patients who cannot be curedRe-treat with chemotherapy early onHigh-dose chemotherapy and stem cell transplant later on

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20
Q

What are the characteristics of of lymphocyte predominant Hodgkin disease?

A

Popcorn cellsGood prognosis

21
Q

What are the complications of Hodgkin disease treatment?

A

Immunologic deficitsInfectionThyroid dysfunction (because ofradiation to the neck)Cardiac/pulmonary dysfuction (because of radiation on the left side)Gonadal dysfunction (chemo can impact fertility)Bone complicationsSecondary malignancies (increased risk of leukemias and lymphomas that seems to plateau after 8-10 years but solid cancers keep increasing)

22
Q

What is the relationship between PET results and Hodgkin lymphoma prognosis?

A

Perform a PET scan after 2 cycles of treatmentPET-positive patients have a worse prognosisPET-negative patients have a much better prognosis

23
Q

What are the risk factorsof non-Hodgkin lymphoma?

A

No known risk factors in most casesAberrations of immunityViruses (HIV, EBV, HHV-8, hepatitis C)Chronic immunologic stimulationEnvironmental factorsDietary

24
Q

What is the cell of origin in non-Hodgkin lymphoma?

A

B cell (80%)and T cell (20%)Follicular center cells vs. otherDifferentiate state (immature or transformed is aggressive and mature or differentiated is indolent)Chromosome translocations

25
Q

What is the chromosomal abnormality associated with follicular cell non-Hodgkin lymphoma?

A

t(14;18)Increased Bcl-2 expression (anti-apoptosis promotes survival)

26
Q

What is the chromosomal abnormality associated with mantle cell non-Hodgkin lymphoma?

A

t(11;14)Bcl-1 regulates cell cycle in G1

27
Q

What is the chromosomal abnormality associated with Burkittlymphoma?

A

t(8;14) mostly but 8 can also be involved in translocations with2 and 22C-myc promotes proliferation

28
Q

What is the chromosomal abnormality associated with large cell non-Hodgkin lymphoma?

A

3q27 with over-expression of Bcl-6t(2;5) with over-expression of NPM-ALK

29
Q

What is an important part of the work-up for non-Hodgkin lymphoma?

A

Bone marrow because bone marrow involvement is much more common in non-Hodgkin lymphoma than in Hodgkin disease

30
Q

What is the clinical presentation for non-Hodgkin lymphoma?

A

Lymph node enlargementSplenomegalyExtranodal is more commonHematological abnormalities (cytopenias because of increased bone marrow involvement)B symptoms

31
Q

What are the low-grade/indolent non-Hodgkin lymphomas?

A

Small lymphocyte/plasmacytoid (SLL)Follicular small/mixed cell (grade 1 and 2) (most common)Mucosa-associated lymphoid tumor (MALT)Marginal zone lymphomat(14;18) commonIncurable

32
Q

What are the intermediate grade/aggressive non-Hodgkin lymphomas?

A

Follicular large cell lymphomaMantle cell lymphomaDiffuse large B cell lymphoma (most common)Peripheral T cell lymphomaHigh expression of Bcl-2 in more advanced diseaseBcl-6 rearrangement seen

33
Q

What are the high grade/very aggressive non-Hodgkin lymphomas?

A

Precursor lymphoblastic leukemia/lymphoma (T cell or B cell)Burkitt’s lymphoma (B cell)

34
Q

What is follicular lymphoma?

A

Low-grade/indolent non-Hodgkin lymphomaMost common low-grade NHLTypically advanced stage at presentationOften asymptomaticFLIPI score used for determining risk factors

35
Q

When are indolent lymphomas treated?

A

Pain, shortness of breath, and pleuralor pericardial effusionsCompromised organ functionCytopeniaEnlarged lymph nodes causing problems

36
Q

How are indolent lymphomas treated?

A

RadiationChemotherapy in advanced diseaseMany patients will transform into intermediate or high grade lymphomas (Richter’s transformation)

37
Q

Which CD expression is seen in B cell lymphoma?

A

CD20

38
Q

What is the treatment for intermediate-grade lymphomas?

A

Chemotherapy in localized disease (R-CHOP)R-CHOP in advanced disease

39
Q

What is lymphoblastic lymphoma? How is it treated?

A

High-grade non-Hodgkin lymphomaMediastinal mass in young menTreated with multi-agent chemotherapy and CNS prophylaxis

40
Q

What is Burkitt’s lymphoma?

A

High-grade non-Hodgkin lymphomat(8;14) or t(8;22)C-myc translocationLarge abdominal masses (especially in children)Debulking the tumor may help (usually not helpful in other lymphomas)

41
Q

What is acute-type ATL?

A

Adult T celllymphomaFlower cellsLytic bone lesion/hypercalcemiaFrequent organ involvementAssociated with HTLV-1 infection

42
Q

What is mantle cell lymphoma?

A

Mostly maleIncurable and highly aggressivet(11;14) and over-expression of cyclin D1

43
Q

What is testicular DLBCL?

A

Most common testicular neoplasm in older men

44
Q

What is MALT lymphoma?

A

Patients with autoimmune and inflammatory disordersH. pylori

45
Q

What is mycosis fungoides?

A

Low-grade lymphomaSkin plaques

46
Q

What is Sezary syndrome?

A

Variant of mycosis fungoidesSezary cells seen

47
Q

What is large cell anaplastic lymphoma?

A

Confused with Hodgkin disease because it is also CD30+Skin involvement

48
Q

What is HIV-associated lymphoma?

A

Aggressive B cell lymphoma (Burkitt’s lymphoma or large cell lymphoma)CNS involvement

Non-Hodgkin and Hodgkin Lymphoma (1 decks)

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