Notecards Flashcards
What is the definition of lymphoma?
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
What is the differential diagnosis for lymphadenopathy?
Most cases of lymphadenopathy are not malignantBacterial infectionViral (EBV common, HIV)FungalMycobacterial (TB)SpirochetalProtozoanImmunological diseaseGranulomatous diseaseMalignancy
What is the clinical presentation of lymphomas in general?
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
What determines treatment in NHL and HD?
NHL = histology + stageHD = stage
What is stage I?
Single lymph node involvement or extralymphatic organ
What is stage II?
Involvement of 2+ lymph node regions on the same side of the diaphragm (above or below)
What is stage III?
Involvement of lymph node regions on both sides of the diaphragm
What is stage IV?
Disseminated disease in extralymphatic organs with or without lymph node enlargement
What is A staging?
No systemic symptoms
What is B staging?
Unexplained weight lossUnexplained feverNight sweats
What type of cell is this?
Reed-SternbergOwl eye appearanceCharacteristic of Hodgkin lymphoma
What is the epidemiology of Hodgkin disease?
No direct cause/effect relationship knownViral infectionEBV but not a direct associationHereditary predisposition (common HLA types)
What are the WHO categories for Hodgkin lymphoma?Which lymphomas are included in the classical Hodgkin lymphoma group?
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
What is the clinical presentation for Hodgkin lymphoma?
Painless lymphadenopathy (cervical or supraclavicular)Pruritis (itchy)Back painDyspnea because of enlarged mediastinal lymph nodeB symptoms (weight loss, fever, and night sweats)
What are the most common lymph nodes involved in Hodgkin lymphoma?
CervicalSupraclavicularMediastinal
What would a lymph node biopsy look like for Hodgkin lymphoma?
Few malignant Reed-Sternberg cells with the majority of cells being benign reactive cells (trying to contain Reed-Sternberg cells)
What are the unfavorable factors for Hodgkin lymphoma?
Bulky disease (large mass)ESR (erythrocyte sedimentation rate)elevated> 3 sites of diseaseB symptoms> 2 extranodal sites
What is the treatment for Hodgkin lymphoma?
Early stage disease: radiationLate stage disease: chemotherapy
What is the salvage treatment for Hodgkin lymphoma?
Patients who cannot be curedRe-treat with chemotherapy early onHigh-dose chemotherapy and stem cell transplant later on
What are the characteristics of of lymphocyte predominant Hodgkin disease?
Popcorn cellsGood prognosis
What are the complications of Hodgkin disease treatment?
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)
What is the relationship between PET results and Hodgkin lymphoma prognosis?
Perform a PET scan after 2 cycles of treatmentPET-positive patients have a worse prognosisPET-negative patients have a much better prognosis
What are the risk factorsof non-Hodgkin lymphoma?
No known risk factors in most casesAberrations of immunityViruses (HIV, EBV, HHV-8, hepatitis C)Chronic immunologic stimulationEnvironmental factorsDietary
What is the cell of origin in non-Hodgkin lymphoma?
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
What is the chromosomal abnormality associated with follicular cell non-Hodgkin lymphoma?
t(14;18)Increased Bcl-2 expression (anti-apoptosis promotes survival)
What is the chromosomal abnormality associated with mantle cell non-Hodgkin lymphoma?
t(11;14)Bcl-1 regulates cell cycle in G1
What is the chromosomal abnormality associated with Burkittlymphoma?
t(8;14) mostly but 8 can also be involved in translocations with2 and 22C-myc promotes proliferation
What is the chromosomal abnormality associated with large cell non-Hodgkin lymphoma?
3q27 with over-expression of Bcl-6t(2;5) with over-expression of NPM-ALK
What is an important part of the work-up for non-Hodgkin lymphoma?
Bone marrow because bone marrow involvement is much more common in non-Hodgkin lymphoma than in Hodgkin disease
What is the clinical presentation for non-Hodgkin lymphoma?
Lymph node enlargementSplenomegalyExtranodal is more commonHematological abnormalities (cytopenias because of increased bone marrow involvement)B symptoms
What are the low-grade/indolent non-Hodgkin lymphomas?
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
What are the intermediate grade/aggressive non-Hodgkin lymphomas?
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
What are the high grade/very aggressive non-Hodgkin lymphomas?
Precursor lymphoblastic leukemia/lymphoma (T cell or B cell)Burkitt’s lymphoma (B cell)
What is follicular lymphoma?
Low-grade/indolent non-Hodgkin lymphomaMost common low-grade NHLTypically advanced stage at presentationOften asymptomaticFLIPI score used for determining risk factors
When are indolent lymphomas treated?
Pain, shortness of breath, and pleuralor pericardial effusionsCompromised organ functionCytopeniaEnlarged lymph nodes causing problems
How are indolent lymphomas treated?
RadiationChemotherapy in advanced diseaseMany patients will transform into intermediate or high grade lymphomas (Richter’s transformation)
Which CD expression is seen in B cell lymphoma?
CD20
What is the treatment for intermediate-grade lymphomas?
Chemotherapy in localized disease (R-CHOP)R-CHOP in advanced disease
What is lymphoblastic lymphoma? How is it treated?
High-grade non-Hodgkin lymphomaMediastinal mass in young menTreated with multi-agent chemotherapy and CNS prophylaxis
What is Burkitt’s lymphoma?
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)
What is acute-type ATL?
Adult T celllymphomaFlower cellsLytic bone lesion/hypercalcemiaFrequent organ involvementAssociated with HTLV-1 infection
What is mantle cell lymphoma?
Mostly maleIncurable and highly aggressivet(11;14) and over-expression of cyclin D1
What is testicular DLBCL?
Most common testicular neoplasm in older men
What is MALT lymphoma?
Patients with autoimmune and inflammatory disordersH. pylori
What is mycosis fungoides?
Low-grade lymphomaSkin plaques
What is Sezary syndrome?
Variant of mycosis fungoidesSezary cells seen
What is large cell anaplastic lymphoma?
Confused with Hodgkin disease because it is also CD30+Skin involvement
What is HIV-associated lymphoma?
Aggressive B cell lymphoma (Burkitt’s lymphoma or large cell lymphoma)CNS involvement
