RES & Lymphoma

Question 1

What are the functions of the spleen?

Answer 1

• formation of lymphocytes & plasma cells
• production of tuftsin -> stimulates phagocytosis
• phagocytosis of aged RBCs >120 days
• site for extra medullary hematopoiesis
• pooling site for more than 1/3 of total body platelets

Question 2

What are the causes of splenomegaly?

Answer 2

1- Infection

• TB
• subacute bacterial endocarditis
• brucellosis - AIDs
• IMN - Bilharziasis

2- Neoplastic

• Leukemia
• Hodgkin & non-Hodgkin lymphoma
• secondary metastasis
• splenic tumors

3- Hematological

• hemolytic anemia - polycythemia vera
• pernicious anemia - Plummer-Vinson syndrome

4- Metabolic

• lipid storage disease
• collagen storage disease
• amyloidosis

5- Endocrinal -> acromegaly

6- Congestive causes -> all causes of portal hypertension

7- Collagen disease

• SLE - Rheumatoid arthritis
• PAN - Sarcoidosis

Question 3

What are the causes of huge splenomegaly?

Answer 3

1- inflammatory -> malaria, bilharziasis, kala-azar
2- congestive -> severe portal hypertension
3- hematological -> Thallassemia major, CML, polycythemia vera, lymphoma
4- infiltrative -> amyloidosis & Guacher’s
5- collagen -> sarcoidosis & Felty syndrome

Question 4

What are the characteristics of hypersplenism?

Answer 4

• pancytopenia
• overactive bone marrow to compensate
• splenomegaly

Question 5

What are the causes of hypersplenism?

Answer 5

• primary idiopathic

- secondary with splenomegaly

Question 6

What are the investigations for diagnosis of hypersplenism?

Answer 6

1- blood film
- normocytic normochromic anemia with reticulocytosis
- thrombocytopenia
- granulocytopenia
2- hyper cellular bone marrow -> compensation
3- chromium labeled RBCs -> for diagnosis of hemolytic anemia
4- investigate for cause

Question 7

How is hyperplenism managed?

Answer 7

1- symptomatic treatment

• packed RBCs
• platelet
• antibiotics

2- splenectomy

Question 8

What are the causes of hyposplenism?

Answer 8

• splenectomy
• sickle cell anemia -> autosplenectomy
• splenic irradiation
• congenital aplasia

Question 9

What is the clinical picture of hyposplenism?

Answer 9

• increased liability to infection by capsulated organisms -> pneumococci, H. influenza, & meninngiococci
• Howell jolly bodies

Question 10

How is hyposplenism managed?

Answer 10

• vaccination against capsulated organisms

- broad spectrum antibiotics with any infection n

Question 11

What are the causes of lymphadenopathy?

Answer 11

1- infective

• TB, syphilis, brucellosis, septicemia
• IMN, AIDs, measles, rubella

2- Neoplastic -> Lymphoma, leukemia, multiple myeloma, secondary metastasis

3- metabolic -> Gaucher’s, amyloidosis

4- Miscellaneous -> collagen diseases, sarcoidosis, Grave’s disease
- Drugs -> INH, streptomycin

Question 12

What are the causes of Hodgkin’s lymphoma?

Answer 12

• defective apoptosis in lymphoma cells
• genetic
• EBV infection

Question 13

What is the clinical picture of Hodgkin’s lymphoma?

Answer 13

• bimodal onset with peaks at 25 & 70
• more in males
  1- LN involvement starts in 1 group (cervical or mediastinal then spreads
• they form satellite
• could cause pressure manifestations
  2- hepatomegaly & splenomegaly
  3- organ infiltration
  4- systemic manifestations

Question 14

What are the signs of organ infiltration in lymphoma?

Answer 14

• CNS -> compression of the spinal cord & focal lesions
• Lung -> pleural effusion
• Cardiac -> pericardial effusion
• Peritoneal -> ascites
• skeletal -> bone pain & pathological fractures
• cutaneous -> pruritus, hyperpigmentation, & nodules

Question 15

What are the systemic manifestations of lymphoma?

Answer 15

1-PEL-EBSTEIN’S FEVER
- 1-2 weeks with high fever follow by an afebrile period

2- alcohol ingestion leads to pain at the sites involved with the lymphoma due to release of PG

3- anorexia, anemia & loss of body weight

Question 16

What are the investigations made to diagnose Hodgkin’s lymphoma?

Answer 16

1- blood picture 
2- LN biopsy -> destruction & replacement with Hodgkin tissue 
- epitheloid cells 
- lymphocytes 
- eosinophils 
- fibroblasts 
- Reed-Stemberg cells 
3- BM aspiration 
4- raised ESR
5- increased immunoglobulins -> high proliferation of B cells from lymph nodes lead to high numbers of Igs
6- high level of ALP 
7- liver function tests -> involved

Question 17

what is the treatment of Hodgkin’s lymphoma?

Answer 17

1- radiotherapy 
2- chemotherapy 
3- surgical 
- in localized disease OR compression symptoms 
4- treat complications 
- NSAID for fever & pruritis 
- corticosteroids for autoimmune hemolytic anemia 
5- BM transplantation

Question 18

What are the characteristics of Non Hodgkin lymphoma?

Answer 18

• first presentation is extra-nodal site

caused by

• EBV infection -> Burkett’s lymphoma
• H. pylori -> MALT
• AIDs & immunosuppression
• genetic

Question 19

What is the clinical picture of Non Hodgkin’s lymphoma?

Answer 19

• middle aged patients 50 years
• more in abdominal LNs & diffuse from the beginning (non-contigiuous)
• hepatosplenomegaly -> early
• diffuse BM infiltration -> leads to pancytopenia
• GIT is most commonly affected
• systemic manifestations are less common

Question 20

What are the investigations of Non Hodgkins lymphoma?

Answer 20

same as Hodgkin's 
1- CBC
- decreased RBCs: normocytic normochromic 
- decreased platelets: thrombocytopenia 
- decreased WBCs: lymphopenia 

2- BM aspiration -> infiltration

3- lymph node biopsy -> destruction but without Reed sternberg cells

4- increased Igs

5- increased ALP

6- impaired liver function

Question 21

How is non Hodgkinn’s lymphoma treated?

Answer 21

1- radiotherapy 
2- chemotherapy
- low grade -> single agent 
- high grade -> combination 
3- BM transplant