Week 10: Lymphoma Flashcards
What Do Reed-Steinberg cells look like? Which cancer is it pathognomonic of?
Owl’s eye appearance
Pathognomonic of Hodgkin’s lymphoma
Name the 3 most important medical emergencies associated with lymphoma
- Tumour lysis syndrome
- Cord compression
- Hypercalcaemia
Which blood cancers is tumour lysis syndrome associated with
- Lymphoma
- Acute myeloblastic leukaemia
- Acute lymphocytic leukaemia
Which blood cancers is cord compression associated with
- Lymphoma
2. Myeloma
Which blood cancers is hypercalcaemia associated with
- Lymphoma
- Myeloma
- Acute lymphocytic leukaemia
5 Features of tumour lysis syndrome
- HYPERuricaemia
- HYPERkalemia
- HYPERphosphataemia
- HYPOcalcaemia
- AKI
Features of HYPERuricaemia
- Arthralgia
- Renal colic/ failure
- Pericarditis
- Pruritis
Features of HYPERkalemia
- Cardiac arrhythmias
- Muscle weakness
- Parasthesia
Features of HYPERphosphataemia
Precipitation of calcium phosphate in tissues
Features of HYPOcalcaemia
- Tetany, carpo-pedal spasm
- Seizures
- Parasthesia
- Altered mental state
Treatment for tumour lysis syndrome (explain the MoA of each drug)
- IV fluids (so they pee out excess uric acid)
- Allopurinol (prevents uric acid formation)
- Raspuricase (converts uric acid to water-soluble metabolites)
Features of HYPERcalcaemia
- Dehydration
- Abdo pain
- Confusion
- Muscle weakness
- Cardiac arrhythmias
Treatment for HYPERcalcaemia
- IV fluids (beware fluid overload)
- Bisphosphonates
- Calcitonin
- Corticosteroids
Describe the 4 stages in Ann Arbour staging
- 1 lymph node and its surrounding area
- 2 separate areas on 1 side of the diaphragm
- Involving nodes above and below diaphragm
- Involving at least 1 extra-lymphatic organ (liver/ BM/ lung nodules)
Pathophysiology of lymphoma (NHL and Hodgkin lymphoma)
Rearrangement of immunoglobulin genes -> leading fo translocations and mutations in immunoglobulin gene loci
Name an example of NHL which is
- low grade
- high grade
Low grade: Follicular lymphoma
High grade (aggressive): Diffuse large B cell lymphoma
Clinical features of NHL
- Painless lymphadenopathy at 1 or more sites
- Hepatosplenomegagly
- Non-specific: fatigue, abdo pain
(Diffuse large B cell lymphoma more associated with CNS involvement. Symptoms similar to encephalitis)
Late stage clinical features of diffuse large B cell lymphoma
- Ascites
2. Pleural effusion
What infections are Hodgkin lymphoma associated with
- HIV
2. EBV
Which lymph nodes are normally swollen in Hodgkin’s lymphoma
Cervical
Which type of lymphomas are more associated with extranodal/ BM disease
NHL
rare to get extranodal involvement in Hodgkin
What investigation must be carried out for a diagnosis of lymphoma
BM biopsy
FNA is not adequate
Most common cause of generalised lymphadenopathy (differential for lymphoma).
How is this diagnosed?
Mononucleosis (EBV)
Diagnosed with monospot test
Is NHL or Hodgkin’s lymphoma more aggressive
NHL has low grade and aggressive types
Hodgkins is always aggressive
(but Hodgkins is more curable)
