Week 10: Lymphoma

Question 1

What Do Reed-Steinberg cells look like? Which cancer is it pathognomonic of?

Answer 1

Owl’s eye appearance

Pathognomonic of Hodgkin’s lymphoma

Question 2

Name the 3 most important medical emergencies associated with lymphoma

Answer 2

1. Tumour lysis syndrome
2. Cord compression
3. Hypercalcaemia

Question 3

Which blood cancers is tumour lysis syndrome associated with

Answer 3

1. Lymphoma
2. Acute myeloblastic leukaemia
3. Acute lymphocytic leukaemia

Question 4

Which blood cancers is cord compression associated with

Answer 4

1. Lymphoma

2. Myeloma

Question 5

Which blood cancers is hypercalcaemia associated with

Answer 5

1. Lymphoma
2. Myeloma
3. Acute lymphocytic leukaemia

Question 6

5 Features of tumour lysis syndrome

Answer 6

1. HYPERuricaemia
2. HYPERkalemia
3. HYPERphosphataemia
4. HYPOcalcaemia
5. AKI

Question 7

Features of HYPERuricaemia

Answer 7

1. Arthralgia
2. Renal colic/ failure
3. Pericarditis
4. Pruritis

Question 8

Features of HYPERkalemia

Answer 8

1. Cardiac arrhythmias
2. Muscle weakness
3. Parasthesia

Question 9

Features of HYPERphosphataemia

Answer 9

Precipitation of calcium phosphate in tissues

Question 10

Features of HYPOcalcaemia

Answer 10

1. Tetany, carpo-pedal spasm
2. Seizures
3. Parasthesia
4. Altered mental state

Question 11

Treatment for tumour lysis syndrome (explain the MoA of each drug)

Answer 11

1. IV fluids (so they pee out excess uric acid)
2. Allopurinol (prevents uric acid formation)
3. Raspuricase (converts uric acid to water-soluble metabolites)

Question 12

Features of HYPERcalcaemia

Answer 12

1. Dehydration
2. Abdo pain
3. Confusion
4. Muscle weakness
5. Cardiac arrhythmias

Question 13

Treatment for HYPERcalcaemia

Answer 13

1. IV fluids (beware fluid overload)
2. Bisphosphonates
3. Calcitonin
4. Corticosteroids

Question 14

Describe the 4 stages in Ann Arbour staging

Answer 14

1. 1 lymph node and its surrounding area
2. 2 separate areas on 1 side of the diaphragm
3. Involving nodes above and below diaphragm
4. Involving at least 1 extra-lymphatic organ (liver/ BM/ lung nodules)

Question 15

Pathophysiology of lymphoma (NHL and Hodgkin lymphoma)

Answer 15

Rearrangement of immunoglobulin genes -> leading fo translocations and mutations in immunoglobulin gene loci

Question 16

Name an example of NHL which is

• low grade
• high grade

Answer 16

Low grade: Follicular lymphoma

High grade (aggressive): Diffuse large B cell lymphoma

Question 17

Clinical features of NHL

Answer 17

1. Painless lymphadenopathy at 1 or more sites
2. Hepatosplenomegagly
3. Non-specific: fatigue, abdo pain

(Diffuse large B cell lymphoma more associated with CNS involvement. Symptoms similar to encephalitis)

Question 18

Late stage clinical features of diffuse large B cell lymphoma

Answer 18

1. Ascites

2. Pleural effusion

Question 19

What infections are Hodgkin lymphoma associated with

Answer 19

1. HIV

2. EBV

Question 20

Which lymph nodes are normally swollen in Hodgkin’s lymphoma

Answer 20

Cervical

Question 21

Which type of lymphomas are more associated with extranodal/ BM disease

Answer 21

NHL

rare to get extranodal involvement in Hodgkin

Question 22

What investigation must be carried out for a diagnosis of lymphoma

Answer 22

BM biopsy

FNA is not adequate

Question 23

Most common cause of generalised lymphadenopathy (differential for lymphoma).

How is this diagnosed?

Answer 23

Mononucleosis (EBV)

Diagnosed with monospot test

Question 24

Is NHL or Hodgkin’s lymphoma more aggressive

Answer 24

NHL has low grade and aggressive types

Hodgkins is always aggressive

(but Hodgkins is more curable)

Question 25

What type of lymphoma is Burkitt’s lymphoma

Answer 25

Aggressive NHL

Question 26

In what 2 age groups does Hodgkins lymphoma tend to occur

Answer 26

Students and >70yo