Week 2- approach to the investigation of lymphadenopathy Flashcards

1
Q

What can cause lymphadenopathy?

A
Viral- e.g. EBV
Bacterial
Lymphoma
Malignancy- particularly metastatic spread. 
Connective tissue disorders e.g. SLE.
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2
Q

Put the list of differential diagnosis for lymphadenopathy in order from most likely to least likely?

A
Reactive
Bacterial infection (local)
Viral infection (generalised)
Metastatic malignancy
Lymphoma
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3
Q

What causes tender lymphadenopathy?

A

Viral and bacterial causes.

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4
Q

What causes hard lymph nodes?

A

Viral, bacterial and metastatic carcinoma

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5
Q

What causes rubbery lymph nodes?

A

Lymphoma

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6
Q

What causes the surface of the lymph node to be smooth/

A

Viral, bacterial and lymphoma.

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7
Q

When would the skin become inflamed in lymphadenopathy?

A

In a bacterial infection

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8
Q

When would the skin be tethered in lymphadenopathy?

A

Could be tethered in bacterial infection but also likely to be metastatic carcinoma.

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9
Q

What should you do if lymphoma or other malignancies are suspected?

A

Ask surgeon to biopsy.

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10
Q

How do you assess lymph node pathology?

A
Histology- microscopic appearance
Immunohistochemistry solid node
Immunophenotyping blood/marrow
Genetic analysis
Molecular analysis
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11
Q

What is immunohistochemistry used for?

A

Confirming its a lymphoma and classifying it.

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12
Q

What does immunohistochemistry do?

A

Looks at patterns of proteins on the surface of lymphoma cells. Uses antibodies against these to look for reactions. If it turns brown then it is positive.

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13
Q

What is CD20 found in?

A

Non-Hodgkins lymphoma

B cell lymphomas

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14
Q

What is CD30 found in?

A

Hodgkins disease.

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15
Q

Describe the process of immunophenotyping?

A

Cells are tagged with antibodies attached to a fluorochrome molecule. It emits a certain colour when a laser is shone on it if it binds to an antigen.

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16
Q

When is immunophenotyping useful?

A

Useful in leukaemias and in lymphomas involving bone marrow.

17
Q

What does cytogenetic analysis look for?

A

Specific patterns of chromosome abnormalities.
G banding- aspirate the node and grow cells in culture and look at the spread of chromosomes.
FISH-look for specific abnormalities in chromosomes using probes that emit a specific light colour.

18
Q

If you’ve got a lymphoma, what is the first question?

A

Whether it is Hodgkins or non-hodgkins lymphoma

19
Q

If its non-hodgkins lymphoma, whats the next question needing answering?

A

Is it T cell (10%) or B cell non Hodgkins lymphoma (90%).

20
Q

How can B cell non-hodgkin lymphomas be further divided?

A

Into low grade and high grade non-Hodgkin lymphomas. If low grade- it grows slowly and can be treated with chemo but can’t be cured. If high grade responds well to chemo and can be cured.