Week 2 - Lymphoma

Question 1

Diffuse large B-cell lymphoma

Answer 1

Aggressive, germinal centre B cells

Question 2

Follicular lymphoma

Answer 2

Indolent, slow growing lymphoma, can transform into more aggressive (like Diffuse large B cell), t(14;18)

Question 3

Marginal zone B-cell lymphoma (MALT)

Answer 3

Related to chronic immune stimulation –> many cases H. pylori

Question 4

Mantle cell lymphoma

Answer 4

Naive B cells, t(11;14), frequently has malignant cells in blood

Question 5

Which markers define B or T cell origin?

Answer 5

CD2, CD3, CD5 = T cells, CD19, CD20, CD22, CD79a for B cells

Question 6

Mature/peripheral T cell Lymphoma

Answer 6

Replacement of normal lymph node architecture with pleomorphic T cells and inflammatory infiltrate, can present with generalised lympadenopathy

Question 7

Hodgkin Lymphoma

Answer 7

Germinal/post germinal centre B cells, only minority of cells in node are neoplastic (Reed-Sternberg cells), starts in single node and spreads.

Question 8

Lymphoma stage I

Answer 8

Single lymph node region or a single extranodal tissue

Question 9

Lymphoma stage II

Answer 9

Two or more lymph node regions on the same side of diaphragm

Question 10

Lymphoma stage III

Answer 10

Lymph node regions on both sides of diaphragm

Question 11

Lymphoma stage IV

Answer 11

Disseminated or multiple foci of involvement of one or more organs or extra nodal tissues

Question 12

A vs B in lymphoma staging

Answer 12

A = absence of systemic systems, B = presence of systemic systems e.g. fever, night sweats and/or unexpected weight loss of >10%

Question 13

What is the most common symptom in Hodgkin’s lymphoma?

Answer 13

Painless lump

Question 14

Principles for establishing drug combinations for cancer

Answer 14

1. Only drugs with some efficacy as single agents should be used
2. Drugs with different limiting toxicities should be used
3. Drugs should be used at optimum dose and schedule
4. Drugs with different MOAs should be combined

Question 15

What are Reed-Sternberg cells?

Answer 15

Giant cells with 2+ nuclei, lymphoid origin, characteristic of Hodgkin’s lymphoma

Question 16

What is tumour lysis syndrome?

Answer 16

Collection of metabolic abnormalities that may occur following cytotoxic therapy. More likely to occur with rapidly proliferating tumours that are responsive to therapy.

Question 17

Major metabolic effects of tumour lysis syndrome?

Answer 17

1. Hyperkalemia
2. hyperphosphataemia
3. hyperuricaemia

Question 18

Thyroglossal cyst

Answer 18

From persistent remnants of thyrogloassal duct
Non-tender, smooth cystic lump, usually midline at the level of hyoid bone, moves upwards on swallowing and protrusion of tongue

Question 19

Branchial cleft cyst

Answer 19

From persistent remnants of the branchial cleft. Smooth cystic swelling, lateral, near angle of mandible or anterior border of sternocleidomastoid

Question 20

Therapy for H. pylori is indicated in this form of lymphoma

Answer 20

MALT

Question 21

Age distribution of Hodgkin lymphoma

Answer 21

Bimodal (young and >50)

Question 22

Form of lymphoma endemic in parts of Africa

Answer 22

Burkitts

Question 23

Describe the CHOP protocol and what is it used to treat?

Answer 23

Chemotherapy regimen used to treat non-Hodgkin lymphoma

Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone

Question 24

Cyclic fever which may occur in Hodgkin’s lymphoma

Answer 24

Pel-Ebstein fever

Question 25

Peripheral blood finding when there is extensive marrow involvement with lymphoma

Answer 25

Pancytopaenia

Question 26

Which symptom referable to the skin may be an early sign of lymphoma?

Answer 26

Pruritis

Question 27

On clinical examination, lymphomatous lymph nodes are often described as…

Answer 27

Rubbery

Question 28

What chromosomal abnormality is a risk factor for lymphoma?

Answer 28

Klinefelters

Question 29

MOPP protocol and what is it used to treat?

Answer 29

Combination chemotherapy used to treat Hodgkin’s

Mustargen, Oncovin, Procarbazine, Prednisone