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Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

How do B cells mature?

A

BM stem cell > Mature in BM > Mature B lymphocytes > blood > Lymph nodes spleen > recirculates back into blood

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2
Q

How do T cells mature?

A

BM stem cell > Mature in thymus > Mature T lymphocytes > blood lymp > mucosal and cutaneous lymphoid tissues> recirculation into blood lymph

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3
Q

Classification for lymphomas:

A

Hodgkin & Non-Hodgkin Lymphomas
High grade and Low grade Lymphomas
B, T, NK cell Lymphomas

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4
Q

Timeline for lymphoma?

A

Clinical assessment
Histology
Staging ( scans, endoscopy, cytology, biopsy )
Prognostics
Treatment
Follow up

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5
Q

What happens in clinical assessment?

A

Age
race,
performance status,
co-morbidities,
medication
allergy
medical history,
B symptoms
lymphadenopathy
organomegaly
lumps/bumps

Laboratory assessments:

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6
Q

What laboratory assessments can be done?

A

FBC, organ functions,viral screen, G6PD,uric acid,LDH,B2microglobulin,ESR

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7
Q

Histology assessments:

A

Liquid phase cytology/ FCM ,Core biopsy, BM biopsy, LN excision, splenectomy

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8
Q

What is used for Staging:

A

CT,MRI, PET-CT, endoscopies ,biopsies
Ann-Arbor staging
Tumour bulk

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9
Q

Prognostics of lymphoma:

A

Patient characteristics ( performance status, age, co-morbidities )
Disease characteristics ( stage, LDH, extranodal involvement, response to treatment/PET-CT)
Genetics

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10
Q

Treatment for lymphomas:

A

Immunochemotherapy
Radiotherapy
Autograft
Allograft
Check Point Inhibitors
BITE
CAR-T/NK

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11
Q

What are lymphomas?

A

group of cancers that affect the lymphocytes inside the lymphatic system

cancerous cells proliferate within the lymph nodes and cause the lymph nodes to become abnormally large (lymphadenopathy).

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12
Q

Main lymph nodes?

A

Cervical, axillary, inguinal

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13
Q

What is Hodgkins lymphoma?

A

Hodgkin’s lymphoma is a specific disease
Overall 1 in 5 lymphomas are Hodgkin’s lymphoma.
It is caused by proliferation of lymphocytes. There is a bimodal age distribution with peaks around aged 20 and 75 years.

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14
Q

What is non-Hodgkins lymphoma?

A

non-Hodgkins lymphoma encompasses all the other lymphomas.

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15
Q

What are the risk factors for Hodgkins lymphoma?

A

HIV
Epstein-Barr Virus
Autoimmune conditions such as rheumatoid arthritis and sarcoidosis
Family history

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16
Q

What is the difference between leukaemia and lymphomas?

A

neoplastic cells predominantly involve the lymph nodes and extranodal sites, unlike leukaemia which predominantly involves the bone marrow and blood.

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17
Q

What is the presentation for Hodgkins lymphoma?

A

Lymphadenopathy is the key presenting symptom.

enlarged lymph node or nodes might be in the neck, axilla (armpit) or inguinal (groin) region.

haracteristically non-tender and feel “rubbery”.

Some patients will experience pain in the lymph nodes when they drink with alcohol.

18
Q

Epidemiology of hodgkins lymphoma

A
  • HL is a rare malignancy.
  • In the UK, there were 2107 new cases of HL between 2015 and 2017, accounting for < 1% of total cancer cases.
  • Bimodal age distribution: 15-35 years and > 60 years
  • M>F
19
Q

What happens in classical Hodgkin lymphoma?

A

B-cell in the germinal centre has an abnormal antibody gene rearrangement > doesnt undergo apoptosis > starts dividing uncontrollably becoming a neoplastic cell

These dont produce antibodies

20
Q

What are the neoplastic cells like in Hodgkins lymphoma?

A
  • large mononuclear cells called Hodgkin cells or multi-nucleated cells called Reed-Sternberg cells.
  • In classical HL these cells don’t express CD45 or CD20, which are typically seen on B-cells.
21
Q

What are neoplastic cells surrounded by?

A

non-neoplastic inflammatory cells - mostly T cells - which are attracted by chemokines

neoplastic cells also activate fibroblasts which make collagen, as well as eosinophils.

22
Q

What can Hodgkins lymphoma be divided into?

A

Hodgkin Lymphoma can be split into classical HL (expressing CD15 and CD30), and lymphocyte predominant (non classical, expressing CD45 and CD20) HL.

Classical HL is further subdivided into 4 categories.

23
Q

Classical HL 4 subcategories

A

Nodular sclerosing - Good prognosis
Mixed cellularity - GP
lYMPHOCYTE rich - GP - Best prognosis
Lymphocyte depleted - BP

24
Q

B syptoms (systemic symptoms) of lymphoma:

A

Fever
Weight loss
Night sweats

25
Q

Other symptoms:

A

Fatigue
Itching
Cough
Shortness of breath
Abdominal pain
Recurrent infections

26
Q

Key diagnostic test for hodgkins?

A

Lymph node biopsy

27
Q

Lactate dehydrogenase

A

blood test that is often raised in Hodgkin’s lymphoma but is not specific and can be raised in other cancers and many non-cancerous diseases.

28
Q

Red-Sternberg

A

abnormally large B cells that have multiple nuclei that have nucleoli inside them.

This can give them the appearance of the face of an owl with large eyes. The Reed-Sternberg cell is a popular feature in medical exams.

Only in Hodgkins not in Non- Hodgkins

key finding from lymph node biopsy in patients with Hodgkin’s lymphoma.

29
Q

What scans can be used for diagnosing and staging lymphomas?

A

CT, MRI and PET

30
Q

Ann Arbor staging

A

used for both Hodgkins and non-Hodgkins lymphoma. The system puts importance on whether the affected nodes are above or below the diaphragm

Stage 1: Confined to one region of lymph nodes.
Stage 2: In more than one region but on the same side of the diaphragm (either above or below).
Stage 3: Affects lymph nodes both above and below the diaphragm.
Stage 4: Widespread involvement including non-lymphatic organs such as the lungs or liver.

31
Q

Key treatments for hodgkins lymphoma

A

Chemotherapy and Radiotherapy
Chemo - increased risk of leukaemia and infertility
Radiotherapy - cancer, damage to tissues and hypothyroidism.
Rituximab - monoclonal antibdody targetting CD20 on lymphocytes

32
Q

Complications secondary to chemotherapy

A
  • Myelosuppression and neutropenic sepsis
  • Tumour lysis syndrome - treatment with chemotherapy causes rapid cell destruction leading to hyperkalaemia, hyperphosphatemia, hyperuricemia, and hypocalcaemia. This can cause seizures, arrhythmias, and renal failure
33
Q

Non-hodgkins lymphoma:

A

group of lymphomas. There are almost endless types of lymphoma.

34
Q

Epidemiology of NHL

A
  • NHL is far more common than HL
  • Diffuse large B-cell lymphoma is the most common haematological malignancy overall
  • B-cell lymphomas are more common than T-cell lymphomas
35
Q

Notable non hodgkins lymphoma

A

Burkitt lymphoma is associated with Epstein-Barr virus, malaria and HIV.

MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach. It is associated with H. pylori infection.

Diffuse large B cell lymphoma often presents as a rapidly growing painless mass in patients over 65 years.

36
Q

Risk factor for non-hoodgkins lymphoma:

A

HIV
Epstein-Barr Virus
H. pylori (MALT lymphoma)
Hepatitis B or C infection
Age 50
Male
Immunodeficiency
Family history

37
Q

What happens in non-Hodgkin lymphoma

A

genetic mutation in a lymphocyte - either a B- or a T-cell. Instead of undergoing apoptosis, they divide uncontrollably becoming a neoplastic cell

Usually, lymphomas develop in lymph nodes - nodal lymphomas.

38
Q

What happens when lymphomas happens in other parts of the body?

A
  • GI tract - bowel obstruction
  • BM - Pancytopenia
  • Spinal chord - Spinal chord compression
39
Q

What are NHLs divided by

A

NHLs can be divided by cell type (proliferation of B cells, T cells, or NK cells), and grade (high or low).

40
Q

B cell NHLs

A

Low grade - Follicular lymphoma, Marginal zone lymphoma, Hairy cell leukaemia

High grade - Diffuse large b-cell lymphoma, mantle cell lymphoma , Burkitt lymphoma

41
Q

T cell NHL- (rare and typically involve the skin)

A

Low grade - Mycosis fungoides
High grade - Adult T cell leukaemia/ lymphoma

42
Q

Management for non-hodgkins lymphoma:

A

Watchful waiting
Chemotherapy
Monoclonal antibodies such as rituximab
Radiotherapy
Stem cell transplantation

Haematology (9 decks)

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