0415 - Lymphoid Neoplasms Flashcards
Label this diagram
Provide a broad classification outline of lymphomas
Hodgkin (10%) or non-Hodgkin (90%)
Non-Hodgkin are classified into B or T cell, and precursor or mature. Then into individual type.
Hodgkin classified into classical (for our purposes)
Then further categorised into nodular sclerosing, mixed cellularity, lymphocyte deplete, or lymphocyte-rich.
What is the normal cellular counterpart of CLL?
Ag-experienced mature B-cell (pre-germinal centre), or memory B-cell (germinal centre).
What is the normal cellular counterpart of DLBCL/FL?
DLBCL is centroblast (germinal centre, GCB DLBCL), or plasmoblast (post-germinal centre, ABC DLBCL)
What is the normal cellular counterpart of Myeloma?
Plasma Cell (post-germinal centre)
What is clonality? Why is it useful?
Clonality relates to whether or not all cells in a given population arise from a single parent cell. It is useful in determining whether a population is reactive (e.g. to infection, polyclonal), or malignant (monoclonal).
What are some methods used to detect clonality when analysing lymphoma?
Immunophenotyping - by flow cytometry or immunohistochemistry.
Molecular studies - IgH/IgL or TCR gene rearrangements.
Discuss the common presentations of lymphoma
Often incidental, though may have enlarged lymph nodes, other masses/lumps or organomegaly.
Fever, weight loss, night sweats, or opportunistic infections
Metabolic complications - hypercalcaemia.
What might a physical exam find in a lymphoma patient?
Lymphadenopathy
Organomegaly (hepatomegaly, splenomegaly)
Extranodal lumps, including thyroid, breast, testicular.
Explain how a diagnosis of lymphoma is established in the laboratory
FNA can distinguish reactive vs malignant via flow cytometry. Is less invasive and allows for triaging.
Excision/core biopsy most definitive, and allows assessment for architecture.
Bone marrow biopsy of limited utility in diagnosis unless predominant BM involvement.
What investigations are valuable in staging lymphomas?
Radiology - structural and functional
Bone marrow biopsy
FBC and biochemistry
Identify the basic clinical, molecular and prognostic features of the common lymphoma Chronic Lymphocytic Lymphoma/Small Lymphocytic Leukaemia
Male, >50 presentation with nonspecific symptoms, lymphocytosis, lymphadenopathy and bone marrow failure.
CD19, 20, and 5 positive (characteristic). Normal Cell counterpart - Ag-experienced mature B cell (pre-Germinal Centre).
Prognosis originally Binet staging (areas involved/anaemia), now based on genetic abnormalities.
Identify the basic clinical, molecular and prognostic features of Follicular Lymphoma
Low grade, mature B-cell NHL from Germinal centre cell. Markers are normal on FISH, with a t(14;18), and BCL-2 locus on 18. Centrocyte counterpart.
Painless, generalised lymphadenopathy (malignant follicles) >60. Elevated LDH.
Around 50% transform to DLBCL. Prognosis based on FL International Prognostic Index (FLIPI)
Identify the basic clinical, molecular and prognostic features of DLBCL
High grade mature B-cell NHL. Diffuse infiltration of LN with large cells causes lymphadenopathy.
Most common subtype. Look for BCL2 Oncogene.
Prognosis based on International Prognostic Index (clinical), or Activated B-Cell (ABC - Post-Germinal Centre - Plasmoblast counterpart) vs Germinal Centre (GC - Centroblast counterpart) type.
Identify the basic clinical, and molecular features of BL
Highly aggressive B-cell lymphoma. Germinal Centre - Normal Cellular counterpart Centroblast.
Associated with EBV, often localised at the presentation.
Associated with t(8:14).
