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Ha - Lymphoma / CLL Flashcards

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1
Q

Why are there so many diff subtypes of lymphoma

A

can arise from cells at many diff stages of lymphoid maturation

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2
Q

Why are lymphocytes prone to lymphoma -give 3 reasons

A

1) Rapid proliferation in infection
2) VDJ recombination
3) Highly dependent on apoptotic process (so if this goes wrong…there is prolif of abnormal cells)

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3
Q

examples of oncogenes in lymphoma

A

c-myc, cyclin D1, bcl2, bcl6

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4
Q

Diff in presentation of CLL and lymphoma?

A
  • CLL = symmetrical
  • Lymphoma = asymmetrical painless lymphadenopathy
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5
Q

causes of lymphoma

A

Sporadic mutations is biggest cause
Infections: HTLV1 or EBV
Immunodeficiency eg HIV can allow EBV infection / AIDs
Constant antigenic stimulation eg H. Pylori

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6
Q

Hodgkin’s lymphoma - where do the cells tend to arise from

A

Germinal centre

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7
Q

Smear cells

A

CLL

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8
Q

Presentation of hodgkin’s lymphoma

A

Asymmetrical, painless lymphadenopathy

B - Sx: Drenching night sweats/fever/10% wt loss in 6 months

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9
Q

B symptoms of Hodgkin’s lymphoma

A
  • Drenching night sweats
  • Fever
  • 10% wt loss in 6 months
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10
Q

Most common subtype of Hodgkin’s lymphoma

A

Nodular sclerosing

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11
Q

Staging of Hodgkin’s lymphoma

A

1: one group of LNs

2: more than 1 group of LNs on 1 side of diaphragm

3: both sides of diaphragm involved

4: extra nodal sites

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12
Q

What is stained for in ?Hodgkin’s lymphoma

A

CD15 and CD30

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13
Q

2 useful investigations for staging Hodgkins?

A

CT/PET
Lymph node biopsy

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14
Q

Treatment of Hodgkin’s lymphoma

A

COMBINATION CHEMOTHERAPY FOR ALL
Adriamycin, Bleomycin, Vinblastin, Dacarbazine

+/-radiotherapy

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15
Q

Common dilemma in the management of hodgkin’s lymphoma?

A

Do we use radiotherapy?

Radiotherapy would cure the lymphoma, but increases risk of malignancy later in life

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16
Q

Mx of relapse of Hodgkin’s lymphoma

A

Intensive chemo + autologous SCT

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17
Q

what is autologous SCT

A

PATIENT’S OWN SCs are harvested + frozen

  • enables high dose radio/chemo to eradicate malignant cells
  • no GvHD
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18
Q

3 high grade NHLs

A

Burkitt’s
Diffuse large b-cell
Mantle cell

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19
Q

3 low grade NHLs

A

Follicular
Small Lymphocytic
Marginal zone

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20
Q

starry sky appearance
high mitosis and proliferation
CD20, BCL6

A

Burkitt’s

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21
Q

Burkitt’s lymphoma
- translocation?
-oncogene?

A

t(8;14)
c-myc

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22
Q

Treatment of Burkitt’s lymphoma

A

Rituximab

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23
Q

t(11;14), abhorent CD5+ and cyclin D1

A

Mantle cell lymphoma

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24
Q

Mantle cell lymphoma
- translocation?
- which oncogene is upregulated?

A

t(11;14)
Cyclin D1

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25
t(14;18) with CD20+ and CD10+, BCL2 expression by neoplastic B cells. Dx?
Follicular B-cell lymphoma
26
HTLV1 infection predisposes to which malignancy?
Adult T-cell lymphoma
27
Coeliac disease is associated with which lymphoma?
Enteropathy associated T-cell lymphoma (EATL)
28
Mycosis fungoides is associated with which lymphoma?
Cutaneous T Cell lymphoma
29
t(2;5)
Anaplastic large cell lymphoma (T- cells)
30
Large epithelioid lymphocytes in sheets
Anaplastic large cell lymphoma (T-cells)
31
T-cell lymphoma which affects younger patients
Anaplastic large cell lymphoma
32
4 chemo drugs used to treat hodgkin's lymphoma
ABVD Adriamycin Bleomycin Vinblastin Dacarbazine
33
define lymphoma
neoplastic tumour of lymphoid cells forming discrete masses
34
what kind of lymphoma does H Pylori cause
B cell lymphoma
35
what kind of lymphoma does coealiacs cause?
enteropathy T cell lymphoma
36
nodular architecure on histology indicates what type of lymphoma?
follicular
37
diffuse architecure on histology indicates what type of lymphoma?
CML
38
small round cells on histology indicates what type of lymphoma?
CLL / mantle
39
small cleaved cells on histology indicates what type of lymphoma?
follicular
40
large cells on histology indicates what type of lymphoma?
high grade
41
marker for T cells?
CD3, CD5
42
marker for B cells?
CD20
43
diffuse small uniform nuclei, CD23+
CLL / small lymphocytic
44
What is Richter transformation?
Small lymphocytic --> high grade lymphoma
45
features of MALT lymphoma
Extranodal sites eg lung / stomach Post germinal centre memory B cells Small, pale cytoplasm
46
what stain is used to show proliferation?
Ki67
47
larger nuclei with prominent nucleoli, variable and pleomorphoc nuclei. CD20+. Sheets of large cells. Dx?
Diffuse large B cell
48
what protein expression betters the prognosis of anaplastic large cell lymphoma?
ALK1
49
Histological features of Hodgkins Inc CD staining
Sclerosis, reactive cells, Reed Sternberg (large nucleoli multi nucleation - Owl's Eye) CD30+, CD15+, CD20-
50
Tx of NHL
MALT - ABx Others: chemo R-CHOP (inc rituximab) x6 cycles
51
Give %s of NHL
Diffuse Large B Cell 40% Follicular 35% Extra Nodal Marginal Zone 8%
52
Describe Tx of diffuse large B cell with prognosis
R-CHOP 50% curative, 25% further salvaged
53
Factors influencing prognosis of diffuse large B cell
Stage, LDH, age, extra nodal, performance status
54
Prognosis of follicular
12-15 years survival but incurable
55
Ix for CLL with results
FBC, WCC - raised, anaemia Blood film - smudge cells with mature lymphocytes
56
Markers of CLL?
CD5+, CD19+
57
Give rules of 1/3rds for CLL
1/3 never progress to blast phase 1/3 progress then respond to Tx 1/3 progress then die of CLL
58
Prognosis of CLL with contributing factors
5-10 years good health, decline to 2-3 years terminal Better prognosis if IgHV mutated and no P53 expression
59
Tx for CLL
Initially supportive: ABx and vaccination Targeted Tx - BCR kinase or BCL2 inhibitors NOT CHEMO Ventoclax - new Tx
60
Side effect of ventolax
Tumour lysis syndrome

Pathology (87 decks)

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