Haematology 10 - Lymphoma 1: multidisciplinary

Question 1

What is multiple myeloma a malignancy of?

Answer 1

Plasma cells

Question 2

Why do bacterial infections and autoimmune disorders increase lymphoma risk?

Answer 2

Constant antigenic stimulation

Question 3

Why do viral infections increase lymphoma risk?

Answer 3

Direct viral integration of lymphocytes

Question 4

Which lymphoma does Sjorgen’s syndrome increase risk of?

Answer 4

Marginal zone lymphoma of the parotid

Question 5

Which lymphoma does Hashimoto’s syndrome increase risk of?

Answer 5

Marginal zone lymphoma of the thyroid

Question 6

How is HTLV1 transmitted, and which cancer does it increase risk of?

Answer 6

A retrovirus that is transmitted at birth, and increases risk of adult T cell leukaemia lymphoma

Question 7

Which type of cells are infected by EBV?

Answer 7

B cells

Question 8

How are EBV-expressing B cells usually eliminated?

Answer 8

Cytotoxic T cell function

Question 9

What type of lymphoma does h pylori infection predispose to?

Answer 9

Gastric MALT

Question 10

Burkitt lymphoma expresses high level of c-myc oncoprotein, why?

Answer 10

Recombination error: on chromosome 14
IgH promotor usually promotes Ig heavy chain production
Mutation in IgH promoter –> c-myc promotion
Mutation is t(8;14)

Question 11

What are the 2 broad subtypes of Non-Hodgkins lymphoma?

Answer 11

B and T cell type

Question 12

What are the subtypes of B cell NHL?

Answer 12

Low grade: follicular, small lymphocytic, marginal zone
High grade: diffuse large cell, Burkitt’s
Aggressive: mantle cell

Question 13

What test can prove germinal centre origin of a lymphoma?

Answer 13

Positive staining for CD10 and bcl6 (Follicular, DLBCL, Burkitts lymphomas)

Question 14

What is the classification of Burkitt’s lymphoma

Answer 14

High grade peripheral B cell lymphoma

Question 15

What gene mutation is associated with follicular lymphoma?

Answer 15

t(14;18) - it causes overexpression of the bcl-2 gene

Question 16

Which lymphoma typically has a ‘starry sky appearance’ on histology?

Answer 16

Burkitt’s lymohoma

Question 17

Where does TCR gene recombination occur?

Answer 17

Thymus

Question 18

What are the key enzymes involved in VDJ (TCR gene) recombination?

Answer 18

RAG1 and RAG2

Question 19

What are the 2 methods of gene recombination in B cells?

Answer 19

Class switching

Somatic hypermutation

Question 20

What is the key enzyme involved in B cell class switching and somatic hypermutation?

Answer 20

Activation-induced cytidine deaminase (AID)

Question 21

Which lymphoma are coeliac’s predisposed to?

Answer 21

EATL (enteropathy-associated t cell lymphoma)

Question 22

What can PCR be used for in lymphoma diagnosis?

Answer 22

Identifying:

1. Translocations
2. TCR rearrangement
3. IG gene rearrangement

Question 23

What is the translocation t(11;14) diagnostic of?

Answer 23

Mantle cell lymphoma

Question 24

What is the translocation of t(2;5) associated with?

Answer 24

A better prognosis for anaplastic large cell lymphoma (T-cell NHL)

(Typically in young boys)

(2 types of ALCL- cutaneous (skin lumps,lesions etc, and systemic (more aggressive)

ALK-1 protein expression

Question 25

Which lymphoma shows aberrant CD5 and cyclin D1 expression?

Answer 25

Mantle cell lymphoma

Question 26

Which type of lymphoma can cause either a jaw or abdominal mass?

Answer 26

Burkitt's lymphoma

Question 27

Recall one good and one bad prognostic indicator in Burkitt's lymphoma?

Answer 27

Good: germinal centre phenotype Bad: p53 mutation

Question 28

What is the grade of peripheral T cell lymphomas?

Answer 28

V aggressive

Question 29

Which lymphoma is particularly common in Japan and the Caribbean?

Answer 29

Adult T cell leukaemia lymphoma

Question 30

What is cutaneous T cell lymphoma known as?

Answer 30

Mycosis fungoides

Question 31

Which age group tends to be affected by anaplastic large cell lymphoma?

Answer 31

Young adults

Question 32

What is the t(2;5) translocation associated with?

Answer 32

Good prognosis in anaplastic large cell lymphoma (cells typically cd30+)

Question 33

Which type of lymphoma is associated with ALK-1 expression?

Answer 33

Anaplastic large cell lymphoma

Question 34

Which type of lymphoma is most likely to involve just one lymph node group?

Answer 34

Classical Hodgkin's

Question 35

Which type of granulocyte will be present within a classical Hodgkin's lymphoma?

Answer 35

Eosinophil

Question 36

Which type of lymphoma is associated with an isolated lymphadenopathy?

Answer 36

Nodular Lymphocyte predominant Hodgkin's lymphoma

Question 37

Recall the subtypes of classical Hodgkin's lymphoma

Answer 37

Nodular sclerosing Mixed cellularity Lymphocyte rich/ depleted

Question 38

Which type of Hodgkin's lymphoma would show B cell rich nodules?

Answer 38

Nodular lymphocyte-predominant lymphoma | popcorn cells on blood film/histology

Question 39

Which type of lymphoma stains positively for CD15 and CD30?

Answer 39

Hodgkin's -ve for CD20 Also typically have reed-sternberg cells (Owl-eyes) Hodgkin's typically associated with EBV (except for nodular lymphocyte predominant)

Question 40

What is the biggest risk of radiotherapy in hodgkin's lymphoma for women?

Answer 40

Breast Ca

Question 41

What is the translocation t(8;14) associated with?

Answer 41

Burkitt's lymphoma

Question 42

What is the best chemotherapy for Burkitt's lymphoma?

Answer 42

Rituximab

Question 43

What is the histological finding of "angular nuclei" pathognemonic for?

Answer 43

Mantle cell lymphoma

Question 44

The Durie-Salmon staging system is used for which type of malignancy?

Answer 44

Multiple myeloma

Question 45

What CD markers do CLL/Small lymphocytic lymphoma stain for

Answer 45

CD5, CD19, CD23 (CD5 should never be seen in a normal mature b-cell) CLL/SLL can transform into higher grade lymphoma (Richter transformation)

Question 46

what malignancy are clover-leaves/flower cells pathognomic of

Answer 46

Adult T Cell Leukaemia/Lymphoma

Question 47

Anaplastic large cell lymphoma CD marker

Answer 47

typically positive for CD30