Haematology 8: Lymphoma 1 Flashcards by Sophie Wouters

Which is more common Hodgkin lymphoma or NHL ?

NHL (80%)

B cell = more common than T cell

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Where does VDJ recombination occur ?

Bone marrow

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Where does class switching occur ?

Germinal centres

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Which lymphoma is associated with chronic H.pylori infection?

Gastric MALT lymphoma

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Which lymphoma is associated with Coeliac disease ?

EATL - enteropathy-associated T cell Lymphoma

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Which virus causes adult T cell lymphoma ?

HTLV1

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Which CD marker is a marker of Germinal centre B cells ?

CD10

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What does Follicular lymphoma look like on Histology ?

Follicular pattern- lots of follicles in lymph tissue

BCL2 possitive

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Which 2 Lymphomas is associated with EBV infection ?

Burkitt’s lymphoma

Hodgkin’s lymphoma

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Which lymphoma has a starry-sky appearance

Burkitt’s lymphoma

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Which Lymphoma is particularly prevelant in the Caribbean and japan ?

Adult T cell Lymphoma

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Which cell allows differentiation between Hodgkin’s and NHL lymphoma ?

Reed-sternberg cells (seen in Hodgkin’s)

looks like Owl eyes

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Describe the staging of Hodgkin Lymphoma from 1-4 A/B

Stage 1: one group of nodes
Stage 2: >1 group of nodes same side of diaphragm
Stage 3: nodes above and below the diaphragm
Stage 4: extranodal spread

A: without any B symptoms
B: Fever, Unexplained weightloss of more than 10% in 6 months, night sweats

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Name the staging system in Hodgkins lymphoma ?

Ann-Arbor

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where are lymphomas usually found

lymph nodes, bone marrow. blood
lymphoid organs - spleen or GALT
skin
rarely anywhere - CNS, oscular, testes, breasts

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describe the process of immunoglobulin and T cell receptor gene recombination

bone marrow - VDJ recombination of germ line genes
germinal centre - class switching (DNA alterations) and somatic hypermutation (insertion of nucleotide point mutations)

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list malignant genes which may be expressed if you translocate an oncogene downstream of the promoter

Bcl2
Bcl6
Myc
cyclinD1

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aetiology of lymphoma

majority have no identifiable RF

constant antigenic stimulation
infection
loss of T cell function

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what lymphomas result from H. Pylori infection

gastric MALT

marginal zone NHL of the stomach

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what lymphomas result from sjogrens syndrome

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marginal zone NHL of parotic lymphoma

what lymphomas result from coeliac disease

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small bowel T cell lymphoma, EATL

what virus can cause adult T cell leukaemia lymphoma

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HTLV1

how can EBV cause lymphomas

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when EBV is quiescent, cytotoxic T cells kill EBV antigen expressing B cells
loss of T cell function –> risk of EBV driven lymphomas
T cell function lost due to HIV/organ transplantation immunosuppression (leads to PTLD)

name examples of :

generative lymphoid tissue
reactive lymphoid tissue
acquire lymphoid tissue

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generative = BM and thymus 
reactive = LN and spleen 
acquired = extra-nodal lymphoid tissue (skin, stomach, lung)

roles of T cells

express surface T cell receptor regulation of B cells and macrophages cytotoxic function

what do normal lymph nodes look like

rounded areas = B cell follicles between B cell follicles = T cell areas medulla = central area where mature B cells end up B cells migrate from the mantle zone inwards to the germinal centre (where they encounter APC and undergo activation and selection)

what is the main B cell marer

CD20

what is the main T cell marker

CD3 (CD5)

how can lymphoma be classified

HODGKIN: - classical - lymphocyte prediminant NHL: - B cell - precursor B, peripheral B (high/low grade) - T cell - precursor T cell, peripheral T cell

diagnostic tools in lymphoma

cytology histology - architecture - nodular/diffuse - cells - small round, small cleaved, large immunophenotyping FISH - id chromosomal translocations PCR - id chromosome translocations, clonal T cell receptor, or Ig gene rearrangement

what are common low grade B cell lymphomas

follociular lymphoma small lymphocytic lymphoma/ chronic lymphocytic manginal zone mantle zone

what are common high grade lymphomas

diffuse large B cell lymphoma

what is a common intermediate grade lymphoma

Burkitt's lymphoma

features of follicular lymphoma

presents as lymphadenopathy in the middle-aged/elderly follicular pattern germinal cell origin (positive staining for CD10 and bcl-6 14;18 translocation involving bcl2 gene neoplastic follicles express bcl-2 on immunohistochemistry

features of small lymphocytic /chronic lymphocytic leaimaemia

presentation = middle aged/elderly detected in LN/blood histopath = small lymphocytes. arises from B cells or post-germinal centre memory B cells CD5 and CD23 positive multiple genetic abnormalities indolent, but can transform into a higher grade lymphoma (Richter transformation)

features of marginal zone lymphoma/ MALT lymphoma

arise mainly at extranodal sites arises after chronic antigenic stimulation arise from post-germinal centre memory B cells

features of mantle cell lymphoma

middle-aged males affects LN and GI tract often presents with disseminated disease histopath - in the mantle zone of the lymph arise from pre-germinal centre structures aberrant expression of CD5 and cyclin D1 11;14 transclocation median survival 3-5 yrs

features of Burkitts lymphoma

``` jaw/abdominal mass in children/young adults associated with EBV arises from germinal centre cells starry-sky appearance c-myc translocation (8;14,2;8 or 8;2) aggressive disease ```

diffuse large b cell lymphoma

middle aged and elderly lymphadenopathy large lyphoid cells germinal centre phenotype phenotype = good prognosis p53 positive and high proliferation fraction - poor prognosis

features of T cell lymphomas

``` middle aged and elderly lymphadenopathy and extranodal sites large T lymphocytes reactive cell population (esp eosinophils) aggressive ```

features of anaplastic large cell lymphoma

``` children and young adults lymphadenopathy large epitheloid lymphocytes 2;5 translocation alk-1 protein expression = better prognosis aggressive ```

differences between NH and H lymphoma

H is more localised - only one nodal site H spreads contiguously NHL involves multiple lymph node sites and spreads discontinuously

features classical hodgkin lymphoma

``` young and middle aged single group of LN EBV associations histopath: sclerosis, Reed sternbeg/ hodgkin cells, eosinophils diagnostic markers = CD30, CD15 ```

nodular lymphocyte predominant hodgkin lymphoma

``` isolated lymphadenopathy no association with Ebv arise from germinal B cells negative for CD30 and CD15 positive for CD20 ```

features of hodgkin lymphoma

``` bimodal age 20-29, 60+ painless enlarged LN nodes can cause obstructive signs + symptoms B symptoms alcohol induced pain ```

how is hodgkin lymphoma staged

1 - one group of LN 2 - >1 group of LN same side of diaphragm 3 - nodes above and below diaphragm 4 - extra nodal spread

how is hodgkin lymphoma treated

``` all should receive chemo radiotherapy also given combined modality = R+ C chemotherapy = ABVD Adriamycin Bleomycin Vincristine Decarbazine (DTIC) 4 weekly intervals preserves fertility long-term consequences = pulmonary fibrosis + cardiomyopathy ```

prognosis for hodgkin lymphoma

80% in stage 1/2 are cured 50% of stage 4 are cured 80% are long-term survivors

Haematology 8: Lymphoma 1 Flashcards

(48 cards)