Hodgkin’s Lymphoma Flashcards by Iseoluwa Ojo

Lymphomas are broadly divided into _____ and ______

Hodgkin and Non hodgkin

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• Hodgkin lymphoma is a incurable lymphoma with distinct histology, biologic behavior, and clinical characteristics.

T/F

potentially curable lymphoma

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Thomas Hodgkin first described the disorder in 1832 in his paper titled “ ________________________ ”

some morbid appearances of the absorbent glands and spleen

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Hodgkin lymphoma:

a (benign or malignant?) lymphoid neoplasm characterised by the presence of neoplastic _________ cells or its variants ( _____________ ) in a background of _________ ————— cell infilterates comprising lymphocytes, eosinophils, histiocytes, plasma cells and neutrophils

Malignant

Reed-sternberg

Hodgkin cell

non-neoplastic inflammatory

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REED-STERNBERG CELL

• Neoplastic giant cells derived from ______ centre or _______ centre ___ cells.

germinal

post germinal

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REED-STERNBERG CELL

___lobed nucleus with prominent ______ nucleoli separated by a _______

eosinophilic

clear space.

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REED-STERNBERG CELL

Account of ___-___% of cell population

1-2

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HODGKIN CELLS

_____nuclear variants: ______nucleus with (small or large?) nucleolus.

Mono

single

Large

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HODGKIN CELLS

Lacunar cells : folded _____lobed nuclei with (scanty or abundant?) cytoplasm.

multilobed

Abundant

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HODGKIN CELLS

_________ variant(L&H cells or _______ cells): _________nuclei,( conspicuous or inconspicuous?) nucleoli and (mild or moderately?) abundant cytoplasm.

Lymphohistocytic

popcorn

polypoid

inconspicuous

moderately

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HODGKIN CELLS

•__________ variants
•___________ cells
•___________ variant or ______ cells

Mononuclear variants

Lacunar cells

Lymphohistocytic

popcorn

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AETIOLOGY of Hodgkin’s lymphoma

Main
• Largely (known or unknown?)
• Strong association with the ________ VIRUS

Unknown

EPSTEIN BARR

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AETIOLOGY of Hodgkin’s lymphoma

Other risk factors
• (Low or High?) socio economic status particularly in the young adults.
• Family history of ________ disease.
•_________
• ____
• Infectious ___________

High

autoimmune

Identical twin

HIV

mononucleosis

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HISTOLOGIC CLASSIFICATION

Hodgkin lymphoma is classified into 2 main types:

1)___________ HODGKIN LYMPHOMA
2) _______________ HODGKIN LYMPHOMA.

CLASSICAL

NODULAR LYMPHOCYTE PREDOMINANT

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CLASSICAL HODGKIN LYMPHOMA

• Characterised by large ____________ cells or ____________ cells.

• The cells are CD___+,CD___+,CD20-,CD45-,CD____+,CD79a-,PAX5+

mononuclear hodgkin

binucleate reed- sternberg

30, 15; 75

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CLASSICAL HODGKIN LYMPHOMA

• Comprises of 4 subtypes.

• __________
•___________
•____________
• ____________

NODULAR SCLEROSIS

MIXED CELLULARITY

LYMPHOCYTE DEPLETED

LYMPHOCYTE RICH

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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• A unique subtype constitutes _____% of cases.

• Reed-sternberg cells are (frequent or infrequent?) or (absent or present?) .

5-10

infrequent

absent

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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• _____________________ cells are seen in a background of _______ ————— cells.

Lymphocytic and histiocytic cells or popcorn

benign inflammatory

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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

It is associated with EBV infection

T/F

not

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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• Unlike reed-sternberg cells they are positive for B cell antigen such as CD__,CD___,CD___,CD___,CD79a,BCL-6 and negative for CD____,CD__,CD__

19; 20; 45; 75;

30;15

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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA

• majority of patients are young adult (male or female?) (4;1) with _______ or _________

• Prognosis is (good or bad?).

Male

cervical or axillary lymphadenopathy.

Good

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CLINICAL FEATURES of HL

• Presentation commonly with (painful or painless?) ‘_______ ’ ____________ lymph node enlargement: frequently ____ gland(s).

• Initial mode of spread occurs predictably to ___________. Often involves _______ and ________ glands and other sites.

painless;rubbery

supradiaphragmatic; cervical

contiguous nodal chains

supraclavicular and axillary

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CLINICAL FEATURES

•_____________ involvement is rare and suggests a diagnosis of _______.

•______________ in HL may wax and wane during observation.

Waldeyer’s ring; NHL

Lymphadenopathy

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CLINICAL FEATURES

• Abdominal lymphadenopathy may occur with ______ involvement.

splenic

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CLINICAL FEATURES of HL • Bulky ________ and _______ lymphadenopathy may produce local symptoms(e.g. _____ or ______ ) or direct extension (e.g. to _____,_____,______, or _______ ).

mediastinal and hilar bronchial or SVC compression lung, pericardium, pleura or rib

CLINICAL FEATURES of HL • Extranodal spread may also occur via ______ (e.g. to _____,_______, or _______ ). Presence of disseminated extranodal disease is generally accompanied by _________________.

bloodstream bone marrow, lung or liver generalised lymphadenopathy

CLINICAL FEATURES of HL • ~33% patients have ≥1 associated constitutional __________ at presentation: •weight loss >____% body weight during the previous ________ •unexplained ________ or ____________. •_______,__________, and __________ -induced lymph node pain.

‘B’ symptoms 10; 6 months fever or drenching night sweats ‘B’ symptoms, pruritus and alcohol

CLINICAL FEATURES of HL • A defect in ______ immunity has been documented in patients with HL rendering them more susceptible to TB, fungal, protozoal and viral infections including Pneumocystis carinii and HZV.

cellular

CLINICAL FEATURES of HL •___________ fever

Pel-ebstein

DIAGNOSTIC WORK UP to be done to check for HL •_______ •_______ •_________

Blood studies Biopsy Imaging

Blood studies of HL • FBC: may show _____chromic _____cytic anaemia, reactive leuco____ and/or a reactive mild thrombo_______. • ESR is (elevated or depressed?) • LDH is (elevated or depressed?)

normo; normo cytosis; cytosis Elevated Elevated

Blood studies of HL • elevated ESR may (help or worsen?) prognosis. • elevated LDH is correlating with ________

Worsen bulk of disease

Blood studies of HL •Elevations of ESR and LDH are seen in ____,_____. • ____glycemia due to _________ •_____ screening.

CRP, ALP Hypo insulin auto antibodies HIV

BIOPSY of HL • Bone marrow biopsy especially in the (youth or elderly?) ,(early or advanced?) stage disease, (local or systemic?) symptoms as well as ____ involvement.

Elderly ; advanced; systemic; liver

BIOPSY in HL • Sampling of pleural fluid by _______ • CNS evaluation by _________

thoracocentesis lumbar puncture

A histologic diagnosis is always required with excisional lymph node biopsy. T/F

MRI is done for HL if __________________

rare CNS symptoms are present.

IMAGING in HL • AP and LATERAL CXR to assess _________ • CT scan of _____,_______, and ________

bulk of mediastinal mass. chest,abdomen,pelvis

IMAGING in HL •________________(PET) scan now considered essential in the ________ of hodgkin lymphoma as well as in _______

Positron emission tomography initial staging assessing treatment.

STAGING OF HODGKIN LYMPHOMA • ____ stage __________ classification is used. • It is a _______ and ______ staging system.

4 stage ann-arbour clinical and pathological

STAGING OF HODGKIN LYMPHOMA • It is a clinical and pathological staging system. • The clinical stage is the result of _____,_______,________, and ________ • Pathological staging refers to the use of ________ or __________

history, physical examination,imaging and laboratory investigation. biopsy procedures or staging laparotomies.

STAGING OF HODGKIN LYMPHOMA Presence or absence of ______________ further modifies the staging system.

constitutional symptoms

ANN ARBOUR STAGING SYSTEM Stage 1: Involvement of _________ region(I) or __________________

single lymph node a single extralymphatic organ or site(Ie)

ANN ARBOUR STAGING SYSTEM STAGE II: Involvement of ________________ regions on ______________ or with involvement of ______________________(IIe)

two or more lymph node the same side of the diaphragm alone(II) limited contiguos extralymphatic organ or tissue

ANN ARBOUR STAGING SYSTEM STAGE III: Involvement of ________________ ,which may include the ________ or limited _____________ or _______

lymph node regions on both side of the diaphragm III spleen IIIs contiguos extralymphatic organ or site IIIe or both IIIes.

ANN ARBOUR STAGING SYSTEM STAGE IV: _______________ of involvement of _____________________ with ___________________

Multiple or disseminated foci one or more extralymphatic organ or tissues or without associated lymph node involvement.

Modifying features in HL • A. ____________ • B. ____________ • X. ________:mass>___cm,.__:__mediastinal:mass ratio • E.Involvement of a ________,______ or ________ • Spread is via __________,________, or ___________

ASYMPTOMATIC B symptoms Bulky disease; 10; 1:3 single,contiguos or proximal extranodal site lymphatics,hematogenous or direct extension.

PROGNOSTIC FACTORS(EORTC) Favourable • Clinical stage ________ • Maximum of _____ nodal areas involved • Age < ___ years • ESR < ____mm/hour without ———— or ESR < ____mm/hour with __________ • Mediastinal/thoracic ratio < ____

I and II three 50 50 ; ‘ B ’ symptoms 30 ; ‘ B ’ symptoms 0.35

UNFAVOURABLE PROGNOSTIC FACTORS • ________ disease • An ESR of _____ mm/h or higher, if the patient is otherwise asymptomatic • More than ___ sites of disease involvement

Bulky 50 3

UNFAVOURABLE PROGNOSTIC FACTORS • The presence of _____ symptoms • The presence of ______ disease

B; extranodal

Bulky disease is defined as a ________ mass >___rd of the intrathoracic diameter on a chest radiograph or greater than ____% of the thoracic diameter at vertebral level ____-____

mediastinal 1/3 33 T5-6.

UNFAVOURABLE FACTORS:ADVANCED DISEASE • Serum albumin less than ___g/dL • Hemoglobin less than ______ g/dL • (Male or female ?) sex

4 10.5 Male

UNFAVOURABLE FACTORS:ADVANCED DISEASE • Stage —— disease • Age ____ years or older • White blood cell (WBC) count greater than _______/μL

IV 45 15,000

UNFAVOURABLE FACTORS:ADVANCED DISEASE • Lymphocyte count less than _____/μL or less than ___% of the total WBC count

600 8

Advanced disease refers to stage ___/___ disease or early stage disease with ______ or ______

iii/iv systemic symptoms or bulky disease.

• Treatment of Hodgkin lymphoma is tailored to disease type, disease stage, and an assessment of the risk of resistant disease. T/F

TREATMENT of HL • It is potentially curable but significant ___________ can arise from therapy.

long term toxicity

TREATMENT of HL •____________ therapy (______ therapy and _________ ) is frequently the preferred approach.

Combined-modality radiation chemotherapy

TREATMENT of HL • In patients with advanced Hodgkin lymphoma, involved-field radiotherapy can be used for sites of persistent disease following chemotherapy(Stanford V)

TREATMENT of HL • In patients with advanced Hodgkin lymphoma, _________ ———-therapy can be used for sites of persistent disease following ———therapy(Stanford V)

involved-field radio chemo

TREATMENT of HL many cases of Hodgkin lymphoma do not relapse T/F

F Despite the high rate of cure for this disease, many cases Hodgkin lymphoma do relapse.

TREATMENT of HL • In most of these relapse cases, _____ chemotherapy followed by _______ chemotherapy (HDC) with _______________ support is indicated.

salvage high-dose autologous hematopoietic stem cell

GOAL OF THERAPY The primary goal of therapy is to induce __________, which is defined as the _____________, as evaluated by ______ scanning, physical examination, and _______ examination.

a complete remission (CR) disappearance of all evidence of disease PET/CT bone marrow

GOAL OF THERAPY • A partial remission (PR) is defined as " __________________________ " of disease.

regression of measurable disease and no new sites

For treatment of classic Hodgkin lymphoma, ______ therapy is generally administered in combination with ______therapy

radiation chemo

RADIATION THERAPY • Radiation fields and doses are selected to minimize _____________, and maximize ________________

the potential side effects of therapy the potential for long-term disease- free survival.

RADIATION THERAPY • Involved-field therapy encompasses __________________. • Regional-field therapy ______________________________

only the areas of observed disease extends the involved field to include adjacent lymph regions

RADIATION THERAPY Other fields that have been used historically and may be used in exceptional clinical circumstances include: the _______ field __________ field ____________ irradiation

mantle inverted Y Subtotal nodal

Radiation therapy 1)the mantle field, covering the ____,______ and ,_________ nodes and avoiding the _________

mediastinal, cervical, and axillary heart and lungs

Radiation therapy •inverted Y field, covering the _____,______. And _____ nodes •Subtotal nodal irradiation involves the ________ plus _________

para-aortic, pelvic, and inguinal mantle field the para-aortic nodes.

In Radiation therapy Careful avoidance of the ________ can reduce the risk of _______.

spinal cord myelitis

In radiation therapy, __________________________________________________ are important during the reproductive years

Shielding the testes and oophoropexy (temporary surgical suspension of the ovaries [eg, outside of a radiation field])

In radiation therapy , Doses used in combined modality therapy are 30-36 Gy for _________ sites and 20-30 Gy for ______ sites.

bulky disease nonbulky disease

In radiation therapy, When radiation therapy is used alone, doses may range from ___-___ Gy.

30-44

INDUCTION CHEMOTHERAPY REGIMEN ____________ was the first effective combination chemotherapy for Hodgkin lymphoma.

MOPP (mechlorethamine, vincristine, procarbazine, prednisolone)

INDUCTION CHEMOTHERAPY REGIMEN • 1)MOPP • It is a ____-drug regimen developed by ___________ and colleagues at the National Cancer Institute in the mid _____s and is primarily of historical importance. • It has a high incidence of _________ and ____________

4; Vincent DeVita 1960 sterility and secondary leukaemia.

INDUCTION CHEMOTHERAPY REGIMEN ___________ combination has now become the standard chemotherapy regimen for Hodgkin lymphoma.

ABVD regimen

MOPP (______,________,________,_______)

mechlorethamine, vincristine, procarbazine, prednisolone

ABVD (_______,________,_________,__________)

Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine

ABVD The ABVD regimen was designed in Italy by ______________ and his colleagues in the early _____s.

Gianni Bonadonna 1970

OTHER INDUCTION CHEMOTHERAPY REGIMENS •_____________ •_____________

Stanford V BEACOPP

SALVAGE CHEMOTHERAPY • When _______ chemotherapy fails, or patients experience _______, salvage chemotherapy is generally given.

induction relapse

SALVAGE CHEMOTHERAPY • Salvage regimens incorporate drugs that are _______________________________________.

complementary to those that failed during induction therapy

SALVAGE CHEMOTHERAPY Some salvage protocols include • -____ • -______ • -_______- regimen

ICE DHAP EPOCH

RESPONSE ASSESSMENT • Assessment of disease response requires _________ and, if infiltrated on staging investigations, repeat __________ • The utility of _____ is increasingly well understood.

repeat imaging bone marrow biopsy. PET

RESPONSE ASSESSMENT PET can help differentiate between _______ and ________

active disease and fibrotic material.

Response to treatment has been graded as follows. • Complete remission CR: ——————— • PARTIAL REMISSION PR: ___________________ and ________________

DISSAPEARANCE OF ALL EVIDENCE OF DISEASE REGRESSION OF MEASURABLE DISEASE AND NO NEW SITES.

Response to treatment has been graded as follows. • STABLE DISEASE SD: ___________________ • RELAPSED DISEASE OR PROGRESSIVE DISEASE PD: ________ OR ______________

FAILURE TO ATTAIN CR/PR OR PD ANY NEW LESION INCREASE BY >50% OF PREVIOUSLY INVOLVED SITES.

Response to treatment has been graded as follows. • Complete remission CR: DISSAPEARANCE OF ALL EVIDENCE OF DISEASE • PARTIAL REMISSION PR:REGRESSION OF MEASURABLE DISEASE AND NO NEW SITES. • STABLE DISEASE SD:FAILURE TO ATTAIN CR/PR OR PD • RELAPSED DISEASE OR PROGRESSIVE DISEASE PD:ANY NEW LESION OR INCREASE BY >50% OF PREVIOUSLY INVOLVED SITES.

Hodgkin’s Lymphoma Flashcards

(89 cards)