hodgkins lymphoma

Question 1

What is hodgkins lymphoma

Answer 1

lymphoid neoplasms affecting lymph nodes

Question 2

Morphology of hodgkins lymphoma

Answer 2

large dysplastic mononuclear and multinucleated cells surrounded by a variable mixture mature non neoplastic inflammatory cells

Question 3

Hodgkins lymphoma will usually present with

Answer 3

Lymphadenopathy

Question 4

History of hodgkins

Answer 4

Thomas hodgkin in 1832 following affected lymph glands in postmoterm cases

dOROTHY REED and carl stenberg identified abnormal cell that defines HL in 1898

Question 5

Diagnostic features of HD

Answer 5

Reed Stenberg cells and its variations in cancerous area

Question 6

Hodgkins cancerous cells overproduce this cytokine

Answer 6

IL-13

Question 7

Cancerous R-S cells origin

Answer 7

B origin

Question 8

Virus that causes HL

Answer 8

EBV

Question 9

Nucleus in R-S cell

Answer 9

Bi or multinucleate with prominent nucleolus in each nucleus

Question 10

Other hodgkins cells apart from R-S cells are

Answer 10

Mononucleate

Question 11

Affected lymph node morphology

Answer 11

Scattered tumour cells mixed with reactive lymphocytes,plasma cells, macrophages,neutrophils,eosinophils, with variable amount of fibrosis

Question 12

Hodgkin disease sex distributuion

Answer 12

M>F

Question 13

HL and age

Answer 13

Increased incidence with age, peaks at third decade, then a decline

Question 14

Classical hodkins dx accounts for what percentage of hodgkins lymphoma

Answer 14

90%

Question 15

Peak incidence in hodgkins dx

Answer 15

between ages 15-35

and another peak in late life for all subtypes than nodular sclerosis

Question 16

Nodular sclerosis occurs mostly in

Answer 16

Young adults

Question 17

Occupational risks foe HL

Answer 17

Wood dust
Benzene exposure
Nitrous oxide as dental anaesthetic

Question 18

Highest incidence of EB virus association

Answer 18

Mixed cellularity HD

Question 19

This confers a 5 fold elevated risk of HD

Answer 19

HIV

Question 20

This karyotype is found rarely in HD

Answer 20

t(14;18)

Question 21

EBV has its strongest association with

Answer 21

children, elderly with mixed cellularity

Question 22

This is expressed in R-S cells of patients with HD

Answer 22

bcl-2

Question 23

Molecular studies for HL

Answer 23

R-S CELLS. Difficult, since R-S cells only make up 2% of total cells in node with HD

Also, point mutations in p53 gene using PCR

Question 24

What cytokines are present in HD

Answer 24

IL 1-9
TGF-BETA
TNF

Question 25

TGF-BETA

Answer 25

Produced by eosinophils and is the source of fibrosis in nodular sclerosis

Question 26

Clinical features of HL

Answer 26

Peripheral lymphadenopathy in 1 or 2 lymph nodes Spread is contiguous along lymph node drenching night sweats fever weight loss Alcohol induced pain in lymph nodes Mediastinal involvement in young adults i.e cough,chest pain, dyspnea

Question 27

Classification of HL

Answer 27

Nodular lymphocyte HL | Classical HL

Question 28

Classical HL features

Answer 28

90% OF ALL HL cases | peak incidence 15-35 and a second peak in late life

Question 29

Rye classification of HL- Classical

Answer 29

Lymphocyte rich Nodular sclerosisng Mixed cellularity Lymphocyte depleted

Question 30

Morpholy of lymphocyte rich

Answer 30

Small lymphocytes few eosinophils R-S cells mononuclear cells 5%

Question 31

Nodular sclerosing morphology

Answer 31

lymph nodes divided by broad band of connective tissue into nodules Nodules contain a mixture of R-S cells, mononuclear H cells,plasma cells,macrphages, eosinophils 70%

Question 32

Mixed cellularity morphology

Answer 32

R-S cells readily seen fibrosis focal necrosis mononuclear H CELLS, PLASMA CELLS, MACROPHAGES, EOSINOPHILS 20-25%

Question 33

Lymphocyte depleted morphology

Answer 33

R-S cells few lymphocytes Abundant mononuclear Hodgkins cells less than 2%

Question 34

Nodular lymphocyte predominant percentage

Answer 34

10% expresses B cell markers

Question 35

This type of CLASSICAL HL is present in stage 3-4

Answer 35

Lymphocyte depleted

Question 36

Basement membrane involvement is common in

Answer 36

Lymphocyte depleted

Question 37

Relatively more commom in HIV patients is

Answer 37

Lymphocyte depleted

Question 38

Ann abor staging system

Answer 38

I- disease in only one LN area II- Dx in 2 or more LN area on same side of diaphragm III-Dx in LN areas of both sides of diaphragm 3i- involvement of splenic,portal,celiac nodes 3ii- Involvement of para-aortic,iliac, mesenteric nodes IV-Extensive dx in liver,bone marrow, other extranodal sites

Question 39

Diagnosis of HD

Answer 39

``` History/physical exam lymph node biopsy FBC and comment Bone marrow for staging LDH, Uric acid imaging for spleen size Chest Xray for intrathoracic involvement CT ```

Question 40

Poor prognosis markers

Answer 40

``` Males Age greater than 50 Advanced dx Low serum albumin conc anaemia ```

Question 41

Chemotherapt

Answer 41

at stage 1A- field radiotherapy and chemotherapy all other stages - chemotherapy plus adjuvant radiotherapy

Question 42

Combination therapy for advanced dx

Answer 42

COPP- cyclophosphamide, oncovin, prednisolone, procabazine ABVD- Andriamycin, Bleomycin, Vincristine, Darcabazine

Question 43

tREATMENT OF CHOICE

Answer 43

ABVD

Question 44

Why is ABVD preferred

Answer 44

less toxic rarely causes sterility secondary leukemia less

Question 45

Antibody for relapsed / refractory dx

Answer 45

Brentuximab

Question 46

How do you evaluate response

Answer 46

Clinical examination and repitition of abnormal exam in initial stages Evaluate after 3-4 courses of chemo scan for residual dx palpate for masses in residual dx

Question 47

How many ppl with HL can approximately be cured

Answer 47

85%