Lymphatic System

Question 1

Mention 2ry causes of lymphedema

Answer 1

1. Post-traumatic: circuferential scars of limbs, block dissection, burns at LN sites, irradiation
2. Post-inflammatory: filarial TB, recurrent non-specific lymphangitis or cellulitis or post-erysipelas lymphedma
3. Neoplastic: 1ry;lymphoma, 2ry: mets

Question 2

What is stemmer’s sign?

Answer 2

Thickened skin fold at base of 2nd toe (+ve if can’t be lifted, only grasped)

Question 3

Mention CCC of lymphedema

Answer 3

1. Infection
2. Elephantiasis
3. Lymphangiosarcoma

Question 4

List Burner’s clinical classification of lymphedema

Answer 4

Latent: excess interstitial fluid, histological abnormalities, no clinical evidence
1: pits on pressure & swelling disappears on elevation & bed rest <3cm inc in CLL
2. Doesn’t pit, no significant reduction on elevation, 3-5 cm inc compared to CLL
3. Irreversible skin changes: fibrosis & papillae >5cm

Question 5

Staging laparotomy for Hodgkin lymphoma has been largely replaced by…..

Answer 5

Spiral CT, liver biopsy, bone scan

Question 6

Discuss definitive TTT of Hodgkin lymphoma

Answer 6

1a, 1b, 2a: radiotherapy, supradiaohragmatic LN: mantle therapy, infradiaphragmatic: inverted Y therapy
2b: radiotherapy & 6 cycles of chemo for 6 months
3 & 4: 12 cycles of chemo & radiotherapy to control bulky lymphnodes
Chemo regimen
Mustine, Oncovine, Pro-carbazine, Prednisolone fir 1st 4 cycles
OR Cyclophosphamide + the rest except mustine

Question 7

MC cell of origin for NHL is….

Answer 7

B-lymphocytes

Question 8

Mention markers of poor prognosis in HL

Answer 8

Loss of weight >10%, night sweats, RSB cells in bone marrow