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MD2 Medicine > Lymphoid Neoplasms > Flashcards

Lymphoid Neoplasms Flashcards

1
Q

Is lymphoma a common malignancy?

A

Yes - 6th most commonly diagnosed cancer

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2
Q

How should lymph nodes be sent to the pathology lab for testing?

A

Fresh, with no formalin or other fluids in tub

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3
Q

Where are T cells made?

A

Bone marrow

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4
Q

Where do T cells mature?

A

Thymus

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5
Q

Where do T cells become activated?

A

Secondary lymphoid organs

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6
Q

Where are B cells made?

A

Bone marrow

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7
Q

Where do B cells mature?

A

Bone marrow

Lymphoid organs

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8
Q

Where do B cells become activated?

A

Lymphoid follicles

Paracortex

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9
Q

Where does the lymph enter a lymph node?

A

Afferent lymphatic vessel > marginal sinus

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10
Q

Where are the follicles and germinal centres located in the lymph node?

A

In cortex

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11
Q

Where do T cell responses occur in the lymph node?

A

Paracortex

Medulla

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12
Q

What is contained within the medulla of the lymph node?

A

T cells

Medullary sinuses

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13
Q

What is the translocation in Burkitt lymphoma?

A

t(8;14)

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14
Q

How is the t(8;14) translocation involved in the pathogenesis of Burkitt lymphoma?

A

c-MYC gene on chromosome 8 translocated to Ig gene on chromosome 14

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15
Q

What is the translocation in follicular lymphoma?

A

t(14;18)

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16
Q

How is the t(14;18) translocation involved in the pathogenesis of follicular lymphoma?

A

Heavy chain locus on chromosome 14 translocated to Bcl-2 locus on chromosome 18 > increased expression of Bcl-2 > increased anti-apoptotic activity

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17
Q

Wat are the characteristic cells seen in Hodgkin’s lymphoma?

A

Reed-Sternberg cells

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18
Q

What methods can be used to identify the CD antigens on cells?

A

Immunohistochemistry
Flow cytometry
In situ hybridisation

19
Q

What investigations can be used to confirm that a monoclonal population of cells is present?

A

All molecular techniques based on clonal proliferation

  • PCR
  • FISH
  • Immunohistochemistry
  • Flow cytometry
20
Q

What does immunohistochemistry identify?

A

Panel of Ag markers to detect surface markers and other proteins
Detect EBV DNA
Can correlate with histology

21
Q

What does flow cytometry identify?

A

Analysis of fluorochrome labelled cells
Detects surface markers for immunophenotyping
Detects B cell clonality
No correlation with histology

22
Q

What does PCR identify?

A

Assesses monoclonality by assessing IgH gene/T cell receptor gene rearrangements
Identify specific translocations

23
Q

What does FISH identify?

A

Specific translocations and other genetic abnormalities

24
Q

A blood smear showed increased numbers of small mature lymphocytes. In the context of haematological malignancies, what is the likely diagnosis?

A

Chronic lymphocytic leukaemia

25
Q

What test would be needed to confirm the diagnosis of chronic lymphocytic leukaemia?

A

FBE
Liver/spleen ultrasound
Bone marrow biopsy

26
Q

What is the likely cause of lymphadenopathy and splenomegaly in the context of haematological malignancies?

A

Malignant infiltrate

27
Q

What is CD19 a marker of?

A

B cells

28
Q

What is CD10 a marker of?

A

Follicular lymphoma

29
Q

What are the management options for someone with chronic lymphocytic leukaemia?

A

Monitor
Treatment
- Chemotherapy
- Immunotherapy

30
Q

What is rituximab?

A

mAb against CD20

31
Q

What is ZAP-70 and what is its relevance in chronic lymphocytic leukaemia?

A

If present, poor prognosis in CLL

32
Q

What is Richter’s transformation?

A

Transformation of small cell lymphomas/CLL into diffuse large B cell lymphoma

33
Q

What are the symptoms of superior vena cava syndrome?

A 
Headache
Facial oedema
Facial congestion
Shortness of breath
Distended veins in upper limbs and neck
34
Q

What causes superior vena cava syndrome?

A

Compression of superior vena cava

35
Q

How much of the lymph node can be neoplastic in Hodgkin’s lymphoma?

A

Up to 5%

36
Q

What is the pathogenesis of Hodgkin’s lymphoma?

A

Clonal proliferation of B cells of germinal centre origin
Produce cytokines > attract other inflammatory cells
EBV present in 40-80%
Other genetic risk factors

37
Q

What are some examples of EBV related diseases?

A

Infectious mononucleosis
Lymphoproliferative disorders
Nasopharyngeal carcinoma

38
Q

What are some lymphoproliferative disorders related to EBV?

A 
Burkitt lymphoma
Plasmablastic lymphoma
DLBCL
Haemophagocytic lymphohistiocytosis
Post-transplant lymphoproliferative disorder
39
Q

What are the risk factors for lymphoma?

A 
Many arise de novo
Immunosuppression/immunodeficiency
Some autoimmune diseases
EBV
H pylori
Other infectious agents
Chemotherapy
Radiation
Chemical exposure
40
Q

What is the usual site of non-Hodgkin’s lymphomas?

A

Usually arise in lymphoid organs
Many extranodal; eg:
- Thyroid in Hashimoto’s disease
- Stomach in H pylori gastritis

41
Q

What is the usual site of Hodgkin’s lymphomas?

A

Initially enlargement of 1 lymph node group

May progress to involve adjacent lymph node groups and other lymphoid organs

42
Q

What are the systemic symptoms of lymphoma?

A

Fever
Weight loss
Night sweats

43
Q

A 65-year-old man presents with a several month history of generalised lymphadenopathy. A lymph node biopsy demonstrates effacement of normal architecture which is replaced by nodular proliferations of predominantly small cleaved lymphocytes resembling germinal centre B cells. A (14;18) translocation in the malignant cells is identified. What is the lymphoma?

A

Burkitt lymphoma

44
Q

A 24-year-old female presented with a 6 week history of fever, weight loss, shortness of breath, and cervical lymphadenopathy. Two months earlier she had spent 2 weeks in Vietnam. Chest x-ray revealed an anterior mediastinal mass. Reed-Sternberg cells are seen in the biopsy. What is the diagnosis?

A

Hodgkin lymphoma

MD2 Medicine (18 decks)

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