Lymphoma Flashcards
(38 cards)
the “B symptoms” of lymphoma (fever, malaise, night sweats, weight loss) are due to what?
increased inflammatory cytokine production
what does generalized adenopathy usually indicate?
generalized adenopathy: in 3+ non-contiguous lymph node areas
think systemic diseases: infection, Lupus, lymphoma
what is the significance of Waldeyer’s ring regarding lymphoma?
Waldeyer’s ring: lymphoid tissue in pharyngeal area that forms tonsils (nasopharyngeal, palatine, lingual)
common extra-nodal site for lymphoma
upon physical examination of a patient’s lymph node, what are some findings that would provide concern for neoplastic disease?
if patient is >40
hard or firm
non-tender (no signs of inflammation)
size >2cm
what are the general features of lymphoma? how is it diagnosed?
painless lymph node enlargement (>2cm)
“B symptoms” due to inflammatory cytokines
Dx: lymph node biopsy (any lymph node >1cm and present >4 weeks without infection)
Hodgkin lymphoma is defined by the presence of what cell type
Reed-Sternberg cell
if not present, it is non-Hodgkin (most cases)
most lymphomas (derived from mature lymphocytes) are [T/B] cell origin and [Hodgkin/non-Hodgkin]?
most lymphomas are non-Hodgkin with B cell origin
develop in primary or secondary lymphoid structures
follicular lymphoma
most common indolent (slow growing) lymphoma (B cell), mean onset 55y
painless lymphadenopathy that waxes and wanes, may not have B symptoms
diagnose via lymph node biopsy
what is the pathogenesis (cause) of follicular lymphoma?
indolent (slow growing) B cell lymphoma
t(14;18) chromosomal translocation in germinal center B cells —> overexpression of BCL2 (anti-apoptotic)
can detect overexpression via immunostaining
how does follicular lymphoma impact lymph node architecture?
follicular lymphoma: indolent B cell lymphoma, t(14;18) causes overexpression of BCL2 (anti-apoptotic)
mature lymphocyte clonal population expands in lymph node - follicles seen throughout (not just cortex)
*note they’re not growing faster, they’re just not dying
what is significant about the finding that in follicular lymphoma, BCL2 is expressed not only in the mantle zone of follicles but also in the center?
BCL2 (anti-apoptotic) should not be found in the middle of the germinal centers, where apoptosis is occurring for B cell selection
in follicular lymphoma it is found throughout (helps distinguish from reactive lymph node from infection, etc)
*remember follicular lymphoma is indolent B cell cancer
how is follicular lymphoma treated?
no cure, treating patients with asymptotic disease does not improve survival (indolent)
rituximab (anti-CD20, kills B cells) for patients with symptoms (only palliative)
mean survival ~10 years
what kind of cancer does this describe?
- BCL-2 overexpression
- waxing and waning lymphadenopathy
- rarely extranodal
follicular lymphoma: indolent B cell cancer
*t(14;18) —> BCL2 (anti apoptotic) overexpression
what is a MALT-oma?
extranodal marginal zone B cell lymphoma in MALT (mucosa associated lymphoid tissue), indolent
associated with chronic inflammation (*Helicobacter pylori) —> most MALT lymphomas are in the stomach
—> peptic ulcer symptoms, abdominal symptoms
how does Helicobacter pylori infection cause MALT lymphoma?
via chronic inflammation
*if patient has early MALT-oma due to H.pylori and you treat infection, cancer can regress and go away
[remember MALT-oma is indolent]
MALT lymphoma, associated with chronic inflammation, can progress to _____ if not controlled/treated
diffuse large B cell lymphoma (aggressive, rapidly growing B cell lymphoma)
[recall that MALT-oma is indolent]
what are the general characteristics of aggressive non-Hodgkin lymphomas? (3)
- rapidly growing mass
- systemic B symptoms
- high levels of serum LDH and uric acid (breakdown product of nucleic acid synthesis)
mantle cell lymphoma
aggressive lymphoma of mantle zone, which contains “pre-germinal center” B cells (surrounds germinal center)
t(11;14) translocation —> overexpression of Cyclin D1 (bypasses check points)
*sex hormone (testosterone) influence
what mutation causes mantle cell lymphoma and what cell markers will be present?
t(11;14) translocation —> overexpression of Cyclin D1 (bypass cell cycle checkpoints)
MCL stains cyclin D1+
and tumor cells express CD19/20 and CD5 (T cell marker on a B cell)
[remember this is an aggressive B cell lymphoma]
how does mantle cell lymphoma present?
usually advanced stage at diagnosis with poor prognosis (aggressive non-Hodgkin B cell cancer)
nodal disease + spleen, liver, and bone marrow enlargement
B symptoms
extranodal disease, commonly GI tract (lymphomatous polyposis)
ring [mantle] around the rosy, pocket full of posy [polyposis]
what kind of cancer does this describe?
- t(11;14) Cyclin D1 overexpression
- aggressive behavior
- M>F presentation
- lymphomatosis polyposis
- immunostaining positive for CD19, CD20, CD5
mantle cell lymphoma: aggressive B cell cancer
lymphomatosis polyposis: involvement in GI tract
diffuse large B cell lymphoma
most common lymphoma overall, mean age 70, sex hormone influenced
aggressive B cell lymphoma
de novo, transformation from low grade tumor, HIV!
BCL-6 and BCL-2 overexpression or mutation
this lymphoma is the most common type and is associated with HIV/AIDS (AIDS-defining malignancy)
what is?
diffuse large B cell lymphoma: aggressive B cell lymphoma
400x increase risk of lymphoma in HIV+ patients, most DLBCL and highly aggressive
risk factors: low CD4, high HIV viral load
what does diffuse large B cell lymphoma look like on histological slides?
diffuse effacement of lymph node by large cells with HIGH growth rate (aggressive cancer)
Ki-67 positive in cells that are rapidly proliferating
