lymphoma Flashcards
(25 cards)
non-hodgkins lymphoma
malignant proliferation of lymphocytes which accumulate in lymph nodes or other organs
- may affect B or T cells
- classified as high or low grade
commoner than Hodgkins
typically effects elderly
(any lymphoma that isnt Hodgkins)
risk factor for non-Hodgkins lymphoma
elderly
causcasians
Hx of viral infection - esp EBV
chemicals - pesticides, solvents
Hx of chemo/radio
immunodeficiency - transplant, HIV, diabetes
autoimmune disease - SLE, sjogrens
non-hodgkins presentation
painless lymphadenopathy - rubbery, asymmetrical
B symptoms - fever, weight loss, night sweats, lethargy
extranodal disease - dyspepsia, dysphagia, abdo pain, pancytopenia, bone pain, nerve palsies
–> extra nodal disease more common in non-hodgkins
non-hodgkins investigations
excisional node biopsy
CT chest, abdo, pelvis
HIV test
non-hodgkins lymphoma staging
Lugano
management of non-hodgkins lymphoma
depends on specific subtype
watchful waiting, chemo or radio
rituximab -> used in combo with chemo
(flu/pneumococcal vaccines)
what must all non-hogkins lymphoma patients be screened for before commencing treatment
hepatitis B
–> rituximab can cause reactivation of HBV in patients with prior exposure
non-hodgkins lymphoma prognosis
Low-grade non-Hodgkin’s lymphoma has a better prognosis
High-grade non-Hodgkin’s lymphoma has a worse prognosis but a higher cure rate
Burkitt’s lymphoma
high grade B-cell neoplasm, 2 mjor forms -
- endemic (african) - involves maxilla or mandible, assoc EBV
- sporadic - abdominal tumours, more common in patients with HIV
which gene + virus is Burkitts lymphoma most assoc with
c-myc gene translocation, usually t(8:14)
Epstein-Barr virus (EBV)
- more assoc with African form than sporadic
microscopy findings in Burkitts lymphoma
“starry sky” appearance
- > lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells
management of Burkitts lymphoma
chemo
- tends to produce rapid response which may cause tumour lysis syndrome
Rasburicase - given before chemo to reduce this risk
patients are commonly given allopurinol prophylactically before chemo
- decreased production of uric acid during cytotoxic damage
what condtions is assoc with MALT lymphoma
hashimotos
MALT lymphoma of thyroid gland (different to gastric MALT)
gastric MALT lymphoma
assoc with Hpylori infection (95% of cases)
- good prognosis
- if low grade, 80% respond to Hpylori eradication
features = paraproteinaemia
Hodgkins lymphoma
malignant proliferation of lymphocytes characterised by the presence of Reed-Sternberg cell
bimodal age distributions
–> 30s + 70s
risk factors for Hodgkins lymphoma
HIV
Epstein-Barr virus
alcohol-indiced lymph node pain
Hodgkins
(seen in <10%)
Reed-sternberge cells
Hodgkins lymphoma! seen on lymph node biopsy
large cells that are multinucleated or have bilobed nucleus with prominent eosinophillic inclusion like nucleoli –> owl’s eye appearance
B symptoms on prognosis in Hodgkins
imply poor prognosis :(
staging of Hodgkins lymphoma
historically = Ann Arbor
now = Lugano
- used to stage other lymphomas
- now includes PET scans (modernised)
management of Hodgkins lymphoma
chemo –> ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
radio
haematopoietic cell transplantation - used for relapsed or struggling to treat
commonest type of non-hodgkins lymphoma
Diffuse large B cell lymphoma
40% of total lymphoma
high grade - aggressive
typically responds better to treatment
type of patient usually affected by Burkitts lymphoma
young or immunosuppressed
lymphoma assoc with coeliac disease
enteropathy assoc T cell lymphoma
