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Flashcards in LYMPHOMA Deck (67):
1

What proportion of lymphoma's are non-Hodgkins lymphoma?

85%

2

What is a lymphoma?

A collection of white blood cells

3

What are the two types of lymphocytes that may form a lymphoma?

B and T

4

What are the markers that you should look for which would indicate a B cell lymphoma?

CD-19
CD-20

5

What are the markers that you should look for which would indicate a T cell lymphoma?

CD-4
CD-8

6

What characterises Hodgkin's lymphoma?

The presence of Reed-Sternberg cells

7

What percentage of non-Hodgkin's lymphomas are B cell lymphomas?

80%

8

What percentage of the B cell non-Hodgkin lymphomas are follicular?

50%

9

What is the difference between follicular and diffuse lymphomas?

Follicular is more differentiated - less proliferative - and restricted to lymph nodes
Diffuse is more primitive - more proliferative - and more widespread

10

Are T-cell lymphomas follicular or diffuse?

Diffuse. Follicular is only in the lymph node, which is where the B cell reside.

11

From a biopsy, what factors might help you work out how proliferative the cells of lymphoma are?

Cleaved cells are less proliferative
Smaller cells are less proliferative
Mature cells (more like normal cells) are less proliferative
Follicular cells (versus diffuse) are less proliferative

12

What are the main low grade non-Hodgkins lymphomas?

Small lymphocytic lymphoma
Follicular lymphoma
Marginal zone B-cell lymphoma (Extranodal lymphoma)
Mantle cell lymphoma (sometimes considered intermediate grade)
Lymphoplasmacytic lymphomas (including Waldenstrom's)
Mycoisis fungoides

13

What are the features of small lymphocytic lymphoma?

B cell
Diffuse
Mature cells
Small cells
CD5 marker positive
CLL without high white cell count in the blood

14

What is the translocation responsible for 85% of the follicular lymphoma?

t(14,18) Bcl-z which leads to dysfunction of apoptosis

15

What are the features of follicular lymphoma?

B cell
Follicular
Cleaved cells
Small cells
Lymphoma of follicle centre B cells (centrocytes and centroblasts)
Most common type of low grade lymphoma

16

What are the positive markers in follicular lymphoma?

CD19
CD20 - this is a target for some treatments
CD10
CD22

17

What are the features of marginal zone B-cell lymphoma (extranodal lymphoma)?

B cell
Small cell
Associated with mucosa-associated lymphoid tissue (MALT)
Lymphoma starts in the mucosa not in the lymph nodes

18

Where is the most common place for MALT lymphomas to develop?

Stomach

19

Other than the stomach, where are the common places for MALT lymphomas to develop?

Small bowel
Salivary glands
Thyroid glands
Tear glands
Lungs

20

What is the infection associated with MALT lymphomas?

H. pylori

21

Are marginal zone B-cell lymphomas positive or negative for CD5?

Negative

22

Are marginal zone B-cell lymphomas positive or negative for CD10?

Negative

23

What is the marginal zone, which is affected by marginal B-cell lymphomas?

The marginal zone is the region at the interface between the non-lymphoid red pulp and the lymphoid white-pulp of the spleen or lymph node.

24

What are the lymphomas associated with the protein marker CD5?

Small lymphocytic lymphoma
Mantle cell lymphoma

25

What are the features of mantle cell lymphoma?

B cell
Found in the mantle zone which surrounds normal germinal centre follicles

26

What is the chromosomal translocation associated with mantle cell lymphoma?

t(11:14)

27

What is the protein that mantle cell lymphoma cells tend to overexpress as a result of the translocation t(11:14)?

Cyclin D1

28

What are the features of Waldenstrom's macroglobulinaemia?

B cell
Excessive amounts of IgM
Causes hyperviscosity

29

What are the features of mycosis fungoides?

T cell lymphoma
Generally affects the skin

30

What are the main high-grade non-Hodgkin lymphomas?

Diffuse large B cell lymphoma
Burkitt's lymphoma
Peripheral T cell lymphoma
Lymphoblastic lymphoma

31

What is the most common type of high-grade non-Hodgkin lymphoma?

Diffuse large B cell lymphoma

32

Is diffuse large B cell lymphoma more common in men or women?

Men

33

Which group of patients are most likely to develop Burkitt's lymphoma?

Children and young adults

34

What are three main clinical variants of Burkitt's lymphoma?

Endemic
Sporadic
Immunodeficiency-associated lymphoma

35

What infections are associated with endemic Burkitt's lymphoma?

EBV
Malaria is believed to reduced resistance to EBV

36

Which parts of the body are typically involved in endemic Burkitt's lymphoma?

Facial bones especially jaw
Distal ileum
Caecum
Ovaries
Kidney
Breast

37

Which parts of the body are typically involved in sporadic Burkitt's lymphoma?

Ileocecal

38

What is most commonly associated with immunodeficiency lymphoma?

HIV

39

What is the gene affected in Burkitt's lymphoma?

c-myc gene

40

What is the most common translocation associated with Burkitt's lymphoma?

t(8;14)

41

Are Reed-Sternberg cells usually positive or negative for CD20?

Negative

42

What markers are Reed-Sternberg cells usually positive for?

CD30 and CD15

43

What is the main recognised risk factor for Hodgkin's lymphoma?

EBV infection

44

Are T cells or B cells affected in Hodgkin's lymphoma?

Most commonly B cells.

45

What are the B symptoms of lymphoma?

Weight loss
Night sweats
Fever

46

Apart from the B symptoms, what are the other classic symptoms of lymphoma?

Lymphadenopathy
Loss of apetite
Fatigue
Respiratory distress
Itching
Hepatosplenomegaly
Symptoms of bone marrow failure

47

What is the definitive method of diagnosis for lymphoma?

Lymph node biopsy

48

What tests might be carried out on the lymph node biopsy?

Immunophenotyping
Flow cytometry
FISH (fluorescence in situ hybridisation)

49

What is the system used for staging lymphomas?

Ann-Arbor staging system

50

What does stage I mean in the Ann-Arbor staging system of lymphomas?

The cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.

51

What does stage II mean in the Ann-Arbor staging system of lymphomas?

The cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.

52

What does stage III mean in the Ann-Arbor staging system of lymphomas?

The cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.

53

What does stage IV mean in the Ann-Arbor staging system of lymphomas?

Diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

54

What does the A or B mean in the staging of lymphoma?

Absence or presence of B symptoms

55

What does the S mean in the staging of lymphoma?

Splenic involvement

56

What does the E mean in the staging of lymphoma?

Disease is "extranodal" (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.

57

What stage would you assign to a lymphoma where two affected lymph nodes are found both above the diaphragm in someone experiencing night sweats?

Stage IIB

58

What stage would you assign to a lymphoma where two lymph nodes above the diaphragm are found to be affected as well as the spleen in someone experiencing frequent fevers?

Stage IIIB S

59

What grade of lymphoma are most successfully treated?

High grade

60

What is the initial approach to the treatment of low-grade lymphomas?

Wait and watch

61

What is an alternative approach to the wait and watch strategy in someone with follicular lymphoma?

Rituximab

62

What is the approach for someone diagnosed with high-grade lymphoma?

Aggressive chemotherapy

63

What is the chemotherapy regimen often used in the treatment of high-grade lymphoma?

CHOP
Cyclophosphamide
Hydroxydaunorubicin (or Adriamycin)
Oncovin (vincristine)
Prednisolone

Rituximab can be added to make R-CHOP

64

How is early staged Hodgkin's lymphoma treated?

Often with radiotherapy alone as long as it can be localised

65

What is the chemotherapy regimen used in more advanced Hodgkin's lymphoma treated?

ABVD
Adriamycin (Hydroxydaunorubicin in the CHOP regime)
Bleomycin
Vinblastine
Dacarbazine

66

After relapse of high-grade lymphoma, what is the treatment of choice?

High-dose chemotherapy followed by autologous stem cell transplantation

67

What is the peak age for Hodgkin's lymphoma?

15-35