Flashcards in Lymphoma Deck (28)
What is the classic histologic halmark of Hodgkin disease?
Hodgkin lymphoma is defined by the presence of Reed-Sternberg cells, which are multinucleated large cells ("owl's eyes") that divide rapidly and live longer than normal cells. *** Image 24-25
What are the three subtypes of non-Hodgkin lymphoma?
Burkitt lymphoma, lymphoblastic lymphoma, and large cell lymphoma.
What (4) features, if present in conjunction with lymphadenopathy, would be worrisome for the presence of lymphoma?
Systemic symptoms (fever, night sweats, weight loss, etc.); fixed, nontender nodes; supraclavicular nodes; and lymph nodes > 2cm with no response to a 2 week course of antibiotics.
How is lymphoma diagnosed?
Biopsy of the worrisome lymph node or mass.
Within what age range is the incidence of Hodgkin lymphoma highest?
The highest incidence is seen in adolescents between 15 and 19 years of age.
T/F: Hodgkin disease is mostly of B cell lineage.
True. Although T-cell lineage is occasionally noted.
What is the most common presentation for Hodgkin disease?
The most common presentation for Hodgkin lymphoma is asymptomatic lymphadenopathy, which often involves the cervical or supraclavicular region.
What are "B" symptoms in Hodgkin disease? What does their presence usually indicate?
Fever, drenching night sweats, and unexplained weight loss. The presence of B symptoms usually indicates a more advanced disease and a worse prognosis.
What infection is common in patients with Hodgkin lymphoma, due to their impaired cellular immunity?
What does ingestion of alcohol cause in a patient with Hodgkin disease?
It can cause alcohol-induced pain localized to areas of disease involvement (bones, lymph nodes, etc.).
How do you definitively diagnose Hodgkin disease?
Excisional biopsy of an accessable lymph node.
T/F: A staging laparotomy is routinely performed in patients with Hodgkin disease.
False. Staging includes several laboratory and imaging studies, but does not include laparotomy.
In general, how are patients treated for Hodgkin disease?
The combination of radiation and chemotherapy was found to improve treatment outcomes in patients with Hodgkin lymphoma, compared with radiation alone.
What are the two multi-agent chemotherapy regimens used to treat Hodgkin lymphoma?
MOPP (nitrogen Mustard, vincristine (i.e. Oncovin), Procarbazine, and Prednisone) and ABVD (doxorubicin (Adriamycin), Bleomycin, Vinblastine, and Dacarbazapine).
What are the (2) treatment-related risks of MOPP chemotherapy in patients with Hodgkin lymphoma?
AML and infertility.
What are the (2) treatment-related risks of ABVD chemotherapy in patients with Hodgkin lymphoma?
Dose-dependent side effects of cardiomyopathy (doxorubicin) and pulmonary toxicity (bleomycin).
What is the most common type of lymphoma in pediatrics?
Non-Hodgkin lymphoma. NHL accounts for 60% of pediatric lymphomas, with Hodgkin making up the other 40%.
What is the male:female ratio for non-Hodgkin lymphoma?
Males outnumber females 3:1.
What four conditions have a high rate of developing non-Hodgkin lymphoma?
Ataxia-telangiectasia, Wiskott-Aldrich syndrome, HIV, and other immunosuppressive diseases.
What is the most common form of non-Hodgkin lymphoma in pediatrics in the U.S.?
The sporadic form of Burkitt lymphoma, which accounts for ~50% of pediatric non-Hodgkin lymphomas.
In which anatomic location do most cases of Burkitt lymphoma originate in US patients?
90% of Burkitt-type lymphomas originate from relatively mature B-cells in Peyer patches within the GI tract, most commonly at the ileocecal junction.
How do most children with Burkitt lymphoma present?
A majority of patients present with an abdominal mass or pain with nausea and vomiting.
What is a common complication of Burkitt lymphoma?
Burkitt lymphoma is the fastest-growing malignant tumor (it can double in size in 2-3 days). Consequently, tumor lysis syndrome is common.
What sites are commonly affected in lymphoblastic lymphoma?
Anterior mediastinum, cervical/supraclavicular/axillary nodes, and involvement of the liver, spleen, and kidneys.
How does the lymphadenopathy of large cell non-Hodgkin lymphoma differ from that of the other forms of lymphoma?
The lymphadenopathy with large cell NHL is usually tender, which separates it from the other lymphomas.
Describe the staging system for non-Hodgkin Lymphoma.
Staging is generally based on the volume of the tumor. Stage I: single tumor or anatomic node, excepting the mediastinum or abdomen. Stage II: ≥ 2 nodal areas on the same side of the diaphragm, 2 extranodal tumors on the same side of the diaphragm, or a resectable primary GI tumor. Stage III: involvement of both sides of the diaphragm, all mediastinal or intrathoracic tumors, all unresectable abdominal disease, and all paraspinal or epidural tumors. Stage IV: any CNS or bone marrow involvement.
T/F: Radiation therapy is a major component of most therapy for non-Hodgkin lymphoma.
False. Radiation therapy is usually limited to CNS disease or emergency situations (airway obstruction).