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Lymphomas Flashcards

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1
Q

What are lymphomas

A

Neoplasms of lymphoid origin, typically causing lymphadenopathy

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2
Q

According to WHO in 2001, lymphomas are classified into

A

Hodgkin’s and Non hodgkin’s

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3
Q

Non hodgkins lymphoma are further divided into

A

B-cell neoplasms :precursor and mature
T cell and Nk neoplasms: p and m

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4
Q

Risk factors for NHL

A

FI³C
Family history of lymphoma
Ionising radiation
Infectious agents
Immunosuppression
Connective tissue disease

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5
Q

Clinical manifestations of lymphoma

A

Be very SLICK when talking about lymphoma: V-SLC
VARIABLE
Could be symptomatic or asymptomatic
Time course- could evolve over weeks, months,even years.
SYSTEMIC MANIFESTATION
Constitutional symptoms like fever, night sweats,weight loss
LOCALISED MANIFESTATION
lymphadenopathy,splenomegaly most common
Any tissue can be infiltrated
Other COMPLICATIONS
Immune hemolysis
Bm failure
Cns infiltration pleural/pericardial effusions

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6
Q

For lymphomas, diagnosis MUST be biopsy proven before initiating therapy and must be Confirmed by Immunopenotyping. T/F

A

T

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7
Q

Gold standard for lymphoma diagnosis

A

Excisional/incisional biopsy

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8
Q

What are the trephine methods that can be used for lymphoma diagnosis

A

Core needle vs open vs fine needle aspiration biopsy
Necessary because enough tissue is needed to assess cells and architecture

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9
Q

Staging of hodgkins lymphoma

A

?

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10
Q

The three common lymphomas include, which is the commonest

A

Follicular lymphoma
Diffuse large b cell lymphoma -commonest
Hodgkin’s lymphoma

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11
Q

What are the indolent lymphomas

A

Slowly follow the margin
Small lymphocytic lymphoma
Lymphoplasmacytic and Waldenstrom macroglobulinemia
Follicular lymphoma
Marginal zone Bcell malt and nodal lymphoma

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12
Q

Most common indolent lynphoma

A

Follicular lymphomas

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13
Q

Hodgkin’s lymphoma was discovered by ?

A

Thomas Hodgkins

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14
Q

Cell of origin of hodgkin’s lymphoma

A

Germinal center B cells

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15
Q

Remember the REAL classification of hodgkins lymphoma

A

Classical and non classical

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16
Q

In hodgkin’s lymphoma, most cells are neoplastic cells rather than polyclonal reactive lymphoid cells . T/f

A

F…most are polyclonal reactive lymphoid cells

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17
Q

Epidemiology of hodgkins lymphoma

A

Less frequent than NHL
Male predilection
Peak incidence at 3rd decade of life

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18
Q

Associated or etiology factors of hodgkin’s lymphoma

A

Shope is the cause of hodgkin’s lymphoma
S- small family size
H-higher socioeconomic status
O-others like hiv, herbicides,occupation
P-possible genetic predisposition
E-EBV infection

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19
Q

The bimodal age distribution of hodgkins lymphoma is between

A

20-30yrs for young adults
>50 yrs for elderly
However may occur at any age

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20
Q

Describe the lymphadenopathy in hodgkin’s lymphoma

A

CAPENERs SIGN
C-Cervical region
A-Asymmetrical, discreete
P-Painless, non tender
E-Elastic character on palpation
N-Non adherent to skin
E-fluctuant in size
R-Rare extranodal involvement
S- Spleen and liver enlargement

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21
Q

Investigations for hodgkins lymphoma

Study These Flashcards
A

Fbc- anemia (normochromic, normocytic) , neutrophils, eosinophilia, lymphopenia
Raised Esr
Lft and renal fxn test before therapy
BMA
Increased urate, calcium

22
Q

On doing chest x-ray, a mediastinal mass was found. This is typically seen in what lymphoma

23
Q

Clinical manifestations of hodgkins lymphoma

Study These Flashcards
A

Lymphadenopathy
Contiguous spread
Rare extra nodal involvement.
B symptoms
3Ps: pallor
Pruritus
Pain at the site of disease after drinking alcohol

24
Q

What are the B symptoms

Study These Flashcards
A

Drenching night sweats
Sustained fever>38 degrees
Weight loss>10% of body weight in 6 months

25
The fever in hodgkins lymphoma is sometimes referred to as
Cyclical. Pel Ebstein fever
26
Pel Ebstein fever is a feature of
Hodgkin's lymphoma
27
Most suitable treatment regimen for hodgkin's lymphoma
A-adreomycin B-bleomycin V-Vinblastin D-dacarbazine Others include M-nitogen mustard O-oncoven P-prednisone P-Procarbazine Copp
28
The ABVD regimen poses a higher risk of developing infertility than MOPP and thus counselling should be included in therapy. T/f
F...Mopp rather has a higher risk
29
Complications of treatment
Infertility Premature menopause Secondary Malignancy like skin aml breast etc Cardiac disease
30
Hodgkins lymphoma is more common than non hodgkin's. T/f
F
31
Epidemiology of NHL
Median age-65-70yrs M>F B-cell 70%..T cell 30%
32
When On Snapchat, Remember the clinical features of NHL
Widely disseminated at presentation Hepatosplenomegaly. Extranodal involvement Nodal involvement On ...most common Snap..Systemic symptoms Chat ....compression syndrome
33
Extranodal involvement of Nhl
Intestinal lymphoma-abd pain, dysphagia, anemia Cns- headache, cranial nerve palsy, sc compression Lung, skin, testes,thyroid Bone marrow, low grade
34
Systemic symptoms of Nhl
Sweating Weight loss Pruritus Metabolic complications like hyperyricemia, calcemia,renal failure
35
Compression syndrome In Nhl
Gut obstruction Ascites Svc obstruction Spinal cord compression
36
Investigations for Nhl
Similar to HD Bma +aspiration Immunophenotyping B cell antigens(CD19, 20,22) T cell antigens(CD 2, 3,5,7) Hiv
37
Systems of classification of NHL
REAL Clinical/working formulation; Low grade? Remember Intermediate High grade?
38
Etiology of Nhl
Cannot be attributed to a single cause Chromosomal translocation t(14,18) Infections like EBV,HIV,HTLV,HHV8 Bacteria like H.pylori in gastric lymphoma Immunodeficiency
39
Management of Nhl
Asymptomatic, no treatment Radiotherapy for localised disease(stage 1) Chemotherapy: Chlorambucil is the mainstay, however repeated relapses median survival 6-10yrs Fludarabine, 2 cda newer Rituximab Sct/Bmt
40
Treatment regimen for high/intermediate grade Nhl
R-CHOP R Rituximab C cyclophosphamide H doxorubicin hydrochloride O-oncovin/vincristine P prednisone
41
Other chemotherapy combos for nhl
Rice Coap. Epoch
42
Distribution of nodes for nhl is centripetal whereas HD is centrifugal t/f
F...HD is centripetal
43
Differences between hl and nhl
Look at picture
44
Nhl illustrates the concept of lymphoma/leukemia .t/f
True
45
Two important things to know about Burkitts
The neoplastic cells are B lymphoblasts with translocations of c-myc oncogene in chromosome 8q Characteristic starry sky appearance
46
The two types of burkitts are? What are their differences
Endemic and non endemic(sporadic) Differences..5
47
The doubling time of burkitts lymphoma is about
26hrs
48
Clinical features of burkitts lymphoma
Usually involves greater than 1 site at presentation Commonly mandible,maxilla, abdomen and pelvis, gonads Destruction of jaw bones- loosening of teeth Dental anarchy and loss of dental lamina dura
49
The most frequent Cytogenetics translocation in burkitts
t(8,14) Others include t(2,8)..t(8,22)
50
Pathogenesis of Burkitts lymphoma
Cmyc oncogene is translocated on a b lymphocyte as a chance event, probably a mutation Ebv infects ad immortalises the b cells Malaria stimulates the immortalised b cells o proliferate and produce antibodies. Leading to uncontrolled proliferation of b cell clone -burkitts lymphoma
51
Treatment of burkitts lymphoma
Prevent and treat tumor lysis effects Endemic burkitts- Coap Cyclophosphamide Oncovin Cytosine arabinosie Prednisone With intrathecal methotrexate or cytosar

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