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Path > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What is the clinical difference between Hodgekins and non-Hodgekins lymphoma?

A

HL: painful after alcohol
NHL: not painful after alcohol

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2
Q

What are the types of HL?

A
  1. Nodular sclerosing HL
  2. Mixed cellularity HL
  3. Lymphocyte rich HL
  4. Lymphocyte depleated HL

(5. Nodular lymphocyte-predominant HL)

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3
Q

What is the microscopy of nodular sclerosing HL?

A
  • LARGE Reed Sternberg cells
  • Nodular fibrosis
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4
Q

What is the microscopy of lymphocyte rich HL?

A
  • Scattered Reed Sternberg cells
  • Lots of lymphocytes
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5
Q

What is the microscopy of lyphocyte depleated HL?

A
  • Reed sternberg cells
  • Paucity of lymphocytes
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6
Q

What is the microscopy of mixed cellularity HL?

A
  • Reed Sternberg cells
  • Eosinophils, plasma cells, histiocytes etc
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7
Q

What is the microscopy of nodular lymphocyte-predominant HL?

A
  • NO REED STERNBERG
  • Popcorn cells (histiocytes with nuclei resembling exploded popcorn kernels)

Non-classical with lymphocytes and histiocytes = NLPHL

Treated in a different way

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8
Q

What are the investigations for HL?

A
  • CT/PET​
  • Tissue diagnosis: LN/BM biopsy (cells stain with CD15 & CD30)​
  • Reed-Sternberg cell (bi-nucleate/multinucleate (‘owl eyed’) cell on background of lymphocytes & reactive cells)
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9
Q

What is the treatment for HL?

A

Combination chemo (used in most cases)​
- ABVD: Adriamycin, bleomycin, vinblastine and dacarbazine​
- 2-4 cycles in stage 1/2, 6 cycles in stage ¾​
- Usually have interim PET (guides rx)

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10
Q

What are the NHLs?

A

B cell:
- Follicular
- Marginal zone
- Diffuse large B cell lymphoma
- Mantle cell lymphoma
- Burkitt’s lymphoma

T cell:
- Adult T-cell leukaemia/ lymphoma

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11
Q

What is the histo of follicular lymphoma?

A
  • Follicular pattern
  • Nodular appearance
  • Centroblasts LN biopsy
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12
Q

What is the mutation in follicular NHL?

A

T(14;18) fusion of BCL2 gene

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13
Q

Management of follicular NHL?

A

Watchful waiting unless high burden of disease

Rituximab/ obinutuzumab + chemo

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14
Q

Prognosis of follicular NHL?

A

Mostly incurable; median survival 12-15 years

Indolent (slow growing)

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15
Q

What is the most common high grade NHL?

A

Diffuse Large B-Cell Lymphoma

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16
Q

Presentation DLBCL?

A
  • Middle-aged/ elderly
  • Aggressive
  • Associated with EBV

(Can be transformed from low-grade lymphoma like follicular)

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17
Q

Histo of DLBCL?

A

Sheets of large lymphoid cells

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18
Q

Management of DLBCL?

A

Rituximab-CHOP

C: cyclophosphamide
H: doxorubicin hydrochloride
O: oncovin (vincristine sulfate)
P: prednisolone

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19
Q

Relapse of DLBCL?

A

Auto-SCT/CAR-T

(Chimeric antigen receptor T-cell therapy)

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20
Q

Features of high grade NHLs?

A
  • Lymphadenopathy & B sx
  • May have BM involvement
  • TLS risk with treatment
21
Q

Clinical presentation of mantle cell lymphoma?

A
  • Middle aged
  • M>F
  • Aggressive (if disseminated at presentation, median survival 3-5yrs)

High grade lymphoma

22
Q

Mutation mantle cell?

A

T(11;14) Cyclin D1 dysregulation

23
Q

Histo mantle cell lymphoma?

A

Angular/ clefted nuclei

24
Q

Management mantle cell?

A

R-CHOP & high dose cytarabine

25
Q

Relapse mantle cell?

A

Auto-SCT

26
Q

Presentation Burkitt’s lymphoma?

A

Endemic
- Most common malignancy equatorial Africa
- EBV associated
- Jaw involvement
- Abdo masses

Sporadic
- Outside Africa
- EBV associated

Immunodeficiency
- NON-EBV ASSOCIATED
- HIV/post-transplant

27
Q

Burkitt’s histology?

A

Starry sky appearance

28
Q

Mutation in Burkitt’s?

A

T(8;14) Cellular myelocytomatosis oncogene (c-myc) overexpression

29
Q

Burkitt’s management?

A

Chemo (rituximab) & secondary CNS prophylaxis

30
Q

What are the MALT lymphomas?

A

Marginal zone NHL
- H.pylori (gastric MALT)
- Sjorgren’s (parotid lymphoma)

31
Q

Management Marginal zone NHLs?

A

Remove stimulus eg. H.pylori triple therapy
Chemo

32
Q

How do cutaneous T cell lymphomas present (NHL)?

A

Weird rashes

33
Q

Features of adult t-cell leukaemia (NHL)?

A
  • Far east (Carribbean & Japanese)
  • Associated with HTLV-1
  • Aggressive
34
Q

Histology of adult t-cell lymphoma/leukaemia?

A

Flower cells blood film

35
Q

Features of anaplastic large cell leukaemia?

A
  • Children/ young adults
  • Aggressive
36
Q

Gene mutation anaplastic large cell lymphoma?

A

T(2;5)
Alk-1 protein expression

37
Q

Features of peripheral T cell lymphoma?

A
  • Middle aged and elderly
  • Aggressive
38
Q

Histology of peripheral T cell lymphoma?

A

Large T cells

39
Q

Features of enteropathy associated t cell lymphoma?

A

Long standing coeliac disease

40
Q

Features of cutaneous t cell lymphoma?

A

Associated with mycosis fungoides

41
Q

Where are lymph nodes in HL usually inflammed?

A

Mediastinum

(+ anywhere else)

42
Q

What is the prognosis of HL?

A

Mostly curable

43
Q

What causes the starry sky appearance in Burkitt’s lymphoma?

A

Large numbers of lymphocytes and a significant number of macrophages containing phagocytosed lymphocytes

44
Q

Which lymphoma is most common in >40 year olds?

A

Diffuse large B cell lymphoma

45
Q

Which lymphoma is most common in 15-40 year olds?

A

Hodgkin’s lymphoma

46
Q

Which lymphoma is most common in <15 year olds?

A

Burkitt’s lymphoma

47
Q

What is the term given to describe the transformation of chronic lymphocytic leukaemia into diffuse large B cell lymphoma?

A

Richter’s transformation

48
Q

What medication can be given to reduce the risk of TLS?

A

IV Rasburicase/ allopurinol

49
Q
A

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