Lymphomas

Question 1

what is a lymphoma

Answer 1

malignancy of lymphoid system originating from lymphocytes

Question 2

2 classifications of lymphoma

Answer 2

Hodgkin’s

Non-Hodgkin’s

Question 3

Hodgkin’s classified by

Answer 3

reed sternberg cell presence

Question 4

what do Reed sternberg cells look like

Answer 4

bi-lobed nucleus -owl eyes

Question 5

majority of lymphomas diagnosed by

Answer 5

incidental finding of raised WBCs

Question 6

B symptoms of lymphoma

Answer 6

night sweats
weight loss
fever

Question 7

most common symptomatic presentation of lymphoma

Answer 7

lymphadenopathy

Question 8

other symptoms of lymphoma

Answer 8

splenomegaly
pruritis
neurological 2nd to SC compression
coagulopathy and marrow failure

Question 9

investigations for lymphoma (5)

Answer 9

PET scan 
biopsy of node 
CT scan 
FBC 
marrow biopsy

Question 10

PET scan done by

Answer 10

injection with 18-fluorodeoxyglucose (FDG) which highlights areas of high metabolic activity

Question 11

90% of lymphomas =

Answer 11

non-Hodgkins

Question 12

Hodgkin’s lymphoma associated with which virus

Answer 12

infection with Ebstein Barr (mononucleosis)

Question 13

most common clinical presentation of Hodgkin’s

Answer 13

cervical lymphadenopathy

Question 14

what is nodular lymphocyte predominant HL characterised by

Answer 14

Reed-sternberg cell variant - popcorn cells

Question 15

classical HL divided into (4)

Answer 15

nodular sclerosing
lymphocyte rich
mixed cellularity
lymphocyte depleted

Question 16

worst prognosis of classical HL =

Answer 16

lymphocyte depleted

Question 17

Ann-arbor stage 1 HL=

Answer 17

single lymph node

Question 18

Ann-arbor stage 2 HL

Answer 18

2 or more same side of diaphragm

Question 19

Ann-arbor stage 3 HL

Answer 19

nodes both side of diaphragm

Question 20

Ann-arbor stage 4

Answer 20

spread beyond nodes

Question 21

factors making a worse prognosis in HL

Answer 21

elderly
stage 4
Hb <10.5
Lymphocyte count <8% 
male 
WCC >15,000

Question 22

treatment of HL aimed at cure?

Answer 22

yes even advanced very curable

Question 23

stage 1 HL treatment

Answer 23

surveillance

Question 24

chemotherapy for HL

Answer 24

Doxorubicin
Bleomycin
vinblastine
dacarbazine

Question 25

inherited conditions associated with non HL (2)

Answer 25

Wiskott aldrich syndrome | Ataxia telangiectasia

Question 26

infections linked to non-HL

Answer 26

H.pylori | EBV

Question 27

immunosuppressant drugs used in HIV and solid organ transplant can predispose to

Answer 27

non-HL

Question 28

pathogenesis of non-HL

Answer 28

malignant clonal expansion of lymphocytes at different stages of development

Question 29

where do lymphomas develop

Answer 29

nodes | or extra nodal (tissues)

Question 30

lymphoma in GI tract causes

Answer 30

obstruction

Question 31

lymphoma in marrow causes

Answer 31

pancytopenia

Question 32

most common presentation of non-HL

Answer 32

painless lymphadenopathy

Question 33

what type of non-Hl is the most rapidly proliferating tumour

Answer 33

Burkitt's lymphoma

Question 34

commonest childhood malignancy=

Answer 34

Burkitts lymphoma

Question 35

what is Burkitts lymphoma

Answer 35

a high grade B-cell neoplasm -highly aggressive

Question 36

gene translocation in Burkitts

Answer 36

t8:14 on Cmyc gene

Question 37

3 types of Burkitts lymphoma

Answer 37

endemic sporadic AIDs related

Question 38

what is endemic Burkitts lymphoma

Answer 38

occurs in equatorial African, EBV associated, malaria distribution, rapidly growing jaw tumour

Question 39

sporadic burkitts lymphoma present mainly with

Answer 39

marrow involvement or abdo mass (ileo-caecal tumours)

Question 40

diagnosis on biopsy of Burkitts

Answer 40

starry sky appearance due to scattered macrophages amongst dark lymphocytes

Question 41

biggest risk of treatment in Burkitts

Answer 41

tumour lysis syndrome give allopurinol

Question 42

treatment for Burkitts lymphoma

Answer 42

intensive cyclical combination chemo -incl rituximab

Question 43

cure rate for Burkitts

Answer 43

generally good

Question 44

second commonest lymphoma=

Answer 44

follicular

Question 45

when does follicular lymphoma tend to occur

Answer 45

middle- late in life

Question 46

growth rate of follicular lymphoma

Answer 46

slow growing (indolent)

Question 47

clinical presentation of follicular lymphoma

Answer 47

- painless lymphadenopathy at multiple sites | - some B symptoms

Question 48

biopsy diagnosis of follicular lymphoma

Answer 48

large plasmablasts/ immunoblasts infiltrating node

Question 49

management of follicular lymphoma

Answer 49

generally incurable -relapsing and remitting | R-CHOP

Question 50

R-CHOP=

Answer 50

``` Rituximab Cyclophosphamide doxorubicin vinctristine (oncovin) prednisolone ```

Question 51

commonest lymphoma worldwide=

Answer 51

diffuse large B cell lymphoma

Question 52

growth of diffuse large B-cell lymphoma =

Answer 52

aggressive

Question 53

clinical presentation of diffuse large B-cell lymphoma

Answer 53

painless lymphadenopathies B symptoms intra-abdo disease sometimes primary mediastinal symptoms mimicking HL

Question 54

management of diffuse large B-cell lymphoma

Answer 54

R-CHOP | -without intervention death in months

Question 55

bad complication of diffuse B-cell lymphoma

Answer 55

CNS involvement -terrible prognosis