Non-Hodgkin's Lymphoma

Question 1

What is Non-Hodgkin Lymphoma?

Answer 1

A group of lymphomas

Question 2

What are some examples of Non-Hodgkin Lymphomas?

Answer 2

Burkitt lymphoma
MALT lymphoma
Diffuse large B cell lymphoma

Question 3

What is Burkitt’s lymphoma?

Answer 3

High grade B-cell neoplasm

Question 4

What are the 2 major forms of Burkitt’s lymphoma?

Answer 4

Endemic

Sporadic

Question 5

What does the endemic form of Burkitt’s lymphoma involve?

Answer 5

Maxilla or mandible

Question 6

What does the sporadic form of Burkitt’s lymphoma involve?

Answer 6

Abdominal tumours

Question 7

Who is Burkitt’s lymphoma more common in?

Answer 7

People with HIV

Question 8

Which gene is Burkitt’s lymphoma associated with?

Answer 8

C-myc gene translocation, usually t(8:14).

Question 9

Which virus is associated with the development of Burkitt’s lymphoma?

Answer 9

Epstein-Barr virus

Question 10

What would you find on microscopy of someone with Burkitt’s lymphoma?

Answer 10

‘starry sky’ appearance

Question 11

What does the starry sky appearance mean?

Answer 11

Lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells

Question 12

What is the management of Burkitt’s lymphoma?

Answer 12

Chemotherapy

Question 13

How is Hodgkin’s lymphoma differentiated from Non-Hodgkin’s lymphoma?

Answer 13

Via lymph node biopsy

Present similarly

Question 14

What are other differences between Hodgkin’s and non-Hodgkin’s lymphoma?

Answer 14

Lymphadenopathy in Hodgkin’s lymphoma can experience alcohol-induced pain in the node

‘B’ symptoms typically occur earlier in Hodgkin’s lymphoma

Extra-nodal disease is much more common in non-Hodgkin’s lymphoma

Question 15

What are some examples of extra nodal disease that can occur in Non-Hodgkin’s lymphoma?

Answer 15

Gastric- dyspepsia, dysphagia, weight loss, abdominal pain
Bone marrow- pancytopenia, bone pain
Central nervous system-nerve palsies

Question 16

What is MALT lymphoma?

Answer 16

It affects the mucosa-associated lymphoid tissue, usually around the stomach

It is associated with H. pylori infection.

Question 17

What is Diffuse large B-cell lymphoma?

Answer 17

Presents as rapidly growing painless mass in patients over 65 years.

Question 18

What is the management of non-Hodgkin’s lymphoma dependent on?

Answer 18

The specific diagnosis

Question 19

What should all patients with non-Hodgkin’s lymphoma be given?

Answer 19

Flu/pneumococcal vaccines

Question 20

What is the main presentation on non-Hodgkin’s lymphoma?

Answer 20

Painless lymphadenopathy-non-tender, rubbery, asymmetrical

Question 21

What constitutional B symptoms can non-Hodgkin’s lymphoma present with?

Answer 21

Fever
Weight loss (>10% in 6 months)
Night sweats

Question 22

What extra-nodal symptoms can someone with non-Hodgkin’s lymphoma present with?

Answer 22

Gastric-dyspepsia, dysphagia, weight loss, abdominal pain
Bone marrow- pancytopenia, bone pain
Central nervous system- nerve palsies

Question 23

What is the classification for staging non-Hodgkin’s lymphoma?

Answer 23

Ann Arbor system

Question 24

What is stage 1 of the Ann Arbor system?

Answer 24

One node affected?

Question 25

What is stage 2 of the Ann Arbor system?

Answer 25

More than one node affected on the same side of the diaphragm

Question 26

What is stage 3 of the Ann Arbor system?

Answer 26

Nodes affected on both sides of the diaphragm

Question 27

What is stage 4 of the Ann Arbor system?

Answer 27

Extra-nodal involvement e.g. Spleen, bone marrow or CNS

Question 28

What is the staging of non-Hodgkin's lymphoma combines with?

Answer 28

A or B- to indicate the presence of B symptoms

Question 29

Does low grade or high grade have a better prognosis?

Answer 29

Low grade lymphoma

Question 30

Does low grade or high grade lymphoma have a better cure rate?

Answer 30

High grade lymphoma

Question 31

What are possible signs of lymphoma?

Answer 31

Signs of weight loss Lymphadenopathy (typically in the cervical, axillary or inguinal region) Palpable abdominal mass - hepatomegaly, splenomegaly, lymph nodes

Question 32

Why would you do a biopsy?

Answer 32

To differentiate between Hodgkin's lymphoma and non-Hodgkin's lymphoma

Question 33

Why would you test for HIV?

Answer 33

Its associated with non-Hodgkin's lymphoma (Burkitt's lymphoma)

Question 34

What might you do to asses stage of lymphoma?

Answer 34

CT chest, abdomen and pelvis

Question 35

What can ESR be useful for?

Answer 35

Prognosis indicator

Question 36

What are some possible complications of lymphoma?

Answer 36

Bone marrow infiltration Superior vena cava obstruction Metastasis Spinal cord compression

Question 37

What can bone marrow infiltration result in?

Answer 37

Anaemia Neutropenia Thrombocytopenia