Non-Hodgkin's Lymphoma Flashcards
(26 cards)
What is the difference between HL and Non-HL
HL in limited to the lymphatic system
Non-HL includes both Lymphatic and immune systems but still 80% are in Lymph nodes
Whatre the 2 main RF of Non-HL?
Infections (viral-mostly or bacterial)
Immunosuppression
What infections (both viral and bacterial) are RF/causative agents for Non-HL
Recall: HL is EBV (only classical)
H.Pylori is the only bacterial RF for Non-HL, what lymphoma is it associated with?
EBV is a common pathogen that can cause both HL and Non-HL. For Non-HL, what is the associated lymphoma?
Are these high or low grade
MALToma (gastric lymphoma) - Low grade - B cell
Burkitt’s lymphoma - High grade - B cell
This is a very distinct rash. What pathogen causes this?
What lymphoma is associated with this pathogen?
Is it low or high grade? B or T cell?
What other diseases does this pathogen cause?
Primary effusion lymphoma - High grade - B cell
Kaposi’s sarcoma - vascular tumour
Castleman’s disease - lymphoproliferative disorder
HIV is a nasty disease, so bad that it causes 2 types of lymphomas What are they and are they high or low grade? Are they B or T cell?
What specific HIV is a RF for lymphoma? 1 or 2?
HIV 1
High grade B-cell lymphoma
Primary CNS lymphoma - High grade
both B cells
Hepatitis C is one of the chronic infections leading to cirrhosis but luckily, it does not cause a high grade lymphoma. What lymphoma is it a/w and is it B or T cell?
Give 1 other low grade
Marginal zone Lymphoma B cell
Mantle cell lymphoma
What are the 2 most common B cell Non-HLs?
What is the grade and morphology? (only for most common)
What is the genetic abnormality associated with this?
What is the oncogene a/w this
It is characterized by large mass localised lesions
HTLV-1 is an infection ive never heard of but it is one that causes lymphoma. The nice thing about it is that it is the only one with a T in its name and also the only one that causes a T-cell lymphoma. What is the T-cell lymphoma that it causes?
What is a T cell lymphoma caused by Coeliac disease?
State if they are high or low grade
Now youre set for T-cell Non-HL. There is a cutaneous one => if lymphoma + skin stuff it is cutaneous lymphoma of T helper cells - This one is high grade
HTLV-1 It causes Adult-T cell Lymphoma
Coeliac disease - Enteropathy associated intestinal T-cell lymphoma
both are high grade
In order to give differentials, you need to know some types of non-hodgkin’s lymphoma. I hate to do this but you gotta figure it out. Here, let me help you. So the main RF is infections, and each infection has its own tumour. Connect the infections to the tumours.
The incidence of Non-HL has doubled in the last 50 years with median age of diagnosis being 10 years increasing with age.
In adults:
What is the most common type (B cell or T cell)
Most common grade (Low vs high)
B cell (80%) > T cell (20%) (Hodgkin’s only B cell, 100%)
Typically low grade as they are clinically indolent (in paeds it is high grade and clinically aggressive)
How many cells are involved in HL? How about Non-HL?
I mean the number of different cells involved and not the literal number of cells in total.
single cell in HL
Numerous in Non-HL
What is meant by leukemic phase of non-HL?
The leukemic phase in non-HL means that malignant lymphocytes are present and detectable in the blood which is not a feature of HL.
Anyways if it is detectable in the blood,
State if each of the following is more likely to indicate HL or Non-HL
Contiguous spread
Large number of tumour cells
CD45
CD15
Involvement of Waldeyer’s Ring
Involvement of peripheral blood
Cutaneous involvement
Extranodal involvement
All Non-HL except CD 15, CD 30 which are Classical HL (nodular HL is CD 20 and 45)
Compare HL to Non-HL
Discuss the following if stuck:
Basic pathophysiology and growth pattern
Mode of Spread
Peripheral blood involvement
Number of Tumour cells
Both involve lymphocytes
In HL a single cell proliferates uncontrollably but in Non-HL, they are multi-centric and diffuse in their growth pattern
Contiguous spread in HL but not in Non-HL
In contrast to HL, Non-HL disseminates early and may involve the peripheral blood like leukaemia. This is called the leukemic phase
Can lymphomas affect the BM?
Yes, however they must start in the lymphatic system and spread to the BM as opposed to leukemias which start in the BM and spread elsewhere
The rate of growth (low vs high grade) dictates treatment and prognosis. What % of low grade non-HL transform into high grade?
30%
Are B symptoms common in Non-HL?
They are common in high grade non-HL (e.g. in paeds) => it is not a common finding in adults.
Important note:
B symptoms is considered a poor prognostic factor only for HL and not Non-HL. A way to remember that is that the classification in Non-HL does not include B symptoms like the Ann Arbor classification of HL
What are the symptoms of Non-HL?
What are the CDs (target antigen) in non-HL for
B cells
T cells
Myeloid (extra)
B-cell = CD19,20 +/-45 (in Classical HL it was CD 15 and 30 and in NHL it was CD20 and 45)
T-cell = CD2,3,7
Myeloid = CD 13,14,33
Non-HL involves Triple assessment of the affected tissue. What tests does this entail?
Microscopic assessment
Immuno-phenotype assessment
FISH Genetic Testing
Microscopic assessment is part of the Triple assessment for Non-HL.
What does it entail, and what are you looking for? (3)
Whole LN excisional biopsy (not FNA!!!) for histology assessing grade and pattern (follicular vs diffuse)
+ Blood film from peripheral blood to assess for atypical cells
+ BM biopsy for assessing invasion
Immuno-phenotype assessment is part of the Triple assessment for Non-HL. What does it entail and what are you looking for? (2)
Immunohistochemistry to determine if B or T cell lineage
B-cell = CD19,20 +/-45 (in Classical HL it was CD 15 and 30 and in NHL it was CD20 and 45)
T-cell = CD2,3,7
Myeloid = CD 13,14,33
Flow cytology allows quantification of cells and subtypes
Just for understanding sake, it is also taken from blood here. In leukemia it was from BM in acute and blood in chronic
Go through the diagnostic investigations for Non-HL
1) Microscopic assessment
Whole LN excisional biopsy (not FNA!!!) for histology assessing grade and pattern (follicular vs diffuse)
+ Blood film from peripheral blood to assess for atypical cells
+ BM biopsy for assessing invasion
Immuno-phenotype assessment
Immunohistochemistry to determine if B or T cell lineage
B-cell = CD19,20 +/-45 (in Classical HL it was CD 15 and 30 and in NHL it was CD20 and 45)
T-cell = CD2,3,7
Myeloid = CD 13,14,33
Flow cytology allows quantification of cells and subtypes
FISH Genetic Testing
