NON HODGKINS LYMPHOMA Flashcards by Iseoluwa Ojo

Lymphomas are ______geneous solid tumours of lymphoid tissues and may arise from ___,______,______, or ______ cells lineages.

hetero

B-, T-, non-B/T, or NK-

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Lymphomas

The tumours are more often seen in regions of the body with high concentration of _______: the _______,______,________, and _______; and less frequently, extra nodal tissues of the _____,_____,______,________ and the central nervous system (CNS).

lymphoid tissues

lymph nodes, Waldeyer ring , spleen and bone marrow

skin, bone, lungs, liver

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Waldeyer ring (_____,_______,_________,_____)

Palatine tonsil, , tubal tonsil, lingual tonsil and pharyngeal tonsil

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Lymphomas are the _____ and ______ most frequent cancers in Nigerian males and females, respectively.

second and third

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Lymphoma incidence has increased by 2-13 folds across sub-Saharan African countries since the _____________

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AIDS-related lymphomas are generally very (indolent or aggressive?) , the poor risk HL (mixed cellularity, lymphocyte depleted), the _____ and the ______ , NHL (with predilection for extranodal sites such as the primary CNS lymphoma).

Aggressive

Burkitt

non-Burkitt

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The incidence of all lymphoma variants in all age groups is higher in (males or females ?) than it is in (males or females?) , ratio = 2-3:1

Males

Females

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The WHO Classification
• B-cell neoplasms

__________ neoplasm
_________ neoplasms

Precursor B-cell

Mature B-cell

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The WHO Classification

Mature B-cell neoplasms
•______/_______
•______
• _______ lymphoma
•______ lymphoma
•_______ lymphoma
•___________

CLL/smalllymphocyticlymphoma

PLL

Mantle cell

Follicular

Burkitt’s

Plasmacytoma

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The WHO Classification
• T- and Putative NK- cell neoplasms

______T-cell neoplasm
_______T-cell and ____ cell neoplasms

Precursor

Mature

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The WHO Classification
• T- and Putative NK- cell neoplasms

Precursor T-cell neoplasm
•____________ lymphoma/leukaemia

T-lymphoblastic

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The WHO Classification
• T- and Putative NK- cell neoplasms

Mature T-cell and NK cell neoplasms

•T-cell ____
• T-cellgranularlymphocyticleukaemia
•_________ cell leukaemia
•___________
• Sezary syndrome
•__________ lymphoma/leukaemia
• Primary cutaneous anaplastic large cell lymphoma

PLL

Aggressive NK

Mycosisfungoides

Adult T-cell

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(1) B-cell lineage lymphomas:
__________________________

(2) T-cell lineage lymphomas:
______________________

(3) N/K-cell lymphomas:
__________________________

Burkitt lymphoma
• Hodgkin lymphoma (HL)
• Non-Hodgkin lymphomas (NHL)

• Non-Hodgkin lymphomas (NHL)

Non-Hodgkin lymphomas (NHL)

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HL was found predominantly in children and early adults

T/F

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only 10% of cases of HL occurred after the age of _____ years. The M:F ratio was 1.2:1.

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(Generalized or Localized?) disease and (indolent or aggressive?) lymphomas are rare in children.

Localized

indolent

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Most lymphomas in children are of (indolent or aggressive?) histology that requires ______-like therapy.

Aggressive

ALL

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In sub-Saharan tropical Africa, _____-associated ______ lymphoma,accounts for over ____% of childhood tumours.

EBV; Burkitt

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Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

• Epstein-B Virus (EBV) and endemic ______ lymphoma and _______ lymphomas
• Human herpesvirus-8 (HHV8) and _____ lymphoma;
• Human T-cell lymphotropic virus 1 and __________ leukaemia/lymphoma

Burkitt; Hodgkin

primary effusion

adult T-cell

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Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

• Helicobacter pylori and ___________ lymphoma of the ______.
• Hepatitis-C Virus and _______ lymphoma

mucosa-associated lymphoid tissue (MALT) ; stomach

plasmacytoid

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Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

•__________ and endemic Burkitt lymphoma and Hodgkin lymphomas
• _______________ and primary effusion lymphoma;
•________________ virus 1 and adult T-cell leukaemia/lymphoma;
and

Epstein-B Virus (EBV)

Human herpesvirus-8 (HHV8)

Human T-cell lymphotropic

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Lymphomas resulting from chronic antigenic challenge of the immune system by infections such as:

•___________ and mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach.
•__________ Virus and plasmacytoid lymphoma

Helicobacter pylori

Hepatitis-C

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Investigations of Lymphomas Patients 1

_____________ biopsy: very useful in Burkitt lymphoma; it is best complimented with histochemistry Ki67, BCL6 and BCL2

Fine needle aspiration

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Investigations of Lymphomas Patients 1

• Positive cytology with at least 90% _____ and negative _____ staining reaction is confirmatory of BKT (Ajibade, 2015)

Study These Flashcards

Ki67; BCL2

Investigations of Lymphomas Patients • _______ of _________________ biopsy (most reliable diagnostic approach for all lymphomas)

Histology of whole tumour tissue

Investigations of Lymphomas characterisation of tumour cells by Immunophenotyping using the following monoclonals: • CD3 (___-cells) (______) • CD20 (____-cells) (____________) • CD30/CD15 (___________), • CD45 (__-cells) (___________)

T; T-NHL B; NLPHL, B-NHL, including BL HL leucocyte; NLPHL, NHL

Investigations of Lymphomas Patients 3 characterisation of tumour cells by Cytogenetics: • Burkitt lymphoma:T(__;__),t(__;__),t(__;__) • Small cleaved cell lymphoma, follicular lymphoma: T(__;___) • Small cell lymphocytic lymphoma: T(__;__)

8;14 2;8 8;22 14;18 11;14

Investigations of Lymphomas characterisation of tumour cells by Cytogenetics: •_________ cell lymphoma: T(14;18)

Small cleaved

Investigations of Lymphomas Patients 3 characterisation of tumour cells by Cytogenetics: _______ lymphoma:T(14;18)

follicular

Investigations of Lymphomas Patients 3 characterisation of tumour cells by Cytogenetics: _____________ lymphoma: T(11;14)

Small cell lymphocytic

Investigations of Lymphoma Pretherapy Work Up Investigations: •____ with blood film examination; •___________ rate •_______________ test;

CBC Erythrocyte sedimentation Direct antihuman globulin

Investigations of Lymphoma Pretherapy Work Up Investigations: •________ and __________ biopsy are mandatory for staging of other lymphomas •_________ and or biopsy of the _____ •_______ aspiration as part of diagnostic work (e.g., in BL);

Bone marrow aspiration and trephine Fine needle aspiration ; of the liver Splenic

CLINICAL FEATURES of NHL •_________ (most common manifestation) • Fevers, night sweats, weight loss, and fatigue • Symptoms related to ______ effect • Document ______ of symptoms and ____ of progression

Lymphadenopathy mass duration; pace

CLINICAL FEATURES of NHL • Possibility that waxing and waning lymphadenopathy may be due to ______.

lymphoma

NHL Spontaneous remission, have been documented in some patients with lymphoma T/F

T Spontaneous remission, have been documented in some patients with lymphoma especially in low grade lymphoma

PHYSICAL/SIGNS • There may be (low or high?) fever, ____cardia and respiratory distress. •______ (_____) • Purpura, petechae or ecchymosis (thrombo_________)

high; tachy Pallor (anaemia) cytopenia

PHYSICAL/SIGNS of NHL • Examine all lymph node bearing areas as well as assessing _______ and _______ • Pharyngeal involvement, a thyroid mass, pleural effusion, abdominal mass, testicular mass and cutaneous lesions are findings that might direct further investigations and subsequent therapy. • A neurological examination is vital at diagnosis.

hepatomegaly and splenomegaly.

25% of patients with Waldeyer ring involvement also have involvement of the ________ and vice versa especially in _______ cell lymphoma.

gastro intestinal tract mantle

Patients with paranasal sinus involvement,______ involvement and ______ lymphoma are particularly prone to have ________ involvement and thus requires a diagnostic ______ puncture.

testicular; epidural; meningeal; lumbar

• One quarter of patients with _________ involvement by large cell lymphoma also have CNS disease.

bone marrow

• Patients with one testicle involved are likely to relapse in the ___________

contralateral testis.

In NHL, If pathological proof of involvement of 1 or more extralymphatic sites has been documented, the symbol for the site of involvement followed by a plus (+) sign is listed. T/F

Treatment of NHLs depend on the pathological classification, the clinical stage, the age of the patient and their general health.m T/F

Choice of Treatment for NHL • Conventionally, it is convenient to categorize the pathological entities into: •________ •_________ or •_________

Indolent Aggressive Highly aggressive.

Choice of Treatment for NHL: Indolent NHL • Usually treated ___tively • Runs a (shortened or prolonged?) courses and is (often or rarely?) cured; •Local RT is useful for early stage disease

pallia; prolonged; rarely

Choice of Treatment for NHL: Indolent NHL • CT with alkylating agents, ______ analogues • Interferon, _________ and high dose therapy with __________ transplant. • Median survival is ____-____ years

purine; monclonal antibodies autologous stem cell 8 – 10

• Aggressive NHLs ( _________________ is the commonest type)

Diffuse large cell lymphoma

Choice of Treatment for NHL • Aggressive NHLs : •___ (_______,_______,_____,______); ___ days is the conventional therapy.

CHOP cyclophosphamide, adriamycin, oncovin and prednisolone 21

Choice of Treatment for NHL •______ may help to identify patients who will benefit from more aggressive strategies

IPS

Treatment • Principles of antilymphoma therapy 1. Radiation therapy - Plays limited role because most patients with B-cell lymphomas often have _________ disease - Has a role as ______ therapy in _____ lymphomas that respond to ______. - In the management of some of the complications (eg ________ syndrome, ___ involvement with lymphoma with impending pathological fracture.

disseminated consolidated; aggressive chemotherapy; superior vena cava ; bone

• The use of “second” or “third” generation regimens in aggressive NHLs have met with large success.. T/F

F Little success

Treatment • Principles of antilymphoma therapy Chemotherapy - forms the _____ of therapy in lymphoma

cornerstone

In lymphomas, Chemotherapy has just a palliative role.

F Chemotherapy has a curative, as well as a palliative role.

Treatment • Principles of antilymphoma therapy Biologic Therapy - Comprised of _____ therapy and _________.

interferon monoclonal antibodies

Treatment • Principles of antilymphoma therapy Biologic Therapy - Interferon widely used in ____ for the treatment of (indolent or aggressive?) lymphoma, but seldon used in the ___.

Europe Indolent US

Principles of antilymphoma therapy Biologic Therapy - Recent studies show no overall significant difference in overall survival in patients treated with interferon against those treated with combination chemotherapy alone. T/F

Treatment • Principles of antilymphoma therapy Biologic Therapy - Interferon maintenance therapy suggest ________________ survival but no ___________________ benefit.

prolonged disease – free consistent overall survival

Treatment • Principles of antilymphoma therapy Biologic Therapy -____________ – latest in the treatment against B-cell lymphoma.

Monoclonal antibodies

BEFORE INITIATING THERAPY • Confirm ______ diagnosis • Establish ______ (disease ____) • Confirm tumour _________ • Confirm tumour ________ • Assess ___________

histologic tumour burden staging immunophenotype cytogenetics Prognostic indices

NON HODGKINS LYMPHOMA Flashcards

(59 cards)