Notecards

Question 1

What is the definition of lymphoma?

Answer 1

Malignant proliferation of abnormal lymphocytes in lymph nodes and/or lymphoid tissue of other organs (extranodal)Lymph node architecture is gone and lymphoma cells take over

Question 2

What is the differential diagnosis for lymphadenopathy?

Answer 2

Most cases of lymphadenopathy are not malignantBacterial infectionViral (EBV common, HIV)FungalMycobacterial (TB)SpirochetalProtozoanImmunological diseaseGranulomatous diseaseMalignancy

Question 3

What is the clinical presentation of lymphomas in general?

Answer 3

Painless lymphadenopathyFever, malaise, night sweats, and weight lossExtranodal involvement more common in Non-Hodgkin than HodgkinBone marrow involvement is rare at presentation in HD in contrast to NHL

Question 4

What determines treatment in NHL and HD?

Answer 4

NHL = histology + stageHD = stage

Question 5

What is stage I?

Answer 5

Single lymph node involvement or extralymphatic organ

Question 6

What is stage II?

Answer 6

Involvement of 2+ lymph node regions on the same side of the diaphragm (above or below)

Question 7

What is stage III?

Answer 7

Involvement of lymph node regions on both sides of the diaphragm

Question 8

What is stage IV?

Answer 8

Disseminated disease in extralymphatic organs with or without lymph node enlargement

Question 9

What is A staging?

Answer 9

No systemic symptoms

Question 10

What is B staging?

Answer 10

Unexplained weight lossUnexplained feverNight sweats

Question 11

What type of cell is this?

Answer 11

Reed-SternbergOwl eye appearanceCharacteristic of Hodgkin lymphoma

Question 12

What is the epidemiology of Hodgkin disease?

Answer 12

No direct cause/effect relationship knownViral infectionEBV but not a direct associationHereditary predisposition (common HLA types)

Question 13

What are the WHO categories for Hodgkin lymphoma?Which lymphomas are included in the classical Hodgkin lymphoma group?

Answer 13

Classical Hodgkin lymphoma and nodular lymphoma predominant Hodgkin lymphomaClassical Hodgkin lymphoma:Nodular sclerosis (most common)Lymphocyte-rich (best prognosis)Lymphocyte-depleted (worse prognosis)Mixed cellularity

Question 14

What is the clinical presentation for Hodgkin lymphoma?

Answer 14

Painless lymphadenopathy (cervical or supraclavicular)Pruritis (itchy)Back painDyspnea because of enlarged mediastinal lymph nodeB symptoms (weight loss, fever, and night sweats)

Question 15

What are the most common lymph nodes involved in Hodgkin lymphoma?

Answer 15

CervicalSupraclavicularMediastinal

Question 16

What would a lymph node biopsy look like for Hodgkin lymphoma?

Answer 16

Few malignant Reed-Sternberg cells with the majority of cells being benign reactive cells (trying to contain Reed-Sternberg cells)

Question 17

What are the unfavorable factors for Hodgkin lymphoma?

Answer 17

Bulky disease (large mass)ESR (erythrocyte sedimentation rate)elevated> 3 sites of diseaseB symptoms> 2 extranodal sites

Question 18

What is the treatment for Hodgkin lymphoma?

Answer 18

Early stage disease: radiationLate stage disease: chemotherapy

Question 19

What is the salvage treatment for Hodgkin lymphoma?

Answer 19

Patients who cannot be curedRe-treat with chemotherapy early onHigh-dose chemotherapy and stem cell transplant later on

Question 20

What are the characteristics of of lymphocyte predominant Hodgkin disease?

Answer 20

Popcorn cellsGood prognosis

Question 21

What are the complications of Hodgkin disease treatment?

Answer 21

Immunologic deficitsInfectionThyroid dysfunction (because ofradiation to the neck)Cardiac/pulmonary dysfuction (because of radiation on the left side)Gonadal dysfunction (chemo can impact fertility)Bone complicationsSecondary malignancies (increased risk of leukemias and lymphomas that seems to plateau after 8-10 years but solid cancers keep increasing)

Question 22

What is the relationship between PET results and Hodgkin lymphoma prognosis?

Answer 22

Perform a PET scan after 2 cycles of treatmentPET-positive patients have a worse prognosisPET-negative patients have a much better prognosis

Question 23

What are the risk factorsof non-Hodgkin lymphoma?

Answer 23

No known risk factors in most casesAberrations of immunityViruses (HIV, EBV, HHV-8, hepatitis C)Chronic immunologic stimulationEnvironmental factorsDietary

Question 24

What is the cell of origin in non-Hodgkin lymphoma?

Answer 24

B cell (80%)and T cell (20%)Follicular center cells vs. otherDifferentiate state (immature or transformed is aggressive and mature or differentiated is indolent)Chromosome translocations

Question 25

What is the chromosomal abnormality associated with follicular cell non-Hodgkin lymphoma?

Answer 25

t(14;18)Increased Bcl-2 expression (anti-apoptosis promotes survival)

Question 26

What is the chromosomal abnormality associated with mantle cell non-Hodgkin lymphoma?

Answer 26

t(11;14)Bcl-1 regulates cell cycle in G1

Question 27

What is the chromosomal abnormality associated with Burkitt lymphoma?

Answer 27

t(8;14) mostly but 8 can also be involved in translocations with 2 and 22C-myc promotes proliferation

Question 28

What is the chromosomal abnormality associated with large cell non-Hodgkin lymphoma?

Answer 28

3q27 with over-expression of Bcl-6t(2;5) with over-expression of NPM-ALK

Question 29

What is an important part of the work-up for non-Hodgkin lymphoma?

Answer 29

Bone marrow because bone marrow involvement is much more common in non-Hodgkin lymphoma than in Hodgkin disease

Question 30

What is the clinical presentation for non-Hodgkin lymphoma?

Answer 30

Lymph node enlargementSplenomegalyExtranodal is more commonHematological abnormalities (cytopenias because of increased bone marrow involvement)B symptoms

Question 31

What are the low-grade/indolent non-Hodgkin lymphomas?

Answer 31

Small lymphocyte/plasmacytoid (SLL)Follicular small/mixed cell (grade 1 and 2) (most common)Mucosa-associated lymphoid tumor (MALT)Marginal zone lymphoma t(14;18) commonIncurable

Question 32

What are the intermediate grade/aggressive non-Hodgkin lymphomas?

Answer 32

Follicular large cell lymphomaMantle cell lymphomaDiffuse large B cell lymphoma (most common)Peripheral T cell lymphomaHigh expression of Bcl-2 in more advanced diseaseBcl-6 rearrangement seen

Question 33

What are the high grade/very aggressive non-Hodgkin lymphomas?

Answer 33

Precursor lymphoblastic leukemia/lymphoma (T cell or B cell)Burkitt's lymphoma (B cell)

Question 34

What is follicular lymphoma?

Answer 34

Low-grade/indolent non-Hodgkin lymphomaMost common low-grade NHLTypically advanced stage at presentationOften asymptomaticFLIPI score used for determining risk factors

Question 35

When are indolent lymphomas treated?

Answer 35

Pain, shortness of breath, and pleural or pericardial effusionsCompromised organ functionCytopeniaEnlarged lymph nodes causing problems

Question 36

How are indolent lymphomas treated?

Answer 36

RadiationChemotherapy in advanced diseaseMany patients will transform into intermediate or high grade lymphomas (Richter's transformation)

Question 37

Which CD expression is seen in B cell lymphoma?

Answer 37

CD20

Question 38

What is the treatment for intermediate-grade lymphomas?

Answer 38

Chemotherapy in localized disease (R-CHOP)R-CHOP in advanced disease

Question 39

What is lymphoblastic lymphoma? How is it treated?

Answer 39

High-grade non-Hodgkin lymphomaMediastinal mass in young menTreated with multi-agent chemotherapy and CNS prophylaxis

Question 40

What is Burkitt's lymphoma?

Answer 40

High-grade non-Hodgkin lymphomat(8;14) or t(8;22)C-myc translocationLarge abdominal masses (especially in children)Debulking the tumor may help (usually not helpful in other lymphomas)

Question 41

What is acute-type ATL?

Answer 41

Adult T cell lymphomaFlower cellsLytic bone lesion/hypercalcemiaFrequent organ involvementAssociated with HTLV-1 infection

Question 42

What is mantle cell lymphoma?

Answer 42

Mostly maleIncurable and highly aggressivet(11;14) and over-expression of cyclin D1 

Question 43

What is testicular DLBCL?

Answer 43

Most common testicular neoplasm in older men 

Question 44

What is MALT lymphoma?

Answer 44

Patients with autoimmune and inflammatory disordersH. pylori

Question 45

What is mycosis fungoides?

Answer 45

Low-grade lymphomaSkin plaques

Question 46

What is Sezary syndrome?

Answer 46

Variant of mycosis fungoidesSezary cells seen 

Question 47

What is large cell anaplastic lymphoma?

Answer 47

Confused with Hodgkin disease because it is also CD30+Skin involvement

Question 48

What is HIV-associated lymphoma?

Answer 48

Aggressive B cell lymphoma (Burkitt's lymphoma or large cell lymphoma)CNS involvement