CS Lymphoma

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1.

What is a leukemoid
reaction?

acute inflam response to infect

10.

50% of Hodgkin's
lymphoma cases also have

EBV via the

Inc WBC in response to infection

11.

Typical symptoms of
Hodgkin's Lymphoma?

-painless lymphadenopathy

inc neutrophils, & bands (left shift)

inc LAP (benign neutrophils)
2.

Chromosome 14

B lymphocytes

involved in what

produce antibodies
(translocations common in B cell
lymphomas)

3.

MC presentation of
lymphoma

painless lymphadenopathy

4.

LAP and neutrophils

Leukocyte Alkaline Phosphatase

5.

-2/3 NO SYMPTOMS
else CONSTITUTIONAL "B"
COUGHING/DYSPNEA
(due to node enlargement in
mediastinum)
12.

"B" symptoms

low-grade fever
night sweats
weight loss
(pruritis w/ nodular sclerosing)

13.

Hodgkins typically
detected by

painless lymphadenopathy

reflects BENIGN neutrophils

OR

(low in CML)

Chest XRAY shows nodes

lymphadenopathy at

URI

cervical/neck

Mono

most due to

Bacterial pharyngitis

(symptoms only in 1/3)

14.

Reed Sternberg Cells origin

and cell markers?

B-Cell Origin
CD15+, CD30+
-> Owl Eye's

other viral
6.

lymphadenopathy at

(2 eyes x 15 = 30)

skin infections
15.

unilateral axillary or
femoral

Hodgkins vs non Hodgkins

-

single group of nodes,

contiguous spread vs

nodes/spread

multiple peripheral nodes,

non contiguous spread

most due to
7.

Hodgkin's lymphoma

NECK

MC initial location on
body?

also hilar/mediastinum COUGHING

(prognosis better for

Hodgkins)
16.

Hodgkins vs non Hodgkins

- symptoms

Localized, single group of nodes

w/ contiguous spread
8.

9.

Hodgkin's Lymphoma
cells?

Reed Sternberg Cells

Hodgkin's

Young adults - MALE

age & sex distribution

Bimodal
1 - 15-35
2 - > 55yrs

(OVERALL)_

B symptoms
(fever, night sweats, weight
loss)
17.

NOT "middle age"

NOT KIDS - rare under 5

more vs less

Hodgkins vs non Hodgkins

- age distribution

bimodal (15-35 & >55yrs)

vs
20 - 40 yrs

18.

Hodgkins vs non Hodgkins associations w/ diseases

EBV

Hodgkins:

mixed cellularity

vs

stage with more

(tends to affect older men)

??

SUBDIAPHRAGMIC
involvement

maybe HIV,viruses,
autoimmune, lymphoprolif,
Kaposis
19.

Hodgkins vs non Hodgkins involvement of Waldeyer's

ring

-not in hodgkins
(Waldeyer & mesenteric
nodes rarely involved)
- commonly in Non
Hodgkins
(peripheral)

20.

Hodgkins types

Nodular Sclerosing 80%

MIxed Cellularity 15%

28.

29.

30.

31.

32.

33.

80%

22.

Nodular Sclerosing type & sex

lymphocyte predominant

male predominance

(and overall)

Hodgkins lymphoma w/

lymphocyte predominant

Hodgkins lymphoma w/

lymphocyte depleted type

"sheets" of RS cells

"sheets" means more RS cellls

than reg lymphocytes
90% have EBV

Nodular Sclerosing

CLASSICAL TYPE HL

Hodgkins type w/

peripheral nodes
(spares mediastinum)

Lymphocyte predominant
5%
Lymphocyte depleted <1%
Most common type of
hodgkin's lymphoma?

Hodgkins type more

common in older people

Nodular sclerosing type

Hodgkins
typically involves which
nodes

24.

34.

"most often seen in young

adults, particularly women"

Hodgkins

male >40

25.

26.

27.

large mediastinal nodes

many nodes,

supradiaphragmatic
(above diaphgragm)
Lymphocyte-rich

best prognosis

(indolent)

Hodgkins lymphoma type w/

1 - lympocyte depleted

worst prognosis

2 - mixed cellularity

MC type of Hodgkins in young

adults

nodular sclerosing

Hodgkins type most

associated w/

Nodular Sclerosing

lympocyte depleted, mixed

cellularity

Poor prognostic factors

mediastinal

Hodgkins lymphoma type w/

Lymphocyte depleted
(or in people with HIV)

& less association w/ EBV

23.

lymphocyte predominant

"Popcorn cells"

by percent

21.

Hodgkins type w/

B symptoms
Elev SR
35.

36.

37.

Hodgkins

STARTS AT NODES

spread

CONTIGUOUS SPREAD
via nodes or hematogenously

Hodgkins

LIVER

MC extralymphatic sites

LUNG

(outside nodes)

BONE

non Hodgkins

can start OUTSIDE NODES

(1/3)

PRURITIS
spread

Non CONTIGUOUS SPREAD

PERIPHERAL

38.

Non hodgkins
MC extralymphatic
sites

MC Stomach/GI
(Peyers)
Waldeyers
CNS - rare

(outside nodes)

48.

Lymphoma's Affecting
B Cells (4)
49.

(Bone, Liver )
39.

40.

Workup for
lymphomas

Hodgkins Staging
XR or CT

CBC
LDH
Renal Function
LFT's
Calcium/uric acid

10 yr survival rate of

(not itching)
50.

51.

>80%

42.

43.

44.

Hodgkins lymphoma
treatment
I, IIA

Radiation low dose (w/ chemo)

Hodgkins lymphoma
treatment

Comb chemotherapy
(ABVD)

III, IV

RADIATION ONLY RARELY

(too diffuse?)

Risk factors
for I, II

poor prog: MC/depleted

Non hodgkins
lymphoma

MC Stomach/GI tract
(Peyers)

MC extralymphatic
sites

Waldeyers
CNS - rare

(outside nodes)

(Bone, Liver )

Hodgkins lymphoma

Lung

MC extralymphatic
sites

(Bone, Liver)

(outside nodes)
52.

Hodgkins

non hodgkins
lymphoma

Elev LDH
B symptoms
53.

Burkitts etc not

covered in clin med

...

54.

Burkitt's Lymphoma
mutation?

t(8;14)
MYC
is chromosome 8 - transcription
activator.
heavy chain Ig is chromosome 14

LARGE MEDIASTINAL nodes

B symptoms
Risks of Comb/ABVD
chemo

55.

Burkitts lymphoma
presentation?

pulmonary fibrosis

Hodgkins Relapses
timeframe

within first 2 years

(rare after 5 years)
20% Stage I, II - radiation only

Pelvic/Abdominal Lesion elsewhere

56.

Burkitt's lymphoma
disease association?

EBV

57.

Burkitts lymphoma
appearance on
microscope?

Starry Sky Appearance - sheets of

lymphocytes with interspersed
macrophages.

58.

Diffuse B cell
lymphoma typically
affects?

Kids 20%, Older Adults

59.

MC NHL in adults?

diffuse B cell

& most likely w/

47.

Hodgkins lymphoma

w/ relapse or failure to respond

salvage therapy

HIGH DOSE chemo

Autologous stem cell

Extranodal sites
Jaw Lesion in endemic african
population

cardiac myopathy
(enlarged heart)
46.

Stage III or IV

poor prognosis if

(treat as III, IV)

45.

B symptoms
20% (less than Hodgkins)

IV - extensive extanodal involvement

(liver, marrow, lungs, skin)
41.

Non hodgkins
lymphoma

1. Burkitt's Lymphoma
2. Diffuse Large B Cell Lymphoma
3. Mantle Cell Lymphoma
4. Follicular Lymphoma

symptoms

I - one lymph node

II - 2+ nodes on one side of
diaphragm
III - both sides of diaphragm - limit
extranodal/spleen

Non hodgkins

(a group of disorders)

60.

Diffuse B Cell lymphoma

arises from

30 % Arise from follicular

(Also 14 18, BCL2)

61.

Mantel Cell lymphoma

translocation?

t(11;14)
Cyclin D1 and Heavy Chain
Ig

62.

Mantel cell lymphoma

population?

Older Males

63.

Mantle cell lymphoma

poorer prognosis?

CD5+

64.

Follicular lymphoma
translocation?

t(14;18)
BCL2
- Heavy Chain Ig and bcl2

65.

Bcl2 function?

Inhibition of apoptosis

66.

Follicular lymphoma
population?

Adults

67.

Follicular lymphoma
treatment?

Indolent course, difficult to

treat

68.

Cause of adult T cell

lymphoma?

HTLV RNA retrovirus

RNA Icosahedral, Enveloped,
Diploid linear SS+, retrovirus

69.

T cell lymphoma typical

presentation?

Cutaneous lesions

70.

T cell lymphoma
populations?

Japan, West Africa, Carribean

71.

t(8;14)

Burkitt's lymphoma

72.

c-MYC oncogene

Burkitt's lymphoma

moves next to heavy-chain Ig

gene
73.

Starry sky appearance

Burkitt's lymphoma

(sheets of lymphocytes with

interspersed macrophages)
74.

Associated w/EBV

Burkitt's lymphoma

jaw lesions in African

endemic form
75.

Burkitt key attributes

t(8;14)
MYC
starry sky
jaw lesion/EBV

76.

Most common adult NHL

Diffuse large B-cell

lymphoma