Lymphomas

Question 1

What is the difference between Hodgekin’s and Non-Hodgkin’s lymphomas?

Answer 1

The presence of Reed-Sternberg cell if present:

• Hodgekin’s lymphoma
• also possible: presence of Hodgekin-cells

Question 2

What is a Reed-Sternberg cell?

Answer 2

The defining type of cells for Hodgekin’s lymphoma

• giant, irregular cells
• binucleated
• normally derived from B-lymphocytes
• look like owel eyes
• (often surrounded by no-maglignant inflammatory cells), T and eosinophils

Question 3

What are characteristics of Hodgekin’s lymphomas?

Answer 3

• usually derive from B-cells
• spread in continous manner
  
  • to nearby lymph nodes
  • rarely to extranodal sites

Question 4

What is the normal time in which Hodgekin’s lymphomas arise?

Answer 4

Bimodal distribution

• young adults around 20
• old üeople >60

Question 5

What are the main subgroups of Hodgekin’s lymphoma?

Answer 5

1. Classical
   
   1. Reed-Sternberg don’t express normal B-cell markers (CD20+45 but do express CD15)
      
      1. With 4 subtypes
2. Non-Classical
   
   1. Reed-Sternberg cells express CD20+45 but not 15+30

Question 6

How many sub-types of Hodgekin’s lymphomas are there?

Answer 6

7 subtypes

• B-cell
  
  • Follicular
  • • Burkit
  • Tranlocation 8-14
  • EBV associated
  • Extranodal involvement
• Mantle Cell
• Lymphoplasmacytic Lymphoma
• Adult T-cell lymphoma (leukemia)
• Mycosis Fungoides

Question 7

What are B-symptoms?

What do they indicate?

Answer 7

Weith loss

Night Sweat and

Fever

–> common in leukemias and lymphomas

Question 8

What are the characteristics of non-Hodgekin’s lymphomas?

Answer 8

Normally spread non-continously

• involvement of extranodal sites
  
  • GI
  • Skin
  • Brain
• usually no reed-sternberg cells

Question 9

What is a Hodgekin cell?

What is it characteristic of?

Answer 9

It is a large, mononuclear lymphocyte

Question 10

What are presenting symptoms of a patient with Hodgekin lymphoma?

Answer 10

Normally present with

• cervical persistant lymphadenopathy
• B-symptoms (30%)
• generalised pruritus
• and alcohol-induced pain at involved sites

Question 11

What are the presenting symptoms of a patient with non-Hodgekin lymphoma?

Answer 11

Very different presentation (involves over 30 conditions)

• Agressive Lymphomas
  
  • B-symptoms, malaise, SOB, cough, abdominal discomfort, anaemia, fatigue, change in mental status
• P. with low-grade often are asymptomatic

Question 12

What are possible presenting signs in patient with non-hodgekin lymphomas?

Answer 12

• Signs may include lymphadenopathy,
• pallor (anaemia),
• purpura (thrombocytopenia),
• jaundice (liver failure),
• hepatomegaly,
• splenomegaly,
• skin nodules
• abnormal neurological examination.

Question 13

What are possible signs of Hodgekin-lymphomas?

Answer 13

Palpation of all lymph nodes (cervical, inguinal, supraclavicular, axillary)

Hepato+splenomegaly

Question 14

What is the aetiology of Hodgekin’s lymphomas?

Answer 14

• unclear, multifactoral
• infective (e.g. EBV)
• genetic-predisposition

Question 15

What are risk factors for developing Hodgekin’s lymphomas?

Answer 15

• history of Epstein-Barr virus (EBV) infection
• family history of Hodgkin’s lymphoma
• young adults from higher socio-economic class
• HLA types

Question 16

What is the aetiology of non-Hodgekin lymphomas?

Answer 16

Associated with viral infection and immunosupression/ auto-immune conditions

Question 17

What are apropriate investigations for suspected lymphomas?

Answer 17

• FBC with differentials
  
  • abnormalities if BM involvement
• Blood smear
  
  • Reed-sternberg cells
• Lymph node biopsy
• different for Non-Hodgekin and Hodgekin Lymphomas