Lymphomas

Question 1

What is the clinical difference between Hodgekins and non-Hodgekins lymphoma?

Answer 1

HL: painful after alcohol
NHL: not painful after alcohol

Question 2

What are the types of HL?

Answer 2

1. Nodular sclerosing HL
2. Mixed cellularity HL
3. Lymphocyte rich HL
4. Lymphocyte depleated HL

(5. Nodular lymphocyte-predominant HL)

Question 3

What is the microscopy of nodular sclerosing HL?

Answer 3

• LARGE Reed Sternberg cells
• Nodular fibrosis

Question 4

What is the microscopy of lymphocyte rich HL?

Answer 4

• Scattered Reed Sternberg cells
• Lots of lymphocytes

Question 5

What is the microscopy of lyphocyte depleated HL?

Answer 5

• Reed sternberg cells
• Paucity of lymphocytes

Question 6

What is the microscopy of mixed cellularity HL?

Answer 6

• Reed Sternberg cells
• Eosinophils, plasma cells, histiocytes etc

Question 7

What is the microscopy of nodular lymphocyte-predominant HL?

Answer 7

• NO REED STERNBERG
• Popcorn cells (histiocytes with nuclei resembling exploded popcorn kernels)

Non-classical with lymphocytes and histiocytes = NLPHL

Treated in a different way

Question 8

What are the investigations for HL?

Answer 8

• CT/PET​
• Tissue diagnosis: LN/BM biopsy (cells stain with CD15 & CD30)​
• Reed-Sternberg cell (bi-nucleate/multinucleate (‘owl eyed’) cell on background of lymphocytes & reactive cells)

Question 9

What is the treatment for HL?

Answer 9

Combination chemo (used in most cases)​
- ABVD: Adriamycin, bleomycin, vinblastine and dacarbazine​
- 2-4 cycles in stage 1/2, 6 cycles in stage ¾​
- Usually have interim PET (guides rx)

Question 10

What are the NHLs?

Answer 10

B cell:
- Follicular
- Marginal zone
- Diffuse large B cell lymphoma
- Mantle cell lymphoma
- Burkitt’s lymphoma

T cell:
- Adult T-cell leukaemia/ lymphoma

Question 11

What is the histo of follicular lymphoma?

Answer 11

• Follicular pattern
• Nodular appearance
• Centroblasts LN biopsy

Question 12

What is the mutation in follicular NHL?

Answer 12

T(14;18) fusion of BCL2 gene

Question 13

Management of follicular NHL?

Answer 13

Watchful waiting unless high burden of disease

Rituximab/ obinutuzumab + chemo

Question 14

Prognosis of follicular NHL?

Answer 14

Mostly incurable; median survival 12-15 years

Indolent (slow growing)

Question 15

What is the most common high grade NHL?

Answer 15

Diffuse Large B-Cell Lymphoma

Question 16

Presentation DLBCL?

Answer 16

• Middle-aged/ elderly
• Aggressive
• Associated with EBV

(Can be transformed from low-grade lymphoma like follicular)

Question 17

Histo of DLBCL?

Answer 17

Sheets of large lymphoid cells

Question 18

Management of DLBCL?

Answer 18

Rituximab-CHOP

C: cyclophosphamide
H: doxorubicin hydrochloride
O: oncovin (vincristine sulfate)
P: prednisolone

Question 19

Relapse of DLBCL?

Answer 19

Auto-SCT/CAR-T

(Chimeric antigen receptor T-cell therapy)

Question 20

Features of high grade NHLs?

Answer 20

• Lymphadenopathy & B sx
• May have BM involvement
• TLS risk with treatment

Question 21

Clinical presentation of mantle cell lymphoma?

Answer 21

• Middle aged
• M>F
• Aggressive (if disseminated at presentation, median survival 3-5yrs)

High grade lymphoma

Question 22

Mutation mantle cell?

Answer 22

T(11;14) Cyclin D1 dysregulation

Question 23

Histo mantle cell lymphoma?

Answer 23

Angular/ clefted nuclei

Question 24

Management mantle cell?

Answer 24

R-CHOP & high dose cytarabine

Question 25

Relapse mantle cell?

Answer 25

Auto-SCT

Question 26

Presentation Burkitt's lymphoma?

Answer 26

Endemic - Most common malignancy equatorial Africa - EBV associated - Jaw involvement - Abdo masses Sporadic - Outside Africa - EBV associated Immunodeficiency - NON-EBV ASSOCIATED - HIV/post-transplant

Question 27

Burkitt's histology?

Answer 27

Starry sky appearance

Question 28

Mutation in Burkitt's?

Answer 28

T(8;14) Cellular myelocytomatosis oncogene (c-myc) overexpression

Question 29

Burkitt's management?

Answer 29

Chemo (rituximab) & secondary CNS prophylaxis

Question 30

What are the MALT lymphomas?

Answer 30

Marginal zone NHL - H.pylori (gastric MALT) - Sjorgren's (parotid lymphoma)

Question 31

Management Marginal zone NHLs?

Answer 31

Remove stimulus eg. H.pylori triple therapy Chemo

Question 32

How do cutaneous T cell lymphomas present (NHL)?

Answer 32

Weird rashes

Question 33

Features of adult t-cell leukaemia (NHL)?

Answer 33

- Far east (Carribbean & Japanese) - Associated with HTLV-1 - Aggressive

Question 34

Histology of adult t-cell lymphoma/leukaemia?

Answer 34

Flower cells blood film

Question 35

Features of anaplastic large cell leukaemia?

Answer 35

- Children/ young adults - Aggressive

Question 36

Gene mutation anaplastic large cell lymphoma?

Answer 36

T(2;5) Alk-1 protein expression

Question 37

Features of peripheral T cell lymphoma?

Answer 37

- Middle aged and elderly - Aggressive

Question 38

Histology of peripheral T cell lymphoma?

Answer 38

Large T cells

Question 39

Features of enteropathy associated t cell lymphoma?

Answer 39

Long standing coeliac disease

Question 40

Features of cutaneous t cell lymphoma?

Answer 40

Associated with mycosis fungoides

Question 41

Where are lymph nodes in HL usually inflammed?

Answer 41

Mediastinum (+ anywhere else)

Question 42

What is the prognosis of HL?

Answer 42

Mostly curable

Question 43

What causes the starry sky appearance in Burkitt's lymphoma?

Answer 43

Large numbers of lymphocytes and a significant number of macrophages containing phagocytosed lymphocytes

Question 44

Which lymphoma is most common in >40 year olds?

Answer 44

Diffuse large B cell lymphoma

Question 45

Which lymphoma is most common in 15-40 year olds?

Answer 45

Hodgkin's lymphoma

Question 46

Which lymphoma is most common in <15 year olds?

Answer 46

Burkitt's lymphoma

Question 47

What is the term given to describe the transformation of chronic lymphocytic leukaemia into diffuse large B cell lymphoma?

Answer 47

Richter's transformation

Question 48

What medication can be given to reduce the risk of TLS?

Answer 48

IV Rasburicase/ allopurinol