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Anatomy and Clinical Considerations
Lymphomas
Lymphadenopathy
Diagnosis of Lymphoma
Treatment of Lymphoma
100
In what part of the thymus does negative selection of T cells occur?
In the medulla. Negative selection occurs when there is high affinity for MHC.
100
Which age group is most commonly diagnosed with Burkitt’s lymphoma?
Adolescents and young adults
100
List 4 symptoms of lymphadenopathy.
Infectious- Pharyngitis, local tenderness Metastatic malignancy- Difficulty swallowing, hoarseness, pain. Constitutional- Weight loss greater than 10%, fever, night sweats, generalised pruritis.
100
What are the 4 differentials of an anterior mediastinal mass?
4 Ts - Terrible lymphoma - Thymoma - Teratoma - Thyroid goitre
100
What is the gold standard of treatment for Non- Hodgkin lymphoma?
R-CHOP-21- Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone.
200
What is the significance of Virchow’s node?
It is associated with malignancies in the abdominal region including the stomach, gallbladder, pancreas, ovaries and prostate.
200
Which lymphoma is associated with Reed Sternberg cells (and how are they described)?
Hodgkin lymphoma. Reed Sternberg cells release factors that cause aggregation of lymphatic cells. They can have one or multiple nuclei that are mirror images of each other. The nucleus has a halo appearance and there is a large cytoplasm.
200
What are the localised causes of cervical lymphadenopathy?
Infection (EBV, CMV, TB, cat scratch, staphylococcal/ streptococcal), malignancy, inflammatory (sarcoidosis, drugs).
200
What are the 3 essential diagnosis criteria of Hodgkins lymphoma?
1. Non tender lymphadenopathy 2. Constitutional symptoms Eg. Fever, night sweats 3. Biopsy of lymph nodes showing pathology. Excision, core, FNA.
200
List 3 adverse side effects associated with chemotherapy treatment.
Hepatoxicity, nephrotoxicity, haematologic toxicity, neutropenia, infection, thrombocytopenia, anaphylaxis.
300
What is the embryonic origin of the lymphatic vessels?
The embryonic origin of the lymphatic vessels is veins. More specifically, paired jugular sacs (6 in total) form at junctions of prominent veins in the body and eventually branch to become lymph vessels.
300
Which lymphoma is H. pylori most closely linked with?
MALT lymphoma (Non- Hodgkin lymphoma)
300
Describe the term “aggressive lymphoma” and give an example.
Aggressive lymphoma- If left untreated, patient may only have weeks/months survival time. This is a curable lymphoma. Eg. Diffuse large B cell lymphoma, Burkitt’s lymphoma.
300
Describe Stage III of the Ann Arbor staging system for lymphomas.
Stage III- 2 or more lymph nodes on both sides of the diaphragm are affected. It can also be used to describe involvement of organs near the affected lymph nodes as well as the spleen.
300
When is tumour lysis syndrome most likely to occur?
When large tumours are responsive to treatment (Eg. Non- Hodgkin lymphoma, acute leukaemia) and/ or the cancer cells are rapidly multiplying.
400
Where in the body do Mycosis fungoides and Sezary syndrome most often present respectively?
Mycosis fungoides and Sezary syndrome both affect the skin. However, Sezary syndrome is also leukemic (blood related).
400
What are the genetic and clinical features of follicular lymphoma?
Genetic- 14;18 translocation. Clinical- Middle aged males and females affected with painless generalized lymphadenopathy. Has an indolent waxing and waning course and is incurable.
400
What are the differences between acute lymphadenitis and chronic lymphadenitis?
Acute: Cervical or mesenteric lymph nodes (enlarged, tender nodes). Chronic: Inguinal or axillary lymph nodes (enlarged, non tender nodes).
400
What is the selection criteria for a lymph node biopsy? Give two examples.
- Patient over 40 years - Node is bigger than 2cm - Abnormal chest x-ray - Hard, fixed nodules - Supraclavicular - Generalized pruritis - No symptoms of local or systemic inflammation
400
What is the cellular target of Rituximab?
Rituximab as a monoclonal antibody targets the protein CD20 on cells and initiates cytotoxicity. Thus, it is effective in B-cell non-Hodgkin lymphoma.
500
What is Pel- Ebstein fever?
Pel- Ebstein fever is a cyclical fever that decrease and increases over a period of weeks. It is a symptom of Hodgkin lymphoma
500
What are the common translocations found in Diffuse Large B-cell lymphoma?
bcl-2, bcl-6, c-myc. Normally- BCL2 stops that apoptosis of lymphoma cells. BCL6 is involved in repressing the differentiation of B cells in germinal centres as well as inhibiting growth arrest and silencing the expression of p53 (a tumour suppressor protein). C-MYC is an oncogene.
500
What are the common causes of generalized lymphadenopathy?
CHICAGO - Cancer - Hypersensitivity - Infection - Connective tissue disorders - Atypical lymphoproliferative disorders - Granulomatous infiltration - Others (Eg. Drugs)
500
What features of a lump/mass should be noted?
5 x S- Size, shape, surface, surrounds, smoothness 3 x C- Colour, consistency, contours 3 x T- Tender, tethering, transillumination
500
What are the clinical hallmarks of tumour lysis syndrome?
Hyperuricaemia (from increased nucleic acid destruction), hyperkalaemia, hyperphosphataemia, hypocalcaemia.