Hodgkin's Disease vs. Non-Hodgkin's Lymphoma

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Questions and Answers

Which of the following is a key differentiating factor between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?

  • Hodgkin's lymphoma typically presents with widespread, non-contiguous lymph node involvement, unlike Non-Hodgkin's lymphoma.
  • Hodgkin's lymphoma is characterized by nodal involvement and contiguous spread, whereas Non-Hodgkin's lymphoma is more likely to be non-nodal. (correct)
  • Non-Hodgkin's lymphoma often presents with contiguous spread and nodal involvement, a characteristic not typically seen in Hodgkin's lymphoma.
  • Non-Hodgkin's lymphoma has a universally good prognosis compared to the variable outcomes seen in Hodgkin's lymphoma.

A patient presents with painless, rubbery cervical lymphadenopathy and alcohol-induced pain in the affected nodes. Which lymphoma is most likely?

  • Low grade Non-Hodgkin's lymphoma, given the asymptomatic presentation.
  • Multiple Myeloma, considering the possibility of bone marrow failure and associated anemia.
  • Hodgkin's Lymphoma, based on the contiguous spread and characteristic symptoms. (correct)
  • Non-Hodgkin's Lymphoma, due to its association with immunodeficiency.

A young adult is diagnosed with Hodgkin's lymphoma. Considering the typical incidence, in which decade of life did this patient most likely receive the diagnosis?

  • The sixth decade.
  • The first decade.
  • The third decade. (correct)
  • The eighth decade.

Which symptom, when present in Hodgkin's Lymphoma, indicates a worse prognosis?

<p>Weight loss, night sweats, and unexplained fever. (B)</p> Signup and view all the answers

A patient with Hodgkin's lymphoma has lymph node involvement on both sides of the diaphragm. According to the Ann Arbor staging system, what stage is this?

<p>Stage III (B)</p> Signup and view all the answers

A patient's lab results show normochromic normocytic anemia and elevated ESR. Which condition could these findings suggest?

<p>Hodgkin's lymphoma. (A)</p> Signup and view all the answers

What cellular finding is essential for diagnosing Hodgkin's lymphoma via lymph node biopsy?

<p>Presence of Reed-Sternberg cells. (A)</p> Signup and view all the answers

Which of the following is a common treatment approach for early-stage Hodgkin's lymphoma (IA/IIA)?

<p>Chemotherapy followed by radiotherapy. (C)</p> Signup and view all the answers

What is a major etiological factor associated with Non-Hodgkin's lymphoma?

<p>Immunodeficiency. (C)</p> Signup and view all the answers

A patient is diagnosed with Non-Hodgkin’s lymphoma with involvement of Waldeyer’s ring. Where is the primary site of the lymphoma?

<p>Oropharynx. (D)</p> Signup and view all the answers

What is a potential management strategy for low-grade Non-Hodgkin's lymphoma in asymptomatic patients?

<p>No immediate treatment, observation only. (C)</p> Signup and view all the answers

Multiple myeloma arises from the malignant transformation of which type of cell?

<p>Plasma cell. (A)</p> Signup and view all the answers

A patient between 40 and 80 years old presents with bone pain and fatigue. Which hematological malignancy should be suspected?

<p>Multiple Myeloma. (A)</p> Signup and view all the answers

What is the primary mechanism by which myeloma cells cause bone destruction in multiple myeloma?

<p>Stimulation of osteoclasts, leading to increased bone resorption. (B)</p> Signup and view all the answers

Which complication of multiple myeloma directly contributes to anemia, thrombocytopenia, and neutropenia?

<p>Bone marrow failure. (C)</p> Signup and view all the answers

In multiple myeloma, renal failure often results from which pathological process?

<p>Deposition and accumulation of paraproteins in the kidneys causing damage. (A)</p> Signup and view all the answers

Headache and dizziness in multiple myeloma are most likely due to what?

<p>Hyperviscosity syndrome. (C)</p> Signup and view all the answers

Which test directly detects the presence of monoclonal paraproteins, indicative of multiple myeloma?

<p>Protein electrophoresis. (A)</p> Signup and view all the answers

What is the significance of detecting Bence-Jones proteins in the urine during the diagnosis of multiple myeloma?

<p>Identifies the presence of monoclonal light chains, a type of paraprotein. (D)</p> Signup and view all the answers

When is treatment initiated for multiple myeloma?

<p>Only when there is evidence of organ damage. (C)</p> Signup and view all the answers

Flashcards

Hodgkin vs. Non-Hodgkin Differences

Hodgkin's is typically nodal and contiguous, has a good outcome, and is not associated with immunodeficiency. Non-Hodgkin's is typically non-nodal and non-contiguous, has a variable outcome, and is associated with immunodeficiency.

Hodgkin's Peak Incidence

Hodgkin's disease has a peak incidence in the third decade of life (20s).

Hodgkin's Disease Aetiology

While the exact cause is unknown, EBV (Epstein-Barr virus), which causes infectious mononucleosis, is suggested as a possible factor.

Hodgkin's Clinical Features

Painless, rubbery lymphadenopathy (often cervical and contiguous), constitutional 'B' symptoms (fever, night sweats, weight loss), anorexia, fatigue, pruritus, erythematous rash, mediastinal involvement (hilar lymphadenopathy), and hepatosplenomegaly.

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Ann Arbor Staging System

I: Single lymph node region. II: Two lymph node regions on the same side of the diaphragm. III: Lymph node groups on both sides of the diaphragm. IV: Widespread disease outside lymphatic sites.

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Hodgkin's Investigations

FBC (normochromic normocytic anaemia), elevated ESR, LFTs/U&Es/bone profile/LDH, CXR/CT, lymph node biopsy (Reed-Sternberg cells), and sometimes bone marrow examination.

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Hodgkin's Treatment

Early stage (IA/IIA): Chemotherapy + radiotherapy. Advanced stage: Combination chemo. Complete remission achieved in 60-90% of cases.

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Non-Hodgkin's Peak Incidence

Increases with age. Rare in those under 40.

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Non-Hodgkin's Aetiology

Immunodeficiency, infections, ionising radiation, carcinogenic chemicals, and inherited disorders affecting DNA damage and repair.

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Non-Hodgkin's Clinical Features

Generalised lymphadenopathy, oropharyngeal involvement (Waldeyer’s ring), and bone marrow infiltration (leading to anaemia, recurrent infections, and haemorrhage).

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Non-Hodgkin's Management

Low grade: May require no treatment or intermittent oral chemo. High grade: Combination chemo (30% cure).

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Multiple Myeloma Origin

Arises from malignant transformation of terminally differentiated B cells (plasma cells). Monoclonal expansion results in secretion of Ig or light chains (paraproteins).

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Multiple Myeloma Peak Incidence

Typically 40-80 years old.

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Multiple Myeloma Clinical Features

Bone destruction (osteolytic lesions, raised serum Ca2+), bone marrow failure (anaemia, thrombocytopenia, neutropenia, recurrent infections), renal failure (paraprotein deposition), hyperviscosity syndrome, and amyloidosis.

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Multiple Myeloma Investigations

FBC (bone marrow failure), raised ESR and Ca2+, U&Es (renal damage), protein electrophoresis (paraprotein), and Bence-Jones proteins in urine.

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Multiple Myeloma Management

Treated only if organ damage is evident. Chemo is used for bone marrow failure or bone lesions. Radiotherapy is useful for bone pain.

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Study Notes

Hodgkin's Disease vs. Non-Hodgkin's Lymphoma: Key Differences

  • Hodgkin's typically presents with nodal involvement, while Non-Hodgkin's can be extra-nodal.
  • Hodgkin's spreads contiguously, unlike Non-Hodgkin's.
  • Hodgkin's generally has a favorable outcome, whereas Non-Hodgkin's has variable outcomes.
  • Hodgkin's is typically not associated with immunodeficiency but Non-Hodgkin's is.

Hodgkin's Disease: Incidence and Etiology

  • Peak incidence occurs in the third decade of life (20-29 years old).
  • The exact cause is unknown.
  • EBV (Epstein-Barr virus) is a suggested factor.

Hodgkin's Disease: Clinical Features

  • Lymphadenopathy is a key sign, often cervical, contiguous, painless, non-tender, and rubbery in texture. Alcohol-induced pain in affected nodes can occur.
  • Constitutional 'B' symptoms include fever, night sweats, and weight loss exceeding 10% within 6 months.
  • Other signs include anorexia, fatigue, pruritus (itching), and an erythematous rash.

Hodgkin's Disease: Mediastinal Involvement

  • Hilar lymphadenopathy can cause bronchial compression and SVC (superior vena cava) obstruction.
  • Possible Hepatosplenomegaly

Hodgkin's Disease: Staging (Ann Arbor System)

  • Stage I: Single lymph node region affected
  • Stage II: Two or more lymph node regions on the same side of the diaphragm are involved.
  • Stage III: Lymph node groups are affected on both sides of the diaphragm.
  • Stage IV: Widespread disease that has spread outside of the lymphatic system, such as to the lung.

Hodgkin's Disease: Investigations

  • FBC: Normochromic normocytic anemia may be present.
  • Elevated ESR (erythrocyte sedimentation rate).
  • LFTs/U&Es/bone profile/LDH to assess organ function.
  • CXR/CT imaging.
  • Lymph node biopsy to identify Reed-Sternberg cells.
  • Bone marrow examination is rarely needed.

Hodgkin's Disease: Treatment & Prognosis

  • Early-stage disease (IA/IIA) involves chemotherapy and radiotherapy.
  • Advanced-stage disease requires combination chemotherapy.
  • Complete remission rates range from 60-90%.
  • Stage I has a 90% 5-year survival rate.
  • Presence of 'B' symptoms indicates a worse prognosis.

Non-Hodgkin's Lymphoma: Incidence

  • Incidence increases with age
  • Uncommon in people under 40

Non-Hodgkin's Lymphoma: Etiology

  • Immunodeficiency
  • Infections
  • Ionising radiation
  • Carcinogenic chemicals
  • Inherited disorders affecting DNA damage and repair

Non-Hodgkin's Lymphoma: Clinical Features

  • Generalised lymphadenopathy.
  • Oropharyngeal involvement (Waldeyer’s ring).
  • Bone marrow infiltration

Non-Hodgkin's Lymphoma: Bone Marrow Infiltration

  • Anaemia
  • Recurrent infections
  • Haemorrhage.

Non-Hodgkin's Lymphoma: Management

  • Low Grade Disease
  • Asymptomatic patients require no treatment
  • Symptomatic patients need Intermittent oral chemo.
  • High Grade Disease
  • Combination chemo is used. 30% become cured

Multiple Myeloma: Pathophysiology

  • Arises from malignant transformation of terminally differentiated B cell (plasma cell).
  • This malignant transformation is described as monoclonal expansion, which results in a secretion of Ig or light chains (paraproteins).

Multiple Myeloma: Incidence

  • Typically presents between 40-80 years old.

Multiple Myeloma: Clinical Features

  • Long asymptomatic phase (MGUS - monoclonal gammopathy of undetermined significance).
  • Bone destruction due to myeloma cells stimulating osteoclasts, resulting in osteolytic lesions and raised serum calcium.
  • Bone marrow failure caused by marrow infiltration leads to anaemia, thrombocytopenia, neutropenia, and recurrent infections.
  • Renal failure results from deposition and accumulation of paraproteins.
  • Hyperviscosity syndrome presents with headache and dizziness.
  • Amyloidosis is the development of abnormal protein cells that deposit in parts of the body.

Multiple Myeloma: Investigations

  • FBC detects bone marrow failure.
  • Raised ESR and calcium levels.
  • U&Es demonstrate renal damage.
  • Protein electrophoresis demonstrates a monoclonal paraprotein.
  • Bence-Jones proteins can be found in urine.

Multiple Myeloma: Management

  • Only treated if there is evidence of organ damage.
  • Chemo is used if bone marrow failure or bone lesions are present.
  • Most patients respond, but relapse is common.
  • Radiotherapy is useful for bone pain palliation.

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