⁨⁨⁨⁨⁨⁨أسئلة المحاضرة السابعة أورام باطنة الدلتا ⁩⁩⁩⁩⁩⁩
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What is the most common form of lymphadenopathy in Hodgkin's lymphoma?

  • Mediastinal enlargement
  • Axillary enlargement
  • Cervical enlargement (correct)
  • Inguinal enlargement

    • Which of the following symptoms is NOT considered a B symptom of Hodgkin's lymphoma?

  • Intermittent fever
  • Peripheral lymph node enlargement (correct)
  • Night sweats
  • Weight loss greater than 10%

    • In which age group is Hodgkin's lymphoma most commonly diagnosed?

  • Adults (18-30 years)
  • Infants
  • Children (5-15 years) (correct)
  • Toddler age (1-4 years)

    • What percentage of patients experience itching as a symptom?

    <p>15-25%</p> Signup and view all the answers

    Which of the following is a potential CNS manifestation of lymphoma?

    <p>Intra-cranial infiltration</p> Signup and view all the answers

    What characterizes the lymph nodes in Hodgkin's lymphoma?

    <p>Rubbery and painless</p> Signup and view all the answers

    Which of the following best describes the shape and echogenicity of lymph nodes in lymphoma on ultrasound?

    <p>Round and hypoechoic</p> Signup and view all the answers

    What is a significant sign of hepatomegaly in Hodgkin's lymphoma?

    <p>Obstructive jaundice</p> Signup and view all the answers

    What is the most significant finding in a lymph node biopsy for diagnosing Hodgkin’s disease?

    <p>Presence of Reed-Sternberg giant cells</p> Signup and view all the answers

    Which virus has been theorized to be related to Hodgkin's lymphoma?

    <p>Epstein-Barr Virus</p> Signup and view all the answers

    Which of the following conditions is NOT associated with jaundice in lymphoma patients?

    <p>Chronic fatigue syndrome</p> Signup and view all the answers

    What is the sex ratio (males to females) commonly observed in Hodgkin's lymphoma?

    <p>3:1</p> Signup and view all the answers

    What does a prognosis of lymphocyte depletion type of Hodgkin’s disease indicate?

    <p>Worst prognosis</p> Signup and view all the answers

    Which of the following is a common clinical manifestation in advanced stages of Hodgkin's lymphoma?

    <p>Splenomegaly</p> Signup and view all the answers

    What biochemical abnormality is considered a CNS manifestation of lymphoma?

    <p>Decreased sodium levels</p> Signup and view all the answers

    Which of the following statements regarding the size of lymph nodes in lymphoma is correct?

    <p>Lymph nodes in lymphoma tend to be larger in size.</p> Signup and view all the answers

    Which imaging technique is used primarily for detecting mediastinal lymph nodes or lung disease?

    <p>Plain X-ray chest</p> Signup and view all the answers

    What hematologic condition is indicated by a complete blood picture in lymph nodes involvement?

    <p>Anaemia</p> Signup and view all the answers

    Which of the following biochemical changes indicates active disease?

    <p>Increased serum copper level</p> Signup and view all the answers

    What is considered a low-risk category for lymphoma?

    <p>Stage I or II without B symptoms or bulky disease</p> Signup and view all the answers

    In the Ann Arbor classification, what does Stage I represent?

    <p>Single lymph node region or single extra-lymphatic organ involvement</p> Signup and view all the answers

    Which group is classified as high risk for lymphoma?

    <p>Stage IIIB and IVB</p> Signup and view all the answers

    Which of the following is NOT a feature of Stage III in the Ann Arbor classification?

    <p>Localized involvement of a single organ</p> Signup and view all the answers

    Which factor suggests a good prognosis in lymphoma patients?

    <p>Female gender</p> Signup and view all the answers

    What is assessed during a bone marrow exam in relation to lymphatic conditions?

    <p>B.M infiltration</p> Signup and view all the answers

    What is the recommended chemotherapy protocol for intermediate risk lymphoma patients?

    <p>6 cycles + IFRT</p> Signup and view all the answers

    Which of the following biochemical markers is associated with active lymphatic disease?

    <p>Increased serum lactic dehydrogenase</p> Signup and view all the answers

    What is the most common clinical presentation of Burkitt lymphoma?

    <p>Abdominal mass</p> Signup and view all the answers

    Which additional staging category signifies the absence or presence of systemic symptoms?

    <p>Ann Arbor A/B classification</p> Signup and view all the answers

    Which diagnostic method is primarily used to differentiate Non-Hodgkin's lymphoma from leukemia?

    <p>Bone marrow examination</p> Signup and view all the answers

    Which symptom is NOT typically associated with lymphoma progression?

    <p>Persistent fever</p> Signup and view all the answers

    What is the purpose of radiotherapy in the treatment of lymphoma?

    <p>For intermediate and high-risk patients</p> Signup and view all the answers

    What is a significant indication of good prognosis in lymphoma patients?

    <p>Early good response to treatment</p> Signup and view all the answers

    Which of the following treatments is standard for high-risk lymphoma patients?

    <p>8 cycles of chemotherapy + IFRT</p> Signup and view all the answers

    Which symptom is commonly associated with Non-Hodgkin’s lymphoma?

    <p>Painless lymph node enlargement</p> Signup and view all the answers

    What is a common clinical presentation of Burkitt lymphoma?

    <p>Abdominal mass</p> Signup and view all the answers

    In the treatment of lymphoma, which option includes the ABVD protocol?

    <p>4 cycles + IFRT for low risk</p> Signup and view all the answers

    What method is primarily used to differentiate Non-Hodgkin's lymphoma from leukemia?

    <p>Bone marrow examination</p> Signup and view all the answers

    What is the primary indication of hepatic involvement in a lymphoma patient presenting with jaundice?

    <p>Enlarged lymph nodes in the porta hepatis</p> Signup and view all the answers

    Which statement accurately describes the echogenicity of lymph nodes in lymphoma on an ultrasound evaluation?

    <p>Hypoechoic without echogenic hilus</p> Signup and view all the answers

    What characteristic is associated with lymph node biopsies for diagnosing lymphoma?

    <p>Histopathological features</p> Signup and view all the answers

    What unique histopathological finding is diagnostic for Hodgkin’s disease when examining a lymph node biopsy?

    <p>Presence of Reed-Sternberg giant cells surrounded by benign inflammatory cells</p> Signup and view all the answers

    Which CNS manifestation associated with lymphoma is characterized by metabolic changes?

    <p>Metabolic abnormalities like increased calcium and decreased sodium</p> Signup and view all the answers

    Identifying the shape of lymph nodes that are characteristic of lymphoma is crucial. What is this shape?

    <p>Round in shape</p> Signup and view all the answers

    What biochemical abnormalities could indicate a CNS manifestation of lymphoma?

    <p>Increased calcium and decreased sodium</p> Signup and view all the answers

    Which type of hematologic condition is characterized by bone marrow suppression or infiltration in lymphoma patients?

    <p>Immune thrombocytopenia</p> Signup and view all the answers

    Among the types of Hodgkin’s disease, which one is associated with the best prognosis?

    <p>Lymphocyte predominance</p> Signup and view all the answers

    Which imaging technique is NOT typically used for detecting mediastinal lymph nodes or lung disease?

    <p>Abdominal ultrasound</p> Signup and view all the answers

    What biochemical marker indicates an active disease state in lymphoma?

    <p>↑ Serum lactic dehydrogenase</p> Signup and view all the answers

    Which stage in the Ann Arbor classification indicates the involvement of lymph nodes on both sides of the diaphragm?

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

    Which of the following is NOT a common hematologic finding associated with lymphoma?

    <p>Thrombocytosis</p> Signup and view all the answers

    In the Ann Arbor classification, what additional features can be assigned to each stage?

    <p>A or B based on systemic symptoms</p> Signup and view all the answers

    Which of the following does NOT accurately describe Stage IV in the Ann Arbor classification?

    <p>Involvement is confined to lymph nodes</p> Signup and view all the answers

    What is primarily assessed through a bone marrow examination in the context of lymphoma?

    <p>Bone marrow infiltration</p> Signup and view all the answers

    Which of the following biochemical changes is typically NOT associated with active lymphoma disease?

    <p>↑ Serum albumin level</p> Signup and view all the answers

    What is the sex ratio observed in Hodgkin’s lymphoma occurrences?

    <p>3:1</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with B symptoms in Hodgkin's lymphoma?

    <p>Intermittent fever</p> Signup and view all the answers

    What unique characteristic distinguishes lymph nodes in Hodgkin’s lymphoma?

    <p>Rubbery and painless</p> Signup and view all the answers

    Which clinical sign indicates at least stage III of Hodgkin's lymphoma?

    <p>Splenomegaly</p> Signup and view all the answers

    What is the significance of the Epstein-Barr Virus (EBV) in relation to Hodgkin's lymphoma?

    <p>It is theorized to be related to the disease.</p> Signup and view all the answers

    What type of lymphadenopathy is most prevalent in Hodgkin's lymphoma cases?

    <p>Cervical lymphadenopathy</p> Signup and view all the answers

    Which of the following factors contributes to obstructive jaundice in Hodgkin's lymphoma?

    <p>Enlarged lymph nodes at the porta hepatis</p> Signup and view all the answers

    What characterizes the mediastinal syndrome in Hodgkin's lymphoma?

    <p>Presents with mediastinal lymph node enlargement</p> Signup and view all the answers

    Study Notes

    Level 4, Semester 7 Oncology (L7) Lymphoma

    • Lymphoma is a malignant disease of lymphatic tissues.
    • It is the third most common malignant disease in childhood.
    • Two main types: Hodgkin's lymphoma and Non-Hodgkin's lymphoma (NHL). NHL is more common in children.

    Hodgkin's Disease (Overview)

    • One type of malignant lymphoma.
    • Males are affected more than females (3:1 ratio).
    • Age range 5-15 years.
    • Originates from a single site.

    Hodgkin's Disease (Etiology)

    • Cause currently unknown, but theories exist.
    • Possible link to Epstein-Barr Virus (EBV) infection, which causes infectious mononucleosis.
    • High prevalence of EBV positivity associated with Hodgkin's Disease in certain regions (e.g., Iran, Greece, Kenya - 92-94%).

    Clinical Picture of Lymphoma

    • Lymphadenopathy: Swelling of lymph nodes (most common presentation—90% of cases).
      • Cervical (60-80%)
      • Axillary (20%)
      • Inguinal (5%)
    • Characteristics of Lymph Nodes:
      • Rubbery consistency
      • Painless
      • Not tender
    • Mediastinal lymph node enlargement (60% of cases).
    • Nodal mass ≥ 6cm.
    • Mass/thoracic ratio ≥0.33.

    Clinical Picture of Lymphoma (Other findings)

    • Splenomegaly: Spleen enlargement
    • Hepatomegaly: Liver enlargement
    • Bone marrow involvement: Bone marrow affected
    • B symptoms:
      • Intermittent fever
      • Night sweats
      • Weight loss (10% or more over the past 6 months).
    • Stage III or higher is associated with potential complications like:
      • Hepatomegaly and enlarged lymph nodes at the porta hepatis leading to obstructive jaundice.
      • Anemia due to reduced red blood cell count.
      • Bleeding due to reduced platelet count.
    • Itching, CNS manifestations, jaundice, or hematologic manifestations may also occur.

    Lymphoma (Stages, Complications)

    • Stage of disease (III+) is associated with potential complications.
    • Various stages (I-IV) are defined based on location and spread of the disease. Using the Ann Arbor classification.

    Diagnosis Procedures

    • Ultrasound grey scale evaluation of lymph nodes is important. Nodes in lymphoma tend to be larger than normal. Progressive enlargement on repeated scans is a strong indicator.
    • Lymph node biopsy: It is the most crucial diagnostic procedure.
    • Bone marrow examination (for differentiation from leukemia).
    • Peripheral blood examination.
    • Radiology studies (similar to Hodgkin's disease).

    Treatment (Hodgkin's lymphoma)

    • Combinations of chemotherapy and radiation therapy are commonly employed,
      • Specific treatment regimens (e.g., COPADM protocol, ABVD protocol).
    • Autologous or allogeneic bone marrow transplantation (for recurrent or resistant cases).
    • Emergency situations (such as intestinal obstruction, SVC syndrome, or mediastinal syndrome) may require surgical intervention.

    Non-Hodgkin's Lymphoma (NHL)

    • Accounts for 60% of childhood lymphomas.
    • Males are affected more than females (2.5:1 ratio).
    • Multifocal origin.
    • Abdominal mass may be the most noticeable symptom.
    • Peripheral lymph node enlargement (usually firm, painless, non-tender).
    • Mediastinal lymph node enlargement (potentially causing a mediastinal syndrome).
    • Hepatosplenomegaly (enlarged spleen and liver).
    • Bone marrow infiltration possible. Symptoms like anemia, leukopenia, or thrombocytopenia.
    • Histopathology is crucial for diagnosis.

    Risk stratification

    • Based on stage, presence of B symptoms and the presence of bulky disease.
    • Used to tailor treatment (e.g., Low risk, intermediate risk, High risk patients).

    Prognosis

    • Prognosis varies depending on factors involved, including (age, type of lymphoma, stage of the disease, presence of B symptoms).
    • Good prognosis linked to Young age, Stages I or II, Female gender, and Lymphocytic predominance.

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