Questions and Answers
What are the two types of lymphoma?
Hodgkins Lymphoma and Non-Hodgkins Lymphoma
What are the major risk factors for Hodgkins Lymphoma?
Infections (e.g., EBV, HIV), age distribution, gender (more common in males), socioeconomic status, geographic location, and family history.
What are some clinical manifestations of Hodgkins Lymphoma?
Palpable, non-tender lymphadenopathy (often in cervical, supraclavicular, or axilla areas), anterior mediastinal mass, B-symptoms (unexplained weight loss, fever, night sweats), and possible extranodal sites involvement.
What cell is considered the hallmark cell of Hodgkins Lymphoma?
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What are some possible risk factors for Non-Hodgkins Lymphoma?
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Diffuse large B cell lymphoma is a slow-growing type of NHL.
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______ lymphoma is the 2nd leading cause of NHL and tends to grow in a circular pattern in LNs.
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Match the following types of B cell NHL with their descriptions:
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What is the origin of lymphoma?
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Where can lymphomas originate in the body?
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What is the trend of incidence of Hodgkin lymphoma?
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What is the cell of origin in Hodgkin lymphoma?
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What is the role of EBV in the development of Hodgkin lymphoma?
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What is the characteristic of Reed-Sternberg cells in Hodgkin lymphoma?
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What is the ranking of lymphoma in terms of frequency of diagnosis in both sexes?
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What is the trend of incidence of Non-Hodgkin lymphoma?
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What percentage of Hodgkin's Lymphoma is classified as Nodular sclerosis?
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Which of the following is a risk factor for Hodgkin's Lymphoma?
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What is the most common location of palpable lymphadenopathy in Hodgkin's Lymphoma?
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What percentage of normal spleens harbour tumor in Hodgkin's Lymphoma?
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What is the percentage of Hodgkin's Lymphoma patients with B-symptoms in Ethiopia?
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What is the characteristic of lymphadenopathy in Hodgkin's Lymphoma?
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What percentage of Hodgkin's Lymphoma is limited to below the diaphragm?
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What is the correlation between B-symptoms and disease prognosis in Hodgkin's Lymphoma?
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What is the definition of a mediastinal mass in lymphoma?
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What is the most common histologic type of NHL?
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What is the average age of patients with diffuse large B cell lymphoma?
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What percentage of patients with diffuse large B cell lymphoma have non-nodal sites involved?
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What is the risk of CNS involvement in patients with diffuse large B cell lymphoma?
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What percentage of patients with diffuse large B cell lymphoma are cured after initial treatment?
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What is the significance of unexplained weight loss of more than 10% in 6 months in Hodgkin Lymphoma?
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What is the purpose of staging in Hodgkin Lymphoma?
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What is the most common type of biopsy used for Hodgkin Lymphoma?
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What is the significance of a mediastinal mass in Hodgkin Lymphoma?
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What is the purpose of a PET scan in Hodgkin Lymphoma?
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What is the definition of Stage I in the Ann Arbor staging system?
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What is the significance of bulky disease in Hodgkin Lymphoma?
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What is the purpose of ESR and serum ferritin in the investigation of Hodgkin Lymphoma?
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What is the cure rate of Burkett's lymphoma if treated?
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In which region is the endemic form of Burkett's lymphoma commonly found?
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What is the primary method of diagnosing Non-Hodgkin lymphoma?
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Which of the following is a good prognostic indicator in Non-Hodgkin lymphoma?
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What is the primary factor that the International Prognostic Index (IPI) depends on?
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What is a common symptom of Non-Hodgkin lymphoma?
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What is the term for the characteristic appearance of Burkett's lymphoma cells under the microscope?
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In which group of patients is Burkett's lymphoma more common?
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Study Notes
Lymphoma: Definition and Classification
- Lymphoma is a clonal malignant disorder derived from lymphoid cells (either precursor or mature T-cell or B-cell)
- There are two types of lymphoma: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL)
Epidemiology of Lymphomas
- 5th most frequently diagnosed cancer in both sexes
- Males > females
- Incidence: HL stable, NHL increasing (8-10 times more than HL)
Hodgkin's Lymphoma
- Named after Thomas Hodgkin
- Cancer of lymphocytes, almost always starts from B subtype
- Can start at any lymphoid tissue, mostly in the upper part of the body
- Spreads in contiguous manner, rarely hematogenous
- Prototype cell is the Reed Sternberg cell
- Cell of origin: germinal center B-cell
- Etiology: infection (EBV) may cause DNA changes in B lymphocytes, leading to Reed-Sternberg cells
Classification of HL
- Based on microscopic features
- Different types may be treated differently
- All types are malignant, no benign type
- Generally, there are two types: Classic HD and Nodular lymphocytic predominant
Risk Factors for HL
- Infections (e.g., EBV, HIV)
- Age: bimodal distribution
- Gender: more common in males
- Socioeconomic status: higher status
- Geographic location: more common in Western countries, less common in Asians
- Family history: accounts for 5%, twins have a higher risk
Clinical Manifestations of HL
- Variable severity: asymptomatic to extremely ill
- Time course: evolution over weeks, months, or years
- Most patients present with palpable, non-tender lymphadenopathy
- Contiguous spread
- The size may change spontaneously
- Alcohol-induced pain at the site
Staging of HL
- Used to determine the extent of spread, prognosis, and treatment options
- Based on medical history, physical examination, blood tests, biopsy, and imaging tests
- Ann Arbor staging system with Cotswold modification
Non-Hodgkin Lymphoma (NHL)
- More than 60 types, including Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma, Marginal Zone B Cell Lymphoma, and Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma
Types of B Cell NHL
- Diffuse Large B Cell Lymphoma (DLBCL): most common histologic type, appears large under the microscope, average age 60, majority present in advanced stage
- Follicular Lymphoma: 2nd leading cause of NHL, grows in a circular pattern in LNs, average age 60, slow-growing
- Marginal Zone B Cell Lymphoma: 2nd most common indolent lymphoma, 3 types: splenic MZL, Extranodal MZL of MALT, and nodal MZL
Diagnosis of NHL
- History: progressively enlarged LNs, swollen abdomen, chest pain or pressure, SOB, B symptoms, and extreme tiredness
- Physical examination: focuses on LN and spleen examinations
- Biopsies: excisional/incisional biopsies, fine/core needle biopsies, bone marrow aspiration/biopsies, LP, effusion analysis
- Lab tests: immuno-histochemistry tests, flow cytometer, cytogenetic, molecular genetic tests
- Blood tests: LDH, HIV, HCV, HTLV-1, and HHV-8
Staging of NHL
- Tests for staging: history, physical examination, biopsies, blood tests, imaging tests, and bone marrow studies
- Ann Arbor staging system is also adopted for NHL
International Prognostic Index
- Depends on age, stage, extension from the lymph node, performance in daily activities, and serum LDH level
- Good prognostic indicators: age, low stage, and good performance status
Lymphoma Definition and Types
- Lymphoma is a clonal malignant disorder that originates from lymphoid cells, either precursor or mature T-cell or B-cell.
- There are two main types of lymphoma: Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL).
Epidemiology of Lymphomas
- Lymphoma is the 5th most frequently diagnosed cancer in both sexes.
- The incidence of lymphoma is higher in males than females.
- Hodgkin's Lymphoma has a stable incidence, while Non-Hodgkin's Lymphoma is increasing (8-10 times HL).
Hodgkin's Lymphoma (HL)
- Named after Thomas Hodgkin.
- It is a cancer of lymphocytes, almost always originating from B subtype cells.
- It usually starts in lymphoid tissues, mostly in the upper part of the body.
- The course of the disease is variable, but prognosis has improved with modern treatment.
- The prototype cell is the Reed Sternberg cell, which is a hallmark of HL.
- Etiology is linked to infection, particularly EBV, which can cause DNA changes in B lymphocytes, leading to the development of Reed-Sternberg cells.
Classifications of HL
- Classification is based on microscopic features.
- There are four types of Classic HL: Nodular sclerosis, Mixed cellularity, Lymphocytic rich, and Lymphocytic depletion.
- Nodular lymphocytic predominant HL is a rare type.
Risk Factors for HL
- Infections, such as EBV and HIV.
- Age (bimodal distribution).
- Gender (more common in males).
- Socioeconomic status (higher status).
- Geographic location (more common in Western countries).
- Family history (accounts for 5%, with twins having a higher risk).
Clinical Manifestations of HL
- Variable severity, from asymptomatic to extremely ill.
- Time course: evolution over weeks, months, or years.
- Most patients present with palpable, non-tender lymphadenopathy.
- Contiguous spread.
- The size of the LAP may change spontaneously.
- Alcohol-induced pain at the site.
Staging of HL
- Used to determine the extent of spread, to assess prognosis, and decide treatment options.
- Based on medical history, physical examination, blood tests, biopsy of LAP, BM aspiration and biopsies, and imaging tests.
Investigation and Diagnosis of HL
- CBC: Mild to moderate anemia is common in HL.
- ESR, serum ferritin, and haptoglobulin tests.
- CXR: demonstrates mediastinal mass, hilar LAP, pleural effusion, and parenchymal lung lesions.
- CT scan/PET scan: for staging.
- Biopsy: excisional/incisional biopsy, core needle biopsy, and BM aspiration/biopsies.
- Immuno-histocompatibility tests.
Ann Arbor Staging of HL
- Stage I: HD found in only one lymph node area or lymphoid tissue/organ.
- Stage II: HD found in two or more lymph node areas on the same side of the diaphragm.
- Stage III: HD found in lymph node areas on both sides of the diaphragm.
- Stage IV: Diffuse or disseminated involvement of ≥1 extranodal organs beyond that designated as E.
Non-Hodgkin's Lymphoma (NHL)
- Types of B-cell NHL:
- Diffuse large B-cell lymphoma (DLBCL): the most common histologic type of NHL.
- Burkitt's lymphoma: a highly aggressive form of NHL, but with a high cure rate if treated.
Diagnosis of NHL
- History: focused on LN, spleen examinations, and B symptoms.
- P/E: focused on LN and spleen examinations.
- Biopsies: excisional/incisional biopsies, fine/core needle biopsies, and BM aspiration/biopsies.
- Lab tests: immuno-histochemistry, flow cytometer, cytogenetic, and molecular genetic tests.
- Blood tests: LDH level.
- Imaging: CXR, CT scan, MRI, PET, and bone scan.
Staging of NHL
- Tests for staging: Hx, P/E, biopsies, blood tests, imaging tests, and bone marrow studies.
- Ann Arbor staging is also adopted for NHL.
International Prognostic Index (IPI)
- Depends on age, stage, extension from the lymph node, performance in daily activities, and serum LDH level.
- Good prognostic indicators: age, stage, and performance in daily activities.
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Description
Assess your knowledge of lymphoma, a type of cancer that affects the immune system. This quiz covers the types, risk factors, clinical presentation, diagnostic modalities, staging, and management options of lymphoma, as well as the side effects of chemotherapy.
