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59 Cards in this Set
- Front
- Back
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What is a lymphoma?
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A lymphomas is a proliferation of lymphocytes which typically presents with enlargement of the spleen and/or lymph nodes.
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What organs are commonly infiltrated by lymphoma?
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Liver, lung and bowel
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What type of lymphoma is on the rise?
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Incidence of Non-Hodgkin's Lymphoma has been on the rise for 60 years.
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How is the diagnosis of lymphoma made?
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Lymphoma Dx is based on excisional biopsy of a centrally-involved lymph node.
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How is Hodgkin's Lymphoma staged?
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By the degree of dissemination of the disease.
Stage 1 - Single node Stage 2 - Multiple nodes, same side of diaphragm Stage 3 - Multiple nodes, both sides of diaphragm Stage 4 - Disseminated disease with extra-lymphatic involvement |
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What is the characteristic histologic finding in Hodgkin's Lymphoma?
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The "Reed-Sternberg" Cell
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What composes the bulk of a Hodgkin's tumor?
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Unlike other malignancies, most cells in a Hodgkin's tumor are normal. Only a few are the binucleate "Reed-Sternberg" cells.
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What the two broad sub-types of Hodgkin's Lymphoma?
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1) Classical Hodgkin's
2) Nodular Lymphocyte Predominant Hodgkin's Disease (NLPHD) |
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What are the four sub-types of Classical Hodgkin's Disease?
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1) Lymphocyte Rich (rare - good prog.)
2) Nodular Sclerosis (50% - good prog.) 3) Mixed Cellularity (40% - med. prog.) 4) Lymphocyte Depletion (5% - worst prog.) |
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What are B-Symptoms in Hodgkin's Disease?
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Constitutional symptoms: fever, night sweats, unexplained weight loss of more than 10% in the past 6 months.
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What imaging technique can differentiate an active HD tumor?
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PET Scan
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What is the primary goal in the treatment of Hodgkin's Disease?
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HD is treated for CURE, so accurate staging and chemotherapy is critical.
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What is the therapy for Hodgkin's Disease? What are the cure rates?
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Limited Chemo + Limited Radiation. Cure rates are 70-90%
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What is the modern chemo regimen for Hodgkin's Disease?
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Hodgkin's: ABVD
A - Adriamycin B - Bleomycin V - Vinblastine D - DTIC |
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What are the older chemo regimens for Hodgkin's Disease?
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MOPP
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How is prognosis and therapy determined for Non-Hodgkin's Lymphomas (NHLs)?
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The histologic pattern seen in involved lymph nodes.
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What are the two most important lymph features in NHL?
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1) Overall architecture (diffuse or clustered)
2) Individual tumor cell appearance (large vs. small cells) |
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From what cell lines are NHL tumors derived?
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85% from B-Cells
15% from T-Cells |
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What are the two types of NHL classifications for this course?
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"Indolent/Low Grade" and "Aggressive/Intermediate & High Grade"
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Describe the Classification, Histology, Mean survival, and Chemo for NHL.
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What is the typical clinical presentation of NHL?
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Painless Adenopathy.
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Which lymphomas are curable?
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Aggressive lymphomas are often more curable than indolent ones.
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What chemotherapy drug seems to be key in curing aggressive lymphoma?
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Doxorubicin (Adriamycin)
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What are the treatment options for INDOLENT NHL?
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Stage 1-2 Indolent: radiotherapy alone (50% cure)
Stage 3-4: no therapy, or chlorambucil, CVP and/or rituximab (CD20) |
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What does Rituximab recognize?
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The CD20 antigen
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What's CVP, and what disease is it used for?
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CVP is a chemo regimen for Indolent Stage 3-4 NHL
* Cyclophosphamide * Vincristine * Prednisone |
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What is the standard chemo for an Aggressive Non-Hodgkin's Lymphoma?
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CHOP:
* Cyclophosphamide * Doxorubicin (Hydroxydaunorubicin) * Vincristine (Oncovin) * Prednisone |
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How often can remission be induced with CHOP therapy for NHL?
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60-80% of aggressive NHL patients will go into remission
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What is a Plasma Cell Dyscrasia?
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Disorders of the plasma, or B-Cells, that often generate extra antibodies. Examples are multiple myeloma and Waldenstrom's macroglobulinemia.
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Describe the following Serum Protein Electrophoresis (SPEP) curves:
1) Normal Pattern 2) Polyclonal Gammopathy 3) Monoclonal Gammopathy 4) Hypogammaglobulinemia |
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What are the four major Plasma Cell Dyscrasias?
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1) Multiple Myeloma
2) Waldenstrom's Macroglobulinemia 3) Primary Amyloidosis 4) Monoclonal Gammopathy of Undetermined Significance (MGUS) |
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What are the four clinical manifestations of the plasma cell disorders?
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1) the tumor
2) Paraproteins made by the tumor 3) Decreased normal Ig proteins 4) Other factors produced by the tumor |
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What is Mutiple Myeloma?
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A malignant disorder characterized by the monoclonal proliferation of plasma, or "myeloma," cells.
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How does MM typically present?
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MM commonly presents as "bone pain," esp. in the vertebrae, ribs and long bones. Anemia, thrombocytopenia and neutropenia are common.
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What are focal collections of myeloma cells called? How might they present?
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Plasmacytomas, which might present as subcutaneous nodules.
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Why are lytic lesions common in MM?
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MM tumor cells produce TNF-Beta, which activates osteoclasts and increases bone resorption.
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What is the most common lab abnormality in MM?
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A hypo-proliferative anemia, along with "rouleax" RBCs.
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What is a "rouleaux" finding?
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RBCs stacking on the peripheral smear. Increased serum IgG binds to RBCs, decreasing the normal ionic repulsion between them.
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What is the key diagnostic tool in MM?
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Serum Protein Electrophoresis (SPEP). A prominent MONOCLONAL M-Spike will show.
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What classic urine finding is associated with MM?
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Bence Jones Proteinuria. About 10% of MM will produce the Ig Light Chain proteins, which are small enough to be excreted in the urine.
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What are the marrow findings with MM? Is marrow biopsy a required test with MM?
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MM requires marrow biopsy. Typical findings include 10-30% malignant plasma cells. Easier to detect on biopsy than aspirate.
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What are the 4 diagnostic characteristics of MM?
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1) >10% abnormal plasma marrow cells
2) Serum or urine monoclonal gammopathy 3) Lytic bony lesions 4) Plasmacytomas Not all features are required to make the diagnosis. |
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What are the common clinical complications of MM?
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1) Renal Failure
2) Pathologic Fractures 3) Paraprotein assoc. with hyperviscosity |
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What are the issues commonly associated with high levels of paraprotein in MM?
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1) Hyperviscosity leading to vascular stasis
2) Interference with platelet function leading to mucosal bleeding 3) Suppression of normal plasma cell growth and decreased normal Ig |
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Is there a curative therapy for MM?
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No, only palliative therapies and stem cell transplant.
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What is a suggested palliative chemotherapy for MM?
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1) Thalidomide & Dexamethasone
2) Lenalidomide & Dexamethasone 3) Lenalidomide & Bortezomib (relapse) |
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How might local MM plasmacytomas be managed?
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Local radiation therapy may be used to control painful tumors.
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What can be done about bone resorption in MM?
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Bisphosphonates reduce bone resorption in MM, and may even be toxic to tumor cells.
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What is Waldenstrom's Macroglobulinema?
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A hyperviscous plasma disease similar to MM.
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What proteins are produced in WM? Is this clinically important?
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IgM proteins. Because they are so large, complications of hyperviscosity are more common on WM.
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What are the symptoms of hyperviscosity syndrome?
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1) Headache
2) Confusion 3) Visual disturbances 4) Difficulty hearing 5) Coma |
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What is the "Classic Triad of Hyperviscosity?"
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1) Bleeding (epistaxis, ecchymosis)
2) Visual changes (blurred) 3) Neurologic changes (HA, dizziness) |
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What are the laboratory findings in WM?
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Marked increase in IgM in Serum Plasma Electrophoresis. Pancytopenia is possible with extensive marrow replacement
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How is WM treated?
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There is no cure for WM. Drugs include:
* Chlorambucil * Fludarabine * Rituximab |
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What is the median survival time for WM?
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Approx. 5 years
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How is hyperviscosity managed acutely?
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Plasmapheresis
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What are the clinical features of Amyloidosis?
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Fatigue, weakness, weight loss, dyspnea, purpura and EDEMA.
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How is Amyloidosis diagnosed?
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Isolation of amyloid protein with apple-green birefringence in tissue samples. Bone marrow biopsy is also performed
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What does Congo Red staining in the marrow indicate?
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Amyloidosis
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