Patho MO2 lesson 3 Lymphoma

Which is true of Hodgkin's lymphoma (HL) arising above the diaphragm? Lacks Reed-Sternberg cells Causes frequent B symptoms Presence of natural killer cells Arises in solid organs outside the lymphatic system

Causes frequent B symptoms Hodgkin's lymphoma arising above the diaphragm frequently causes B symptoms, including fever, night sweats, and weight loss Hodgkin's lymphoma that arises out of the diaphragm is diagnosed by the presence of Reed-Sternberg cells.. Natural killer cells are not present with HL arising above the diaphragm. HL arises in lymph nodes above the diaphragm, not in solid organs.

Non-Hodgkin's lymphoma uses the World Health Organization (WHO) and Revised European-American Lymphoma (REAL) classification system. Which is the basis of the classification? Cell of origin Lymph node location Extranodal organ of origin Location in respect to the diaphragm

Cell of origin WHO and REAL have classified non-Hodgkin's lymphoma on the cell of origin. Non-Hodgkin's lymphoma can arise from B cells, T cells, or natural killer cells.

In which body part does Hodgkin's lymphoma typically begin? Liver Spleen Cervical lymph nodes Inguinal lymph nodes

Cervical lymph nodes Hodgkin's lymphoma typically begins in one cervical lymph node or group of cervical lymph nodes.

Which describes lymph nodes in non-Hodgkin's lymphoma? Enlarged and moveable Enlarged and immoveable Smaller than normal and moveable Smaller than normal and immoveable

Enlarged and moveable The lymph nodes in non-Hodgkin's lymphoma are enlarged and moveable. They can be found in a single region of the body or spread throughout the body.

While non-Hodgkin's lymphoma and Hodgkin's lymphoma differ in their presentation, they do share some characteristics. Which pathophysiology do they share? Arise from T cells Extranodal involvement Contain Reed-Sternberg cells B symptoms that occur equally

Extranodal involvement Non-Hodgkin's and Hodgkin's lymphoma can both have extranodal involvement, which is the spreading of the lymphoma to organs.

Hodgkin's Lymphoma Presence of B symptoms

Frequently present and may be among the first symptoms experienced by the patient.

Cancer survival rates vary. Which is the long-term survival rate for Hodgkin's lymphoma? 10% 20% 50% greater than 80%

Greater than 80% The long-term survival rate for Hodgkin's lymphoma is greater than 80%

Hodgkin's lymphoma (HL) occurs more frequently in men than women and more frequently in whites than blacks. It is prevalent in individuals diagnosed with _____

HIV.

Hodgkin's lymphoma and non-Hodgkin's lymphoma has a greater likelihood of being accompanied by B symptoms (fever, night sweats, and weight loss) than does non-Hodgkin's lymphoma.

Hodgkin's

Which characteristics accurately describe the clinical manifestations of Hodgkin's lymphoma? Insidious onset Cough and dyspnea Painful, movable lymph nodes Possible progression to extranodal involvement Initial enlarged lymph nodes felt below diaphragm

Insidious onset Hodgkin's lymphoma has an insidious onset, meaning it comes on slowly. Cough and dyspnea A cough and dyspnea may develop with Hodgkin's lymphoma, particularly when lymph nodes in the mediastinum are involved. Possible progression to extranodal involvement In the later stages of the disease, Hodgkin's lymphoma may progress to extranodal involvement, such as spreading to the liver.

Non-Hodgkin's Lymphoma Presence of B symptoms (fever, night sweats, weight loss)

May be present in a high-grade or (more severe) form of the disease.

Hodgkin's Lymphoma Extranodal involvement

May spread outside the lymphatic system to solid organs.

which lymphoma is more common

Non-Hodgkin's lymphoma (NHL) is more common than Hodgkin's lymphoma. It is associated with aging and the use of immunosuppressant medications.

Which factors increase the likelihood of developing non-Hodgkin's lymphoma? Over age 60 HIV infection Female gender Epstein-Barr virus Immunosuppressant drugs

Over age 60 People over age 60 are more prone to developing non-Hodgkin's lymphoma than younger people. HIV infection HIV infection lowers the immune response, which increases the likelihood of non-Hodgkin's lymphoma arising. Epstein-Barr virus Infection with the Epstein-Barr virus increases the likelihood of developing non-Hodgkin's lymphoma. Immunosuppressant drugs mmunosuppressant drugs suppress the immune system, making non-Hodgkin's lymphoma more likely.

Epidemiology of Hodgkin's Lymphoma The classic form develops from the malignant lymphocytes called _______ cells, which are abnormally large multinucleated cells located in the ______________. The cause is usually unknown. Hodgkin's lymphoma is staged I-IV, ranging from stage I, in which the cancer is less widespread, to stage IV in which the cancer is the most advanced. Survival rates vary by stage, with stages I and II having the highest survival rates.2

Reed-Sternberg lymph nodes

Epidemiology of Hodgkin's Lymphoma Predisposing factors HL develops from the proliferation of ________________ cells, which are abnormal, giant, multinucleated cells found in the lymph nodes. Predisposing factors in the development of HL include infection with the Epstein-Barr virus (EBV), a genetic predisposition, and exposure to occupational toxins. Individuals with human immunodeficiency virus (HIV) have an increased incidence of HL.

Reed-Sternberg cells

Summary HL is differentiated from NHL by the presence of lymphocytes called . HL may arise from B cells but more often arises from ____ cells, which are abnormal, giant, multinucleated cells. The disease manifests initially in the lymph nodes above the diaphragm and then spreads to lymph nodes below the diaphragm. HL can become extranodal as the disease advances.

Reed-Sternberg cells

Hodgkin's lymphoma is diagnosed by the presence of which specific cells? B cells Lymphocytes Natural killer cells Reed-Sternberg cells

Reed-Sternberg cells Hodgkin's lymphoma is diagnosed by the presence of Reed-Sternberg cells, which are lymphocytes that have become malignant. They are frequently large and binucleate.

Hodgkin's lymphoma is distinguished by the presence of malignant lymphocytes called

Reed-Sternberg cells.

Hodgkin's lymphoma is distinguished by the presence of malignant lymphocytes called_____ cells

Reed-Sternberg cells.

B cell of origin to the type of lymphoma. Lymphocytic lymphoma (SLL)

Small B lymphocytes

Which are the prevalent clinical manifestations of non-Hodgkin's lymphoma? Select all that apply. Splenomagaly Painless lymph nodes Enlarged lymph nodes Non-movable lymph nodes Symptoms arising in organs outside the lymphatic system

Splenomagaly Splenomegaly (an enlarged spleen) can be a secondary problem in non-Hodgkin's lymphoma. Painless lymph nodes The lymph nodes in non-Hodgkin's lymphoma are usually painless. Enlarged lymph nodes Enlarged lymph nodes are a prevalent clinical finding of non-Hodgkin's lymphoma. Symptoms arising in organs outside the lymphatic system Symptoms in non-Hodgkin's lymphoma may arise in organs outside the lymphatic system.

Non-Hodgkin's Lymphoma Cells (lymphocytes) involved

1- B-lymphocyte cells 2- T cells or natural killer (NK) cell neoplasms Reed-Sternberg cells are absent. Arises more frequently in B cells than T cells in the United States, but may first appear in any lymph tissue.

Non-Hodgkin's Lymphoma Extent of disease

1- May arise in the lymph nodes or other solid organs present outside the lymphatic system. 2- Scattered node involvement and pattern of metastases is non-organized.

Pathophysiology of Hodgkin's Lymphoma -HL is diagnosed by the presence of ______1____cells in the lymph nodes. -RS cells are ___2____that have transformed to become malignant. -RS cells are frequently large and binucleate (having two nuclei). -HL typically begins in one __3___lymph node or a group of lymph nodes. -HL spreads from lymph nodes above the diaphragm to lymph nodes below the diaphragm. -The disease spreads through the lymph system and can then invade other organs, commonly the spleen, liver, and lungs (referred to as __4___).

1- Reed-Sternberg (RS) cells 2- lymphocytes 3- cervical 4- extranodal

Hodgkin's lymphoma usually first manifests in ___1____or other lymph nodes situated above the diaphragm, then progresses to lymph nodes below the diaphragm.

1- cervical

Hodgkin's Lymphoma Cells (lymphocytes) involved

-B cells, but not T cells or natural killer cells -Reed-Sternberg cells are present. Typically begins in one cervical lymph node or group of cervical lymph nodes.

Stages of Hodgkin's Lymphoma Hodgkin's lymphoma progresses in stages which are used to describe the extent of the disease: Stage I: This stage is characterized by the presence of the disease in a single lymph node region, such as ____1___-lymph nodes. Stage II: This stage indicates the presence of the disease in two or more lymph node regions but still on the same side of the __2___. Stage III: This stage is characterized by further spread of the disease to lymph node regions above and below the diaphragm, and may include involvement of the __-3___. Stage IV: In this stage, the disease is widespread and __4__, affecting one or more organs such as the liver or intestine.

1- cervical 2- diaphragm 3- spleen 4- extranodal

Summary HL usually begins in__1__ lymph nodes spreads to other lymph nodes above the diaphragm, and then moves to lymph nodes below the diaphragm. It may or may not progress to extranodal malignancy as the disease advances. HL has a greater likelihood than NHL of being accompanied by B symptoms (fever, night sweats, and weight loss).

1- cervical lymph nodes,

Clinical Manifestations of Hodgkin's Lymphoma -Hodgkin's lymphoma usually has an insidious onset. -Initial enlarged lymph nodes are usually those in the ____1____ regions, followed by those in the mediastinum. -Mediastinum involvement may be indicated by cough, dyspnea, stridor, and dysphagia. -Individual nodes are movable and not painful unless pressing on nerves. -Initial findings may include B symptoms of weight loss, fatigue, and fever, as well as chills, weakness, and tachycardia. -Drinking even small amounts of alcohol may result in the rapid onset of pain at site of disease -Pruritus may develop. -Hepatomegaly and splenomegaly may occur as the disease progresses. -Anemia develops as erythrocytes are increasingly destroyed and production declines. -Additional clinical signs depend on the location of the disease.

1- cervical, axillary, or inguinal regions

Summary In NHL, the first symptom may be ___1____in any area of the body; or the NHL may be extranodal. When NHL is extranodal, the initial clinical manifestations are specific to the ___2___

1- enlarged lymph nodes 2- involved organ.

Comparison of Hodgkin's and Non-Hodgkin's Lymphoma All lymphomas are ___1____(tumors) that arise when ___2____in the lymph nodes proliferate and transform into malignant cells. Non-Hodgkin's lymphoma and Hodgkin's lymphoma share some characteristics but are also unique in their presentation and are differentiated by____3____

1- neoplasms 2- lymphocytes 3- lymph node biopsy.

Pathophysiology of Hodgkin's Lymphoma Lymph nodes are made of a fine mesh of __1____fibers surrounded by ___2__tissue which is destroyed in Hodgkin's lymphoma due to hyperplasia of __3____ and ___4___. Diagnostically, Hodgkin's lymphoma shows the presence of Reed-Sternberg cells when the lymph nodes are biopsied. In 90% of people diagnosed with Hodgkin's lymphoma, the disease begins in the lymph nodes, typically in the ___5___region, and then travels through the lymphatic system to the nearest lymph node. However, if the disease is recurring, it does not necessarily travel from lymph node to lymph node in a sequential way, but rather may appear scattered throughout the lymphatic system. Hodgkin's lymphoma arising above the __6____affects only the lymph nodes for a period of time. However, when the disease begins below, it often spreads to other organs.

1- reticular 2- connective 3- monocytes 4- macrophages 5- cervical 6- diaphragm

Clinical Manifestations of Hodgkin's Lymphoma The most common initial symptom of Hodgkin's lymphoma is a __1__-which can be felt in the cervical, axillary, or inguinal region caused by one or more enlarged lymph nodes. These usually are not painful. Other lymph nodes may become involved as the disease progresses through the lymphatic system. If the disease continues to advance, it can spread from the lymph system to other organs such as the ___2___ or __-3___, resulting in additional clinical signs and symptoms.

1- swelling 2- liver 3- spleen

Epidemiology of Hodgkin's Lymphoma Prevalence Hodgkin's lymphoma is responsible for about 11% of lymphomas. HL tends to occur between the ages of________ years or after the age of 55. It is rare in children. HL occurs twice as frequently in men as in women. HL occurs twice as frequently in whites compared to blacks. The long-term survival rate for HL is more than 80%

15-40 white men

Which are accurate statements regarding the epidemiology of non-Hodgkin's lymphoma? Select all that apply. 1- Leading cause of cancer-related deaths 2- Occurs more frequently in men than women 3- Occurs more frequently in blacks than whites 4- Most common form of blood-related cancers 5- Decreasing in incidence over the past 30 years

2 4

At which ages does Hodgkin's lymphoma usually occur? Select all that apply. 1- In children 2- During infancy 3- In the pre-teen years 4- After 55 years of age 5- Between 15-40 years of age

4 5

B cell of origin to the type of lymphoma. Burkitt's lymphoma

B cell blasts

B cell of origin to the type of lymphoma. Hodgkin's lymphoma

B cells

Hodgkin's lymphoma is the result of ____ cells which have become malignant.

B cells

Hodgkin's lymphoma is the result of _____ cells which have become malignant.

B cells

Summary NHL and HL differ by the cell of origin. NHL arises from lymphocytes called . It can arise in the lymph nodes in any body region or it can be extranodal, manifesting in organs outside the lymphatic system.

B cells, T cells, or natural killer (NK) cells

Pathophysiology of Non-Hodgkin's Lymphoma Non-Hodgkin's lymphomas arise from _______________________3 cells—lymphocytes within the lymph nodes, which can be in various stages of development or may have stopped developing. _______cells account for about 88% of all non-Hodgkin's lymphomas. NHL may be fast or slow growing.

B cells, T cells, or natural killer (NK) cells B cells more common

Non-Hodgkin's lymphomas arise from __________________ that are in various stages of development.

B cells, T cells, or natural killer (NK) lymphocytes

Non-Hodgkin's lymphomas arise from what 3 cells that are in various stages of development.

B cells, T cells, or natural killer (NK) lymphocytes

Clinical Manifestations of Non-Hodgkin's Lymphomas The symptoms of non-Hodgkin's lymphoma (NHL) vary. These are the most prevalent symptoms and clinical findings: 1- Enlarged lymph nodes, usually painless and moveable, are found in one region of the body or spread throughout the body. 2- Extranodal lymphomas are seen when malignant cells invade major organs, causing compression and organ dysfunction (e.g., metastasis to the brain causing neurological impairments). 3- ___ (constitutional) symptoms are seen, e.g., fever, night sweats, and weight loss occur; also fatigue, malaise, and pruritus. 4- Blood work can mimic leukemia but is usually normal in the beginning of the illness. 5- Hypermetabolism (due to rapidly proliferating cancer cells) may result in anemia, leukopenia, and autoimmune disorders. 6- Obstruction of the airway and tumor lysis syndrome (this usually is caused by chemotherapy and does not occur spontaneously) cause hyperuricemia and renal failure, cardiac tamponade, and gastrointestinal problems may manifest. 7- Lymphadenopathy, splenomegaly, and lymphocytosis (lymphatic leukemia) are possible.

B symptoms

Hodgkin's lymphoma has a greater likelihood of being accompanied by ___ symptoms (fever, night sweats, and weight loss) than does non-Hodgkin's lymphoma.

B symptoms

Which is a predisposing factor for Hodgkin's lymphoma? Being female Being HIV positive Being African American Undergoing chemotherapy

Being HIV positive

Which are predisposing factors for non-Hodgkin's Lymphoma? Genetic predisposition Being over the age of 60 Receiving radiation therapy Having an autoimmune disease Exposure to chemicals in the environment

Being over the age of 60 The risk for all lymphomas is increased in individuals over the age of 60 years. Receiving radiation therapy Receiving radiation therapy increases the risk for non-Hodgkin's lymphoma. Having an autoimmune disease Having an autoimmune disease is a predisposing factor for non-Hodgkin's lymphoma. Exposure to chemicals in the environment The risk for non-Hodgkin's lymphoma is increased by exposure to chemicals in the environment.

Which are possible progressions for the spread of Hodgkin's lymphoma? Liver to cervical lymph nodes Cervical lymph nodes to axillary lymph nodes Inguinal lymph nodes to cervical lymph nodes Mediastinum lymph nodes to axillary lymph nodes Inguinal lymph nodes to mediastinum lymph nodes

Cervical lymph nodes to axillary lymph nodes Hodgkin's lymphoma typically begins in the cervical lymph nodes, and then spreads to the axillary lymph nodes. Inguinal lymph nodes to cervical lymph nodes Hodgkin's lymphoma may begin in the inguinal lymph nodes, and then moves up to the cervical lymph nodes. Mediastinum lymph nodes to axillary lymph nodes Hodgkin's lymphoma may progress from the mediastinum lymph nodes to the axillary lymph nodes. Inguinal lymph nodes to mediastinum lymph nodes Hodgkin's lymphoma may begin in the inguinal lymph nodes, and then progresses to the mediastinum lymph nodes.

Which are the four common initial clinical manifestations of Hodgkin's lymphoma? Select all that apply. Cough B symptoms Hepatomegaly Movable lymph nodes Enlarged lymph nodes in the axillary region

Cough A cough can be a clinical sign of mediastinal lymph node involvement in Hodgkin's lymphoma. B symptoms B symptoms (fever, night sweats, and weight loss) can be an initial clinical sign of Hodgkin's lymphoma. Movable lymph nodes Movable, enlarged lymph nodes are an initial finding in Hodgkin's lymphoma. Enlarged lymph nodes in the axillary region Enlarged lymph nodes in the axillary region are one of the initial manifestations of Hodgkin's lymphoma.

B cell of origin to the type of lymphoma. Most common aggressive lymphoma

Diffuse large B cell

Which would be the clinical manifestations in a patient with stage III Hodgkin's lymphoma? Presence of the disease in a single lymph node region, such as cervical lymph nodes Widespread and extranodal disease, affecting one or more organs, such as the liver or intestine Presence of the disease in two or more lymph node regions but still on the same side of the diaphragm Spread of the disease to lymph node regions above and below the diaphragm and possible involvement of the spleen

Spread of the disease to lymph node regions above and below the diaphragm and possible involvement of the spleen In stage III of Hodgkin's lymphoma, the patient would show spread of the disease to lymph node regions above and below the diaphragm and may also have involvement of the spleen.

Hodgkin's Lymphoma Extent of disease

Spreads from lymph nodes above the diaphragm to nodes present below the diaphragm.

Non-Hodgkin's Lymphoma Extranodal involvement

Usually spreads beyond lymphatic system

Non-Hodgkin's lymphoma (NHL) is more common than Hodgkin's lymphoma. It is associated with

aging and the use of immunosuppressant medications.

Other Types of Lymphoma 1- Other lymphomas arising from B cells include: Lymphocytic lymphoma (SLL) arising from small B-lymphocytes. 2- Chronic lymphocytic leukemia (CLL) arising primarily from_______2_____ 3- Diffuse large B cell lymphoma that originate in the ______3______—the most common aggressive lymphoma. 4-Burkitt's lymphoma, the most highly aggressive lymphoma, most likely arises from_____4_____- in the lymph nodes.

arising from 1- B cells= lymphocytic lymphoma 2- bone marrow 3- lymph nodes 4- B cells blast

Hodgkin's lymphoma usually first manifests in ______or other lymph nodes situated above the diaphragm, then progresses to lymph nodes below the diaphragm.

cervical

The initial clinical symptom for non-Hodgkin's lymphoma can be swelling of one or more lymph nodes in one or more regions of the body (e.g.,____________________ ).

cervical, axillary, or inguinal

Pathophysiology of Non-Hodgkin's Lymphoma -Classifications of NHL now follow the World Health Organization (WHO)/Revised European-American Lymphoma (REAL) classification based on the cell of origin. -The clinical presentation of these malignancies varies because the stages of cell development differ. -NHL is characterized by multiple scattered node involvement and a non-organized pattern of widespread metastases. -NHL may arise from organs outside the lymphatic system, such as in solid organs, and are then referred to as __________lymphomas. -NHL can mimic some leukemias, including lymphocytic lymphoma (SLL) and chronic lymphocytic leukemia (CLL).

extranodal

Hodgkin's lymphoma usually develops in the _________and can then spread to other organs.

lymph nodes

Lymphomas collectively are a group of malignant hematologic diseases of ________of which there are no benign forms.

lymphocytes

Epidemiology of Non-Hodgkin's Lymphoma Predisposing factors -Most lymphomas in adults occur in individuals over ____ years of age. -The risk of developing NHL is higher for men or women -Whites are more likely to develop NHL than African Americans or Asian Americans (in the United States). -Exposure to certain chemicals in the environment may be a risk factor. -Chromosomal abnormalities may also cause NHL. -Chemotherapy and radiation therapy for other cancers may carry a risk for developing NHL. -Autoimmune diseases show a link to NHL. -Individuals receiving drugs for immune suppression (e.g., for organ transplants) carry an increased risk for NHL. -Infection with certain viruses (e.g., Epstein-Barr virus and HIV) increases the risk of developing NHL.

over 60 y.o men white

Pathophysiology of Non-Hodgkin's Lymphoma In non-Hodgkin's lymphoma (NHL), malignant cells may be found in the lymph nodes or they may initially arise in organs outside the lymphatic system, including the ____________________________. Unlike HL, which arises from a common cell, NHL arises from a variety of cells.

spleen, thymus gland, bone marrow, gastrointestinal system, brain, eyes, and skin.

Hodgkin's lymphoma (HL) occurs more frequently in men than women and more frequently in whites than blacks. It is prevalent in individuals diagnosed with HIV.

white men