Hodkin’s / Nonhodgkin’s lymphoma

1. Hodkin’s/Nonhodgkin’s lymphoma By: Brittni McClellan

2. Classifications • Hodgkin’s Lymphoma • Non-Hodkin’s Lymphoma

3. Hodgkin’s Lymphoma - description • Description: • Malignant enlargement of lymph nodes. • Reed Sternberg Cells: • Pleomorphic Cellular Infiltrate with Multinucleated Giant Cells • Pathophysiology: • Reed-Sternberg Cells: • Malignant Cells • Monoclonal, Derived from Germinal Center B Cells • Histologic Categories: • Classical Hodgkin Lymphoma (90%) • Nodular Sclerosis: Most Common in Children • Mixed • Lymphocyte Deletion • Lymphocyte Rich • Nodular Lymphocyte-Predominant Bimodal Age Distribution: 20s and >50 years.

4. Hodgkin’s lymphoma– H&P • Patient History: • B-Symptoms: • Unexplained Fever (>38 C) for >3 days. • Unexplained Weight Loss >10% of Body Weight in 6 months • Drenching Night Sweats • Stage A: • Absence of B Symptoms/Asymptomatic • Other: • Fatigue, Anorexia, Pruritis, Chest Pain, Orthopnea • History: • Immunodeficiency, Epstein-Barr Virus, HIV • Physical Exam: • Painless Lymphadenopathy (Most Common) • Firm, Rubbery, Less Mobile • Cervical Chain: 80% of Patients • Mediastinal Mass: 2/3 Patients • Hepatosplenomegaly • Pallor, Bruising, Petechiae • Erythema Nodosum

5. Hodgkin’s lymphoma - Diagnosis Diagnosis: • Lymph Node Biopsy • Imaging: • Chest Radiograph: Mediastinal Mass • CT Scan: Rule Out Disseminated Disease • PET Scan: Standard for Children Ann Arbor Staging:

6. Hodgkin’s lymphoma – treatment • Medication +/- Radiotherapy • COPP • Cyclophosphamide • Vincristine • Procarbazine • Prednisone • ABVD: • (Adriamycin) Doxorubicin • Bleomycin • Vinblastine • Decarbazine

7. Non-Hodgkin’s Lymphoma - description • Categories: • Pediatric NHL: • Small Non-Cleaved Cell Lymphomas (B-Cell) (40%) • Burkitt/Non-Burkitt • CD20+ • IgM + (Kappa or Lambda) • T(8;14), C-MYC Oncogene • Lymphoblastic Lymphomas (30%) • 90% T-Cell • TdT+ • Large Cell Lymphomas (30%) • 2/3: Large Non-Cleaved/Cleaved, B-Cell Origin • 1/3: Anaplastic • ALK+ • Nodular Lymphocyte-Predominant • Description: • Malignant proliferation of lymphocytic or histiocytic lineage. • Pleomorphic Cellular Infiltrate with Multinucleated Giant Cells • Pathophysiology: • Risk Factors: • Drugs: Immunosuppressants • Radiation: Atomic Bomb Survivors/Ionizing Radiation • Viruses: EBV, HIV

8. Non-Hodgkin’s lymphoma– H&P • Patient History: • B-Cell Lymphomas • Systemic: • Fever, Weight Loss, Anorexia, Fatigue • Lymphadenopathy • T-Cell Lymphomas • Mediastinal Tumors: • Cough, Hoarseness, Dyspnea, Orthopnea, Chest Pain • Anxiety, Confusion, Lethargy, Headache, Syncope • Marrow Involvement: • Bleeding/Bruising • Bone Pain • Physical Exam: • Small Non-Cleaved Cell Lymphomas • Intra-Abdominal Mass: • Involving Ileocecal Region, Appendix, or Ascending Colon • Causes Intussusception, Peritonitis, Ascites, or GI Bleeding • Burkitt Lymphoma • Jaw Tumors +/- Orbital Involvement • Abdominal Masses (50%) • Lymphoblastic Lymphoma: • Mediastinal Mass (50—70%) • Lymphadenopathy (50-80%) • No Abdominal Masses • Large Cell Lymphomas • Sites: Mediastinum, Bone, Inguinal Nodes, Skin

9. Non-Hodgkin’s lymphoma - Diagnosis Diagnosis: • Lymph Node Biopsy • Imaging: • Chest Radiograph: Mediastinal Mass • Abdominal U/S • CT Scan: Rule Out Disseminated Disease • PET Scan • MRI: Bone Involvement Murphy Staging:

10. Non-Hodgkins lymphoma – treatment • Medication • Chemotherapy 1-24 Months • Cyclophosphamide, Vincristine, Methotrexate • Prednisone, Daunorubicin, Asparaginase, Cytarabine, etc. • Immunotherapy • Rituximab: • Chimeric Monoclonal Antibody against CD20

11. nonHodgkins lymphoma

12. Question 1 • Follicular lymphoma is an indolent form of non-hodgkins lymphoma that arises from a translocation t(14:18), Which of the following genes, paired with its normal function, is affected by this DNA rearrangement? • BRCA1, tumor suppression • Bcl-2, Anti-apoptosis • p53, tumor suppression • Rb, Anti-apoptosis • Bcl-2, tumor suppression b) Bcl-2, Anti-Apoptosis