Case-2-NScHL-(C)-Non-Hodgkin Lymphoma

#TG

What is Non-Hodgkin’s Lymphoma

A malignant proliferation of lymphocytes (B and T cells) often presenting with constitutional signs and painless lymphadenopathy

What are the common B cell Non-Hodgkin lymphomas

Burkitt lymphoma, diffuse large B cell lymphoma, mantle cell lymphoma, marginal zone lymphoma

What are the common T cell Non-Hodgkin lymphomas

Adult T cell lymphoma and mycosis fungoides

What percentage of all cancers is Non-Hodgkin lymphoma

4%

What is the most common hematopoietic cancer

Non-Hodgkin lymphoma

In which age group does Non-Hodgkin lymphoma commonly occur

Both children and adults, with 50% of cases in those over 65 years old

What genetic translocation in NHL leads to Bcl-2 overexpression

t(14;18)

What genetic translocation in NHL leads to c-myc overexpression

t(8;14)

What genetic translocation in NHL leads to Cyclin D1 overexpression

t(11;14)

What infections are associated with Non-Hodgkin lymphoma

Epstein-Barr virus, Human T cell leukemia virus, and H. pylori

What chronic inflammatory conditions are linked to NHL

Hashimoto thyroiditis, Sjögren syndrome, chronic gastritis

What is the hallmark symptom of Non-Hodgkin lymphoma

Painless lymphadenopathy

What are common clinical features of indolent lymphomas

Lymphadenopathy, hepatosplenomegaly, cytopenias, anemia, neutropenia, thrombocytopenia

What are common clinical features of aggressive lymphomas

B symptoms such as fever, night sweats, weight loss, and rapidly growing masses

What complication can a rapidly growing NHL mass cause

Superior vena cava obstruction with facial swelling, venous distension, and pleural effusion

What lab findings are associated with aggressive Non-Hodgkin lymphoma

Elevated LDH and uric acid levels

What is the diagnostic gold standard for NHL

Excisional lymph node biopsy

What laboratory work-up is done for NHL

CBC with differential, platelet count, electrolytes, BUN, creatinine, LFTs, LDH, and uric acid

What imaging is used in the work-up of NHL

CT and PET scans for staging and treatment response monitoring

What additional tests are done in suspected MALToma

Endoscopy or gastroscopy

When is lumbar puncture indicated in NHL

When CNS symptoms are present

What procedures are done if pleural effusion or ascites is suspected in NHL

Thoracentesis or paracentesis

When is bone marrow biopsy indicated in NHL

If aggressive lymphoma is suspected

What is the importance of staging in NHL

Limited importance for treatment, more relevant in Hodgkin lymphoma

What does the letter E indicate in NHL staging

Extranodal extension

What defines Stage I NHL

Involvement of one lymph node group

What defines Stage II NHL

Two or more lymph node groups on the same side of the diaphragm

What defines Stage III NHL

Lymph node involvement on both sides of the diaphragm

What defines Stage IV NHL

Disseminated, widespread disease

What is the treatment for localized non-Hodgkin lymphoma (stage I or II)

Local radiation and a short course of chemotherapy

What is the treatment for advanced non-Hodgkin lymphoma (stage III, IV, or with B symptoms)

Rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisone)

Before beginning treatment for NHL, what baseline evaluations may be needed

Cardiac function, pulmonary function, and fertility goals

What does the International Prognostic Index (IPI) for NHL assign 1 point for

Age >60, stage III/IV, elevated LDH, poor performance status, >1 extranodal site

What is Burkitt’s lymphoma

An aggressive B-cell non-Hodgkin lymphoma with two types: endemic (African) and sporadic

What is the common age range and sex ratio for endemic Burkitt lymphoma

Children aged 4–7 years, with males twice as commonly affected as females

What is the sex ratio for sporadic Burkitt lymphoma

Male-to-female ratio of 3–4:1

What genetic mutation is characteristic of Burkitt lymphoma

Translocation and deregulation of the c-MYC gene on chromosome 8

What virus is associated with endemic Burkitt lymphoma

Epstein-Barr virus (EBV)

What is the histologic appearance of Burkitt lymphoma

“Starry sky” appearance due to macrophages among proliferating B-cells

What is the typical presentation of endemic Burkitt lymphoma

Large mass involving the mandible or maxilla

What is the typical presentation of sporadic Burkitt lymphoma

Primary abdominal involvement with masses, distension, and ascites

What symptoms are common in Burkitt lymphoma

Painless lymphadenopathy, B-symptoms (fever, night sweats, weight loss), fatigue, vomiting, and signs of intoxication

What are other clinical features of Burkitt lymphoma

Abdominal masses, ascites, hepatosplenomegaly, ecchymosis, petechiae, and CNS signs

What lab findings are seen in Burkitt lymphoma

Pancytopenia (if bone marrow involvement), hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, elevated LDH, and kidney dysfunction

What is indicated by very high uric acid levels in Burkitt lymphoma

High-grade malignancy and risk for tumor lysis syndrome

What imaging studies are used in Burkitt lymphoma diagnosis

CT, MRI, bone scanning, and plain radiography

What immunologic and viral tests should be performed in Burkitt lymphoma patients

HIV, hepatitis B, beta-2 microglobulin

What is beta-2 microglobulin a marker for in Burkitt lymphoma

Disease extension and relapse

What is the mainstay of treatment for Burkitt lymphoma

Chemotherapy is the mainstay of treatment for Burkitt lymphoma.

What is included in the CODOX-M/IVAC regimen for Burkitt lymphoma

Cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate / ifosfamide, etoposide, high-dose cytarabine.

What does the Hyper-CVAD regimen for Burkitt lymphoma consist of

Modified fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone.

What monoclonal antibody is commonly added to Burkitt lymphoma therapy

Rituximab.

What enzyme is used to prevent tumor lysis syndrome in Burkitt lymphoma

Urate-oxidase enzyme (rasburicase).

What glucocorticoid is commonly used in Burkitt lymphoma treatment

Prednisone.

When is autologous stem cell transplantation considered in Burkitt lymphoma

During early stages of the disease with promising results.

Are radiotherapy and surgery recommended in Burkitt lymphoma

No, they are not recommended options.

What supportive therapy is required for anemia and thrombocytopenia in Burkitt lymphoma

Transfusion of red blood cells or platelets.

What is administered for neutropenic fever and CNS involvement in Burkitt lymphoma

Intravenous antibiotics.

Why are intravenous fluids important in Burkitt lymphoma treatment

To hydrate the patient and prevent tumor lysis syndrome by maintaining high urine output.

What is follicular lymphoma

Follicular lymphoma is a B-cell tumor, the second most common subtype of non-Hodgkin lymphoma, characterized by slow growth and long asymptomatic periods.

What percentage of non-Hodgkin lymphoma cases are follicular lymphoma

Follicular lymphoma accounts for approximately 35% of all NHL cases in the United States.

What is the median age of diagnosis for follicular lymphoma

The median age at diagnosis of follicular lymphoma is 60 years.

Is follicular lymphoma common in children and adolescents

No, follicular lymphoma is uncommon in children and adolescents.

What chromosomal translocation is associated with follicular lymphoma

The translocation t(14;18) is associated with follicular lymphoma.

What gene is overexpressed due to t(14;18) in follicular lymphoma

The BCL2 oncogene is overexpressed due to t(14;18) translocation in follicular lymphoma.

What is the function of BCL2 in follicular lymphoma

BCL2 blocks apoptosis, leading to prolonged cell survival.

Name some risk factors for follicular lymphoma. Risk factors include immunocompromised conditions, infections, chemical exposure (benzene, pesticides, herbicides), obesity, and autoimmune diseases.

What is the hallmark clinical feature of follicular lymphoma

Enlarged, non-tender, firm, rubbery lymph nodes with a waxing and waning pattern.

What are B-symptoms of follicular lymphoma

Fever >38°C, drenching night sweats, and unintentional weight loss >10% in 6 months.

What other clinical features may be present in follicular lymphoma

Breathlessness, chest pain, abdominal pain, bone pain, CNS involvement, anemia signs, thrombocytopenia signs, palpable masses, pleural effusion, and skin lesions.

How is follicular lymphoma diagnosed

By histopathological examination of an enlarged lymph node plus additional tests like CBC, bone marrow studies, cytogenetics, flow cytometry, and imaging.

What laboratory findings are common in follicular lymphoma

Possible pancytopenia, decreased blood cell lines, high LDH, and β2-microglobulin levels.

What imaging is used in follicular lymphoma diagnosis and staging

CT scans of neck, thorax, abdomen, pelvis, and PET scans in higher-grade disease.

How is early-stage follicular lymphoma treated

Radiotherapy or rituximab monotherapy for low-grade disease.

What drugs are used in frontline immunochemotherapy for follicular lymphoma

Alkylating agents, antimetabolites, anthracyclines, vinca alkaloids, and corticosteroids.

When is bone marrow transplantation indicated in follicular lymphoma

In non-advanced stages of the disease.

What factors are included in the follicular lymphoma international prognostic index

Four affected lymph node regions, LDH > normal, age > 60, Ann Arbor stage III/IV, and hemoglobin

What is the 10-year survival rate for follicular lymphoma based on prognostic factors

It depends on the number of risk factors present.