Updated: 7/5/2018

Non-Hodgkin Lymphoma

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Introduction
  • A neoplasia of lymphoid cells
  • Subtypes of NHL include (from large to small cell)
    • diffuse B-cell lymphoma
    • Burkitt lymphoma
    • follicular lymphoma
    • marginal zone lymphoma
    • mantle cell lymphoma
    • primary central nervous system lymphoma
    • adult T-cell leukemia/lymphoma
    • cutaneous T-cell lymphoma
  • Prognosis
    • small cell NHLs typically have a better prognosis than large cell because a cell becomes small with differentiation
Diffuse Large B-cell Lymphoma
  • Introduction 
    • large-size B cell proliferation
      • CD20 +
      • may have predominance of reactive T cells in T cell histiocyte rich large B cell lymphoma
    • most common subtype of NHL
    • arises de novo or progression from a small B cell NHL subtype
    • generally seen in the adult population, but can be seen in children
  • Presentation
    • rapidly enlarging lymph node
  • Prognosis, Prevention, and Complications
    • very aggressive with poor prognosis
Burkitt Lymphoma
  • Burkitt'sIntroduction
    • intermediate-size B cell proliferation
      • CD20 +
    • caused by 8;14 translocation 
      • approximates the Ig heavy chain locus (14) with c-myc (8) 
      • increased levels of c-myc drives cell growth
    • associated conditions
      • EBV infection
    • generally seen in pediatric/adolescent population
  • Presentation
    • extranodal mass 
      • jaw (African-type)
      • abdomen (sporadic-type)
  • Evaluation
    • biopsy
      • "starry-sky" appearance
Follicular Lymphoma
  • Introduction
    • small-size B cell proliferation in the follicles
      • CD20 +
    • caused by 14;18 translocation
      • approximates the Ig heavy chain locus (14) with BCL2 (18)
      • increased levels of Bcl2 inhibits apoptosis  
    • generally seen in the adult population
  • Presentation
    • painless lymphadenopathy
  • Evaluation
  • Treatment
    • rituximab (anti-CD 20)
      • only used for symptomatic patients
  • Prognosis, Prevention, and Complications
    • can progress to large B cell lymphoma
      • presents with a rapidly enlarging lymph node
Marginal Zone Lymphoma
  • Marginal ZoneIntroduction
    • small B cell proliferation in margin
      • CD20 +
    • associated conditions
      • chronic inflammatory states (Sjogren syndrome, Hashimoto's thyroiditis)
      • H. pylori infections
        • note that gastric MALTomas are a type of marginal zone lymphoma
Mantle Cell Lymphoma
  • Introduction
    • small B cell proliferation of the area surrounding the follicular zone (the mantle)
      • CD20+, CD5 +
    • caused by 11;14 translocation
      • approximates the Ig heavy chain locus (14) with Cyclin D (11)
      • increased levels of Cyclin D drives cell into S phase
    • generally seen in older adult population
  • Presentation
    • painless lymphadenopathy
 

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Questions (3)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.ON.29) A 17-year-old male African immigrant visits his primary care physician with a mass on the right side of his jaw. He denies drug or alcohol use and does not take any medication. Serology for Epstein-Barr Virus (EBV) infection is positive. A biopsy of the lesion is taken and shown in Figure A. Which of the following chromosomal translocations is most likely present in this tissue? Review Topic

QID: 101339
FIGURES:
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1

t(9;22)

4%

(6/135)

2

t(8;14)

81%

(110/135)

3

t(11;22)

6%

(8/135)

4

t(14;18)

6%

(8/135)

5

t(15;17)

1%

(1/135)

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(M1.ON.147) A 40-year-old male presents to his primary care physician for a regularly scheduled check-up. Physical examination reveals nontender cervical lymphadenopathy. A biopsy of the lymph node reveals aggregates of follicular architecture, and cytogenic analysis shows a t(14;18) translocation. The protein most likely responsible for the patient’s condition does which of the following: Review Topic

QID: 101457
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1

Regulates passage through the cell cycle

12%

(10/85)

2

Activates DNA repair proteins

8%

(7/85)

3

Provides mitotic cytoskeleton

6%

(5/85)

4

Inhibits apoptosis

55%

(47/85)

5

Regulates cell growth through signal transduction

16%

(14/85)

M1

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