Lymphoma

LYMPHOMA

Q. 1

A patient with Hodgkin’s lymphoma presents with isolated cervical lymphadenopathy. Biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:

 A

Chemotherapy with Radiotherapy

 B

Chemotherapy alone

 C

Radiotherapy alone

 D

No treatment needed

Q. 1

A patient with Hodgkin’s lymphoma presents with isolated cervical lymphadenopathy. Biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:

 A

Chemotherapy with Radiotherapy

 B

Chemotherapy alone

 C

Radiotherapy alone

 D

No treatment needed

Ans. A

Explanation:

Answer is A (Chemotherapy with Radiotherapy)

Combined modality treatment with Chemotherapy and Radiotherapy is the treatment of choice in limited stage (stage III Hodgkin’s lymphoma with a classical Histological subtype.

Patient has limited Stage I Hodgkin’s Lymphoma

Patient in question presents with involvement of single lymph node region and hence can be staged as having stage I (Limited) disease.

Stage I          Disease Involvement of single lymph node region.

Patient has a classical Hodgkin’s Lymphoma of nodular sclerosis subtype

The presence of frequent Lacuner cells suggests a diagnosis of nodular sclerosis

Hodgkins lymphoma

Classical Hodgkin’s                         

Non classical Hodgkins                      

Nodular sclerosis (Lacunar cells) Mixed cellularity (Mononuclear cells) Lymphocyte rich (Mononuclear cells) Lymphocyte depletion

Nodular lymphocyte predominance Hodgkins NLPHL (popcorn cell/lymphohistiocytic cell)

 

The treatment of choice for limited Stage I Classical Hodgkins Lymphoma is combined modality therapy with  Chemotherapy and Radiotherapy


Q. 2

Treatment of choice in Hodgkin’s Lymphoma is:

 A

CHOP

 B

MOPP

 C

ABVD

 D

MOPP and ABVD hybrid

Q. 2

Treatment of choice in Hodgkin’s Lymphoma is:

 A

CHOP

 B

MOPP

 C

ABVD

 D

MOPP and ABVD hybrid

Ans. C

Explanation:

Answer is C (ABVD)

ABVD is the chemotherapy regimen of choice in Hodgkins lymphoma

‘Chemotherapy with ABVD is considered the standard first line treatment for most patients and is superior to MOPP in efficacy and toxicity profile ‘- Manual of Clinical Oncology 6′”/443

Regimen

Agents

Comments

ABVD

Doxorubicin

Bleomycin

Vinblastine

Dacarbazine

•   First line treatment of choice

•   Most popular regimen in United States

•   More effective than MOPP

•   Lesser incidence of Sterility and secondary malignancies than MOPP

•    More satisfactory than MOPP and ABVD in alternating cycles or MOPP/ABV

Hybrid

MOPP

Mechlorethamine

Vincristine

Procarbozine

Prednisolone

•   Less effective and more toxic than ABVD

•   Higher incidence of sterility and secondary malignancies than ABVD



Q. 3

All of the following statements about Treatment of Hodgkin’s lymphoma are true, Except:

 A

ABVD is the most commonly used Regimen

 B

Sterility is more frequent after ABVD than MOPP

 C

Combination chemotherapy is the mainstay of treatment in Advanced Hodgkin’s disease

 D

WBC count > 15000/mm3 is a poor prognostic factor

Q. 3

All of the following statements about Treatment of Hodgkin’s lymphoma are true, Except:

 A

ABVD is the most commonly used Regimen

 B

Sterility is more frequent after ABVD than MOPP

 C

Combination chemotherapy is the mainstay of treatment in Advanced Hodgkin’s disease

 D

WBC count > 15000/mm3 is a poor prognostic factor

Ans. B

Explanation:

Answer is B (Sterility is more frequent complication of ABVD than MOPP)

Sterility is more frequent complication of MOPP than AB VD.

Infertility and Treatment of Hodgkins Lymphoma

  • Infertility is a concern for all patients undergoing treatment
  • Risk of infertility is age related – Risk is increased in old age (younger patients are more likely to recover fertility)
  • Risk of infertility is more with MOPP than ABVD (Treatment with ABVD rather than MOPP increases the chances to retain fertility – Harrison)

Q. 4

The classification proposed by the International Lymphoma Study Group for non-Hodgkin’s lymphoma is known as:

 A

Kiel classification

 B

REAL classification

 C

WHO classification

 D

Rappaport classification

Q. 4

The classification proposed by the International Lymphoma Study Group for non-Hodgkin’s lymphoma is known as:

 A

Kiel classification

 B

REAL classification

 C

WHO classification

 D

Rappaport classification

Ans. B

Explanation:

Answer is B (REAL Classification)

In 1994, a group of hematopathologists, oncologists and molecular biologists came together (International Lymphoma Study Group) and introduced a new classification, called the ‘Revised European-American Classification of Lymphoid Neoplasms (REAL).

WHO has now reviewed and updated the real classification resulting in inclusion of additional rare entities.

WHO Classification / Modified ‘REAL’ Classification

I. Precursor B-cell Neoplasm

Precursor-B lymphoblastic leukemia/lymphoma

II. Peripheral B-Cell Neoplasms

Chronic lymphocytic leukemia/small lymphocytic lymphoma

B-cell prolymphocytic leukemia Lymphoplasmacytic lymphoma

Splenic and nodal marginal zone lymphomas Extranodal marginal zone lymphomas

Mantle cell lymphoma

Follicular lymphoma

Marginal zone lymphoma

Hairy cell leukemia

Plasmacytoma/plasma cell myeloma

Diffuse large B-cell lymphoma

Burkitt lymphoma

III. Precursor T-Cell Neoplasms

Precursor-T lymphoblastic leukemia/lymphoma

iv Peripheral T-Cell and NK-Cell Neoplasms 

T-cell prolymphocytic leukemia

Large granular lymphocytic leukemia Mycosis fungoides/Sezary syndrome Peripheral large cell lymphoma, unspecified Anaplastic large cell lymphoma Enteropathy-associated T-cell lymphoma Hepatosplenic y8 T-cell lymphoma

Adult T-cell leukemia/lymphoma

NK/T-cell lymphoma, nasal type

NK cell leukemia

V. Hodgkins LF mphoma 

– Classical subtypes

–   Nodular sclerosis – Mixed cellularity

–   Lymphocyte-rich

–   Lymphocyte depletion Lymphocyte predominance


Q. 5

Plasmacytoid Lymphomas may be associated with:

 A

IgG

 B

IgM

 C

IgA

 D

IgE

Q. 5

Plasmacytoid Lymphomas may be associated with:

 A

IgG

 B

IgM

 C

IgA

 D

IgE

Ans. B

Explanation:

Answer is B (IgM)

Plasmacytoid Lymphomas may be associated with a monoclonal IgM paraprotein (Waldenstrom’s Macroglobulinemia).

Plasmacytoid Lymphocyte Type Malignant Lymphoma / Plasmacytoid Lymphoma

  • This is a B cell neoplasmQ that is associated with plasmacytoid differentiation of lymphocytes
  • Plasmacytoid lymphocytes are transitional forms between lymphocytes and plasma cells
  • These may be associated with a monoclonal IgM paraprotein and are thus considered the histological counterparts of Waldenstrom’s Macroglobulinemia
  • Synonyms include immunocytoma

Kiel Classification : Malignant Lymphoma, Lymphoplasmacytoid immunocytoma REAL Classification: Lymphoplasmacytoid Lymphoma / Immunocytoma

These are low grade lymphoid neoplams0 that occur in middle aged or older individuals.


Q. 6

“International prognostic index” for lymphoma includes the following prognostic factors except:

 A

Stage of disease

 B

Number of extralymphatic sites involved

 C

LDH

 D

Hemoglobin and Albumin

Q. 6

“International prognostic index” for lymphoma includes the following prognostic factors except:

 A

Stage of disease

 B

Number of extralymphatic sites involved

 C

LDH

 D

Hemoglobin and Albumin

Ans. D

Explanation:

Answer is D (Hemoglobin and Albumin)

`International prognostic index’ does not include Hemoglobin and Albumin as prognostic factors.

Prognostic Factors according to International Prognostic Index for NHL

1  .

AgeQ

: (Age       60 years carries adverse prognosis)

2.

Stages

: (Ann Arbor stage III or IV carries adverse prognosis)

3.

LDH levelse

: (Elevated LDH levels above normal carry adverse prognosis)

4.

Performance status

: (P.S      2 (ECOG) or <70 (Karnafsky) carries adverse prognosis)

5.

Number of Extranodal sites involvedQ

: (>1 extranodal site involvement carries adverse prognosis)

 International Prognostic Index for NHL

Five clinical risk factors:

  • Age  60 years
  • Serum lactate dehydrogenase levels elevated
  • PerfOrmance status 2 (ECOG) or 70 (Karnofsky)
  • Ann Arbor stage III or IV
  • > / site of extratiodal involvement

Q. 7

‘Intermediate form’ of Non hodgkin’s lymphoma is :

 A

Small non cleaved cell

 B

Diffuse, small cleaved cell

 C

Lymphoblastic

 D

Large cell immunoblastic

Q. 7

‘Intermediate form’ of Non hodgkin’s lymphoma is :

 A

Small non cleaved cell

 B

Diffuse, small cleaved cell

 C

Lymphoblastic

 D

Large cell immunoblastic

Ans. B

Explanation:

Answer is B (Diffuse, small cleaved cell):

Working formulation of NHL for clinical usage is as follows:

Low grade

  1. Small lymphocytic Q
  2. Follicular, predominantly small cleaved cell Q
  3. Follicular, mixed, small cleaved and large cell. Q

Intermediate grade

  1. Follicular predominantly large cell Q
  2. Diffuse small cleaved cell
  3. Diffuse mixed small and large cell.
  4. Diffuse large cell.

High grade

  1. Large cell immunoblastic Q
  2. Lymphoblastic Q
  3. Small non cleaved cell.

Note that all varieties of diffuse fall in the intermediate grade category only.


Q. 8

Most common variant of Non-Hodgkin’s Lymphoma (NHL) in India is;

 A

Diffuse large B-cell lymphoma

 B

Follicular Lymphoma

 C

Mantle Cell Lymphoma

 D

T-cell lymphoblastic lymphoma

Q. 8

Most common variant of Non-Hodgkin’s Lymphoma (NHL) in India is;

 A

Diffuse large B-cell lymphoma

 B

Follicular Lymphoma

 C

Mantle Cell Lymphoma

 D

T-cell lymphoblastic lymphoma

Ans. A

Explanation:

Answer is A (Diffuse large B-cell lymphoma)

The most common variant of Non-Hodgkin’s Lymphoma in India is Diffuse Large B cell Lymphoma

Diffuse Large B cell Lymphoma is also the most common variant of Non-Hodgkin’s Lymphoma in the United States (Western Data)

‘The majority of Non-Hodgkin’s Lymphoma (NHL) in India are B-cell Lymphomas (around 80 percent). The distribution of Non-Hodgkin’s Lymphoma (NHL) subtypes in India shows important differences with those from the rest of the world. Diffuse  large B-cell lymphoma remains the most common form of NHL as in Western Data. However, Follicular lymphoma and mantle-cell lymphoma are less common in India compared to Europe and the USA. T cell Lymphomas account for approximately 16 percent of all NHL. T-cell lvmphohlastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are less prevalent.’

Taken from : ‘Distribution of various subtypes of non-Hodgkin’s lymphoma in India: a study of 2773 lymphomas using R.E.A.L. and WHO Classifications’ (http://www.ncbi.nlm.nih.gov/pubmed/10707782)


Q. 9

Most common variant of Lymphoma seen in HIV E Patients is:

 A

Immunoblastic Lymphoma

 B

Burkitt’s Lymphoma

 C

Primary CNS Lymphoma

 D

Mantle Cell Lymphoma

Q. 9

Most common variant of Lymphoma seen in HIV E Patients is:

 A

Immunoblastic Lymphoma

 B

Burkitt’s Lymphoma

 C

Primary CNS Lymphoma

 D

Mantle Cell Lymphoma

Ans. A

Explanation:

Answer is A (Immunoblastic Lymphoma)

The most common lymphomas seen in HIV Patients are Immunoblastic Lymphomas. Majority of these are Diffuse Large B Cell Lymphomas (DLBLS).


Q. 10

Variant of Immunoblastic Lymphoma primarily seen in HIV Patients is

 A

Primary Effusion Lymphoma

 B

Centroblastic Lymphoma

 C

Anaplastic Lymphoma

 D

Any of the Above

Q. 10

Variant of Immunoblastic Lymphoma primarily seen in HIV Patients is

 A

Primary Effusion Lymphoma

 B

Centroblastic Lymphoma

 C

Anaplastic Lymphoma

 D

Any of the Above

Ans. A

Explanation:

Answer is A (Primary Effusion Lymphoma):

Primary Effusion Lymphoma (PEL) is a rare variant of Immunoblastic Lymphomas seen primarily in HIV infected patients.

Primary Effusion Lymphoma (PEL) is a rare variant of Immunoblastic Lymphomas seen primarily in HIV  infected patients

‘Two variants of Immunoblastic Lymphomas seen primarily in HIV infected patients are Primary Effusion Lymphoma(PEL) and its solid variant Plasmacvtic lymphoma of the oral cavity

Centroblastic Lymphoma and Anaplastic Lymphomas are variants of Diffuse Large B call Lymphomas and are distinct entities from I mmunoblastic Lymphomas

Morphologic Variants of Diffuse Large B Cell Lymphomas ( DLBCL)

  • Centroblastic
  • Immunoblastic
  • Anaplastic

Q. 11

In Burkitts lymphoma, translocation seen is chromosome

 A

12 – 14 translocation

 B

8 – 14 translocation

 C

4 – 8 translocation

 D

12 – 18 translocation

Q. 11

In Burkitts lymphoma, translocation seen is chromosome

 A

12 – 14 translocation

 B

8 – 14 translocation

 C

4 – 8 translocation

 D

12 – 18 translocation

Ans. B

Explanation:

Answer is B (8 – 14 translocation)

Presence oft (8; 14) or one of its variants t (2; 8) or t (8; 22) can be confirmatory – Harrison 16th/ 652. Important translocation to be remembered


Q. 12

Burkitt’s Lymphoma is associated with which of the following viruses

 A

EBV

 B

HTLV-1

 C

HHV- 8

 D

Adenovirus

Q. 12

Burkitt’s Lymphoma is associated with which of the following viruses

 A

EBV

 B

HTLV-1

 C

HHV- 8

 D

Adenovirus

Ans. A

Explanation:

Answer is A (t(8:14))

‘Demonstration of very high proliferative fraction and the presence of the t (8; 14) or one of its variants t (2; 8) or t(8:22) can be confirmatory of Burkitt’s lymphoma /leukemia’


Q. 13

Burkitt’s Lymphoma is associated with:

 A

t (8:14)

 B

t (11:14)

 C

t (15:17)

 D

t (14:18)

Q. 13

Burkitt’s Lymphoma is associated with:

 A

t (8:14)

 B

t (11:14)

 C

t (15:17)

 D

t (14:18)

Ans. A

Explanation:

Answer is A (EBV)

Burkitt’s Lymphoma is typically associated with Epstein Barr virus (EBV).

EBV is associated with upto 95% of cases of Endemic Burkitt’s Lymphoma.

EBV is associated with approximately 30% of cases of Sporadic Burkitt’s Lymphoma and Immune Deficiency associated Burkitt’s Lymphoma.

Infectious Agents Associated with the Development of Lymphoid Malignancies

Lymphoid Malignancy

  • Thu-kites lymphoma
  • Post–organ transplant lymphoma
  • Primary CNS diffuse large B cell lymphoma
  • Hodgkin’s disease
  • Extranodal NK/T cell lymphoma, nasal type
  • Adult T cell leukemia/lymphoma
  • Diffuse large B cell lymphoma
  • 8111-kW’s lymphoma
  • Lymphoplasmacytic lymphoma
  • Gastric MALT lymphoma
  • Primary effusion lymphoma
  • Multicentric Castleman’s disease

 CNS, central nervous system; HIV, human immunodeficiency virus; HTLV. human T cell lymphotropic virus; MALT, mucosa­associated lymphoid tissue; NK, natural killer


Q. 14

All of the following statements about Burkitt’s lymphoma are true, Except:

 A

B cell lymphoma

 B

8, 14 translocation

 C

Can present as an abdominal mass

 D

Radiotherapy is the treatment of choice

Q. 14

All of the following statements about Burkitt’s lymphoma are true, Except:

 A

B cell lymphoma

 B

8, 14 translocation

 C

Can present as an abdominal mass

 D

Radiotherapy is the treatment of choice

Ans. D

Explanation:

Answer is D (Radiotherapy is the treatment of choice)

The treatment of choice for Burkitt’s Lymphoma is chemotherapy and not Radiotherapy.

‘Burkitt’s lymphoma responds well to short term high dose chemotherapy. Treatment of Burkitt’s lymphoma in both children and adults should begin within 48 hours of diagnosis and involves the use of intensive combination chemotherapy regimens’ – Harrisons

Burkitt’s Lymphoma is a B cell lymphoma

Burkitt’s Lymphoma are tumors of mature B cells – Robbins 7th/677

t (8;14) translocation is the most common translocation in Burkitt’s Lymphoma  Burkitt’s lymphomas are associated with translocation of the c-MYC gene on chromosome 8. Translocation

t (8; 14)

t (8; 22)

t (2; 8)

Burkitt’s Lymphoma may present with an abdominal mass

Most Burkitt’s Lymphoma presents at extranodal sites but may present with lymphadenopathy 

Extranodal sites of involvement include the mandible and abdominal viscera

`Burkitt’s Lymphomas may present with peripheral lymphadenopathy or an intraabdominal mass’ – Harrison

CNS involvement is frequent

The disease is rapidly progressive and has a propensity to metastasize to CNS, prophylactic therapy to CNS is therefore mandatory.

Burkitt’s Lymphoma is the most rapidly progressive human tumor


Q. 15

Which of the followings combinations of cytogenetic abnormality and associated leukemia/lymphoma is incorrect?

 A

t (8:14): Burkitts lymphoma

 B

t (15:17) : AML-M3

 C

t (9:22) : CML

 D

t (9:20) : ALL

Q. 15

Which of the followings combinations of cytogenetic abnormality and associated leukemia/lymphoma is incorrect?

 A

t (8:14): Burkitts lymphoma

 B

t (15:17) : AML-M3

 C

t (9:22) : CML

 D

t (9:20) : ALL

Ans. D

Explanation:

Answer is D ( t(9; 20): ALL)

Acute Lymphoblactic leukemia (ALL) may he associated with t(4;11), t(9;22) or 1(8; 14) but association with 1(9; 20) is not seen.

Type of Leukemia

Translocation

 

Deletion (-) / Trisomy (+)

Chronic myelocytic leukemia (CML)

t(9; 22)Philadelphia

chromosome

 

‑

Acute Myoblastic Leukemia (AML)

t(8; 21),

t(9;22)

 

 

+8, 7-, 5-, 7q, 5q‑

Acute Monocytic Leukemia

t(9; 11),

t(11; 23)

 

 

‑

Acute Promyelocytic leukemia (M3)

t(15; 17)

 

 

 

 

Acute lymphoblastic leukemia (ALL)

t(4; 11),

t(9; 22),

t(8;

14)

20q‑

Chronic lymphocytic leukemia (CLL)

 

 

 

 

+12

Erythroleukemia

 

 

 

7q-, 5q‑

Polycythemia Rubravera

 

 

 

20q‑


Q. 16

All of the following statements about Mucosa Associated Lymphoid Tissue Lymphomas (MALT) are true, Except:

 A

Present at extranodal sites

 B

Predisposed by H. Pylori infection

 C

Present as stromal polyps

 D

Are sensitive to chemotherapy

Q. 16

All of the following statements about Mucosa Associated Lymphoid Tissue Lymphomas (MALT) are true, Except:

 A

Present at extranodal sites

 B

Predisposed by H. Pylori infection

 C

Present as stromal polyps

 D

Are sensitive to chemotherapy

Ans. C

Explanation:

Answer is C (Present as stromal polyps):

Stromal polips are infrequent primary gastric malignancies classified as Gastrointestinal Stromal Cell Tumors (GSIT). These are not associated with MALT Lymphomas

  • MALT Lymphomas presents at extranodal sites (Harrisons)
  • MALT Lymphomas are also called ‘Extranodal Margmal zone B cell Lymphomas of MALT type’ and typically occur at extranodal sites as suggested by the terminology
  • MALT Lymphomas are predisposed by H.Pylori (Harrison) Gastric presemation of 11141.1″ Lymphoma is associated with H. Pylori injection – Harrisons
  • MALT Lymphomas are sensitive to chemotherapy  Extensive MALT Lymphomas (Ire most Oen treated with single agent chemotherapy such as chloramhticil- Harrison

Q. 17

Development of Lymphoma in Sjogren’s syndrome is suggested by all of the following, except:

 A

Persistent parotid gland enlargement

 B

Cyoglobulinemia

 C

Leukopenia

 D

High C4 Compement levels

Q. 17

Development of Lymphoma in Sjogren’s syndrome is suggested by all of the following, except:

 A

Persistent parotid gland enlargement

 B

Cyoglobulinemia

 C

Leukopenia

 D

High C4 Compement levels

Ans. D

Explanation:

Answer is D (High C4 complement levels):

Development of Lymphoma in Sjogren’s Syndrome is suggested by Low C4 Complement levels

Lymphoma in Sjogren’s syndrome (Extra-nodal, low grade marginal B cell Lymphomas)

The development of Lymphomas in patients with Sjogren Syndrome is suggested BY :

  • Persistent Parotid gland enlargement
  • Purpura
  • Leukopenia
  • Cryoglobulinemia
  • Low C4 complement levels

Lymphoma is a well-known complication of Sjogren’s syndrome; Most lymphomas are extra-nodal, low grade marginal B cell Lymphomas


Q. 18

A man presents with mass at duodenojejunal flexurs invading renal papillae.

Histopathology reports it as lymphoma; true statement is:

 A

II E stage

 B

III E Stage

 C

IV E stage

 D

Staging cannot be done until bone marrow examination is performed

Q. 18

A man presents with mass at duodenojejunal flexurs invading renal papillae.

Histopathology reports it as lymphoma; true statement is:

 A

II E stage

 B

III E Stage

 C

IV E stage

 D

Staging cannot be done until bone marrow examination is performed

Ans. C

Explanation:

Ans C (IV E stage) :

Involvement of another organ (kidney) by Gi lymhonlma of duodenojejunal flexure classifies it as a stage IV lymphoma.

Gastrointestinal lymphomas are staged using a modified Ann Arbor Classification:

  • IE: Tumor confined to small intestine
  • IIE: Spread to regional lymphnodes
  • IIIE: Spread to non resectable nodes beyond regional nodes
  • IVE: Spread to other organs

Q. 19

Neoplastic giant cells characteristically seen in Hodg­kins lymphoma are:         

March 2013 (e)

 A

Warthin Finkeledy cells

 B

Russel bodies

 C

Reed Sternberg cells

 D

Mikulicz cells

Q. 19

Neoplastic giant cells characteristically seen in Hodg­kins lymphoma are:         

March 2013 (e)

 A

Warthin Finkeledy cells

 B

Russel bodies

 C

Reed Sternberg cells

 D

Mikulicz cells

Ans. C

Explanation:

Ans. C i.e. Reed Sternberg cells


Q. 20

Lacunar cells is seen in which type of Hodgkins Lymphoma:       

September 2010

 A

Mixed cellularity type

 B

Lymphocyte predominant

 C

Nodular Sclerosis Type

 D

All of the above

Q. 20

Lacunar cells is seen in which type of Hodgkins Lymphoma:       

September 2010

 A

Mixed cellularity type

 B

Lymphocyte predominant

 C

Nodular Sclerosis Type

 D

All of the above

Ans. C

Explanation:

Ans. C: Nodular Sclerosis Type

Reed-Sternberg cells (also known as lacunar histiocytes for certain types) are different giant cells found on light microscopy in biopsies from individuals with Hodgkin’s lymphoma (aka Hodgkin’s disease; a type of lymphoma), and certain other disorders. They are usually derived from B lymphocytes.


Q. 21

Hodgkin lymphoma is treated by:

March 2013 (b, d)

 A

20-30 Gy

 B

30-40 Gy

 C

40-50 Gy

 D

50-60 Gy

Q. 21

Hodgkin lymphoma is treated by:

March 2013 (b, d)

 A

20-30 Gy

 B

30-40 Gy

 C

40-50 Gy

 D

50-60 Gy

Ans. A

Explanation:

Ans. A i.e. 20-30 Gy


Q. 22

Treatment regimen for Hodgkins lymphoma is:

September 2008

 A

VAD

 B

CMF

 C

ABVD

 D

CHOP

Q. 22

Treatment regimen for Hodgkins lymphoma is:

September 2008

 A

VAD

 B

CMF

 C

ABVD

 D

CHOP

Ans. C

Explanation:

Ans. C: ABVD

In 1964, researchers at the National Cancer Institute developed the first combination chemotherapy that cured a number of patients who had relapsed following a standard radiation therapy regimen. This drug combination was called MOPP and was, for a long time, the standard treatment for Hodgkin’s disease:

  • Mustargen (mechlorethamine, nitrogen mustard)
  • Oncovin (Vincristine, VCR)
  • Procarbazine (Matulane)
  • Prednisone (Deltasone, Orasone)

MOPP has been mostly replaced by another combination chemotherapy called ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), which is now the standard chemotherapy regimen for Hodgkin’s disease.

However, MOPP may be used if there are lung or heart conditions present or allergies to any of the medications in the ABVD combination. Additionally, 30% to 40% of people will relapse after treatment with ABVD, which will require ‘salvage’ treatment with MOPP.

VAD combination chemotherapy is used for multiple myeloma and CHOP combination chemotherapy is used for B cell chronic lymphoid leukemia


Q. 23

Working formulation in staging of non-hodgkins lymphoma is based on:

March 2010

 A

Morphology of cells

 B

Cell surface markers

 C

Survival characteristic of cells

 D

Cellular genetics

Q. 23

Working formulation in staging of non-hodgkins lymphoma is based on:

March 2010

 A

Morphology of cells

 B

Cell surface markers

 C

Survival characteristic of cells

 D

Cellular genetics

Ans. A

Explanation:

Ans. A: Morphology of cells

The 1982 Working formulation is a classification of non-hodgkin lymphoma.

It excluded the Hodgkin lymphomas and divided the remaining lymphomas into four grades (Low, Intermediate, High, and Miscellaneous) related to prognosis, with some further subdivisions based on the size and shape of affected cells. This purely histological classification included no information about cell surface markers, or genetics, and it made no distinction between T-cell lymphomas or B-cell lymphomas.

The working formulation was widely accepted at the time of its publication but is now obsolete.

It was superseded by subsequent classifications but it is still used by cancer agencies for compilation of lymphoma statistics and historical comparisons.


Q. 24

Prognosis of lymphoma depends on all of the follo­wing except:   

March 2011

 A

Number of lymph node sites

 B

Tumour size

 C

Tumour stage

 D

Associated symptoms

Q. 24

Prognosis of lymphoma depends on all of the follo­wing except:   

March 2011

 A

Number of lymph node sites

 B

Tumour size

 C

Tumour stage

 D

Associated symptoms

Ans. D

Explanation:

Ans. D: Associated symptoms


Q. 25

Burkitts lymphoma associated with ‑

 A

EBV

 B

HHV

 C

HIV

 D

HTLV

Q. 25

Burkitts lymphoma associated with ‑

 A

EBV

 B

HHV

 C

HIV

 D

HTLV

Ans. A

Explanation:

Ans. is ‘a’ i.e., EBV


Q. 26

Which of the following combinations of cytogenetic abnormality and associated leukemia/lymphoma is incorrect‑

 A

t (8:14) Burkitt’s lymphoma

 B

t (15:17) Promyelocytic leukemia

 C

t (9:18) CML

 D

t (4:11)ALL

Q. 26

Which of the following combinations of cytogenetic abnormality and associated leukemia/lymphoma is incorrect‑

 A

t (8:14) Burkitt’s lymphoma

 B

t (15:17) Promyelocytic leukemia

 C

t (9:18) CML

 D

t (4:11)ALL

Ans. C

Explanation:

Ans. is ‘c’ i.e., t (9:18) CML


Q. 27

Most common type of hodgkins lymphoma is ‑

 A

Lymphocyte predominant

 B

Lymphocyte depletion

 C

Nodular sclerosis

 D

Mixed cellularity

Q. 27

Most common type of hodgkins lymphoma is ‑

 A

Lymphocyte predominant

 B

Lymphocyte depletion

 C

Nodular sclerosis

 D

Mixed cellularity

Ans. C

Explanation:

Ans. is ‘c’ i.e., Nodular sclerosis


Q. 28

Paraneoplastic syndrome Hypercalcemia of malignancy, is produced due to ectopic production of which hormone by lymphomas ‑

 A

PTHrP

 B

1,25 dihydroxyvitamin D

 C

PGE2

 D

Parathormone

Q. 28

Paraneoplastic syndrome Hypercalcemia of malignancy, is produced due to ectopic production of which hormone by lymphomas ‑

 A

PTHrP

 B

1,25 dihydroxyvitamin D

 C

PGE2

 D

Parathormone

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1, 25 dihydroxyvitamin D


Q. 29

A patient presented with the reddish discoloration for past 2-3 weeks. There is no associated pain or history of injury to eye. A probable diagnosis of Lymphoma was made.

Which of the following cannot  be the associated complaints in case of a ocular lymphoma

 A

Loss of Vision 

 B

Diplopia 

 C

Proptosis

 D

None of the Above

Q. 29

A patient presented with the reddish discoloration for past 2-3 weeks. There is no associated pain or history of injury to eye. A probable diagnosis of Lymphoma was made.

Which of the following cannot  be the associated complaints in case of a ocular lymphoma

 A

Loss of Vision 

 B

Diplopia 

 C

Proptosis

 D

None of the Above

Ans. D

Explanation:

Most patients notice the reddish discoloration of the surface of the eyeball (conjunctiva).

As the tumor enlarges, patients seek medical attention.

Conjunctival lymphomas can become large enough to displace the eyeball, and restrict eye movement. Eye movement restriction can cause diplopia (double-vision).

If the tumor extends behind the eyeball, it can be pushed forward (proptosis). Rarely, and if large enough, orbital lymphoma can press on the optic nerve and cause loss of vision.

If discovered early, prompt treatment offers the best chance for recovery of vision.


Q. 30

Most common site of Lymphoma in GIT as shown in the photograph below is ? 

 A

1.

 B

2.

 C

3.

 D

4.

Q. 30

Most common site of Lymphoma in GIT as shown in the photograph below is ? 

 A

1.

 B

2.

 C

3.

 D

4.

Ans. A

Explanation:

“The stomach is the most frequent extranodal site for lymphomas. Microscopically, the vast majority of gastric lymphoid tumors are non-Hodgkins lymphomas of B cell origin, Hodgkins ds involving the stomach is extremely uncommon.” 


Q. 31

Development of Lymphoma in Sjogren’s syndrome is suggested by all of the following except

 A

Persistent parotid gland enlargement

 B

Cyoglobilinemia

 C

Leukopenia

 D

High C4 compement levels

Q. 31

Development of Lymphoma in Sjogren’s syndrome is suggested by all of the following except

 A

Persistent parotid gland enlargement

 B

Cyoglobilinemia

 C

Leukopenia

 D

High C4 compement levels

Ans. D

Explanation:

Ans. is ‘d’ i.e., High C4 complement levels

  • Lymphoa is a well-known complication of Sjogren’s syndrome Most lymphomas are extra-nodal, low grade marginal B cell lymphomas.
  • Development of Lymphoma in Sjogren’s syndrome is suggested by low C4 complement levels.

Lymphoma in Sjogren’s syndrome

The development ofLymphomas in patients with Sjogren syndrome is suggested by : –

  • Persistent parotid gland enlargement
  • Purpura
  • Leukopenia
  • Cryoglobulinemia
  • Low C4 complement levels

Q. 32

Which of the following disorders is least likely associated with progression to lymphoma

 A

Sjogren’s syndrome

 B

Araxia telangiectasia

 C

Severe combined immunodeficiency

 D

Lynch II syndrome

Q. 32

Which of the following disorders is least likely associated with progression to lymphoma

 A

Sjogren’s syndrome

 B

Araxia telangiectasia

 C

Severe combined immunodeficiency

 D

Lynch II syndrome

Ans. C

Explanation:

Ans. is ‘c’ i.e., Severe combined immunodeficiency

Choice

Cancers associated

Sjogren syndrome NHL mainly MALT-oma involving salivary glands>stomach
Ataxia telengectasia Elevated incidence of cancers, approximately 100-fold in comparison to the general population. In children, more than 85% of neoplasm cases are acute lymphocytic leukemia or lymphoma. In adults with ataxia-telangiectaisa, solid tumors are more frequent
Lynch-II syndrome Gastrointestinal cancer associated with endometrial/ovarian carcinoma. Early onset brain tumor and lymphoma also seen in children

Q. 33

Lymphoma Marker is:

 A

S-100

 B

HMB-45

 C

Leukocyte common antigen

 D

Cytokeratin

Q. 33

Lymphoma Marker is:

 A

S-100

 B

HMB-45

 C

Leukocyte common antigen

 D

Cytokeratin

Ans. C

Explanation:

Ans. c. Leukocyte common antigen

  • (LCA or CD45):
  • “LCA or CD45 is expressed brightly in normal lymphocytes as well as in most of the lymphoproliferative disorder. It is also variably expressed in other leukocytes. It is absent in erythroid cells.” -Iochims Lymph Node Pathology 4/43
  • S-100: S-100 is a marker that comes positive in chondrocytes, schwann cells, fat cells, oligodendrocytes and other neural crest origin cells and tumors.
  • HMB-45: HMB-45 is a activated melanocytic marker expressed in melanoma cells. Cytokeratin: Cytokeratin is expressed in normal and malignant epithelial cells.

Q. 34

Post transplant lymphomaia most commonly associated with:

 A

Epstein-Barr virus

 B

Cytomegalo virus

 C

Herpes simplex

 D

HHV-6

Q. 34

Post transplant lymphomaia most commonly associated with:

 A

Epstein-Barr virus

 B

Cytomegalo virus

 C

Herpes simplex

 D

HHV-6

Ans. A

Explanation:

Ans. a. Epstein-Barr virus

  • Post transplant lymphoma is most commonly associated with Epstein-Barr virus
Oncogenic DNA virus Oncogenic RNA virus
Human papilloma virusQ Hepatitis C virusQ
Epstein-Barr virusQ Human T-cell leukemia virus type-1Q
Hepatitis B virusQ Helicobacter pyloriQ

Epstein-Barr Virus

  • Epstein-Barr virus infection may lead to the following clinical conditions:
  • Infectious mononucleosis
  • EBV-associated malignancies:
  • Burkitt’s lymphomaQ
  • Lymphomas in immunodeficient persons such as AIDS patients and transplant recipientsQ
  • Nasopharyngeal carcinoma in persons of Chinese origin

Post-Transplant Lymphoproliferative Disorder (PTLD)

  • PTLD is associated with replication of EBV in B cells induced by enhanced immunosuppression, primarily observed
  • in patients who have received more than one course of polyclonal antilymphocyte globulin (ALG) or monoclonal

Clinical Features:

  • Clinical presentation of PTLD includes fever, malaise and lymphadenopathyQ

Diagnosis:

  • The diagnosis is made by tissue biopsyQ

Treatment:

  • Polyclonal PTLD: Discontinuation of immunosuppression and antiviral therapyQ
  • Monoclonal PTLD: Radiation, chemotherapy and occasionally surgical resection. Antibody against CD20Q
  • represents a novel approach in treating monoclonal PTLD with favorable outcome.Q

Q. 35

Stage 1 cutaneous T cell lymphoma treatment is ‑

 A

PUVA

 B

Biological response modifiers

 C

Systemic chemotherapy

 D

Extracorporial photopheresis

Q. 35

Stage 1 cutaneous T cell lymphoma treatment is ‑

 A

PUVA

 B

Biological response modifiers

 C

Systemic chemotherapy

 D

Extracorporial photopheresis

Ans. A

Explanation:

Ans is ‘a’ i.e., PUVA 


Q. 36

Best prognostic type of Hodgkin’s lymphoma is ‑

 A

Lymphocytic predominant

 B

Lymphocytic depletion

 C

Mixed cellularity

 D

Nodular sclerosis

Q. 36

Best prognostic type of Hodgkin’s lymphoma is ‑

 A

Lymphocytic predominant

 B

Lymphocytic depletion

 C

Mixed cellularity

 D

Nodular sclerosis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lymphocytic predominant

  • Prognosis of hodgkin lymphoma mainly depends on the histological type and staging.

Histological type

Best prognosis Lymphocytic predominent
Worst prognosis Lymphocytic depletion type

Best Prognosis

Lymphocytic predominance type 

Worst prognosis

Lymphocytic depletion type

Most common HL

Nodular sclerosis type

Most common type HL in India Mixed cellularity type
Least common type HL Lymphocytic depletion type

Q. 37

Mantle cell lymphomas are positive for all of the following, except ‑

 A

CD 23

 B

CD 20

 C

CD 5

 D

CD 43

Q. 37

Mantle cell lymphomas are positive for all of the following, except ‑

 A

CD 23

 B

CD 20

 C

CD 5

 D

CD 43

Ans. A

Explanation:

Ans. is ‘a’ i.e., CD 23 

Mantle cell lymphoma

  • Mantle cell lymphoma is a type of non-hodgkin lymphoma characterized by presence of tumor cells which closely resemble the normal mantle zone of B-cells that surround germinal centers.
  • Immunophenotype of mantle cell lymphoma
  • Mantle cell lymphoma is neoplasm of B cells.
  • Therefore it expresses B cell marker :
  • CD19,CD20
  • Surface immunoglobulin heavy chain (IgM and IgD).
  • Either /c or X light chain.
  • As the tumor cells are derived from Mantle zone, they are positive for B cell marker of mantle zone i.e., CD-5.
  • Mantle cell lymphoma is CD23 negative, this feature distinguish it from chronic lymphocytic leukemia (CLL) which is positive for both CD5 and CD23.
  • The other characteristic marker of mantle cell lymphoma is cycline DI.

Cytogenetic abnormalities.

  • Mantle cell lymphoma is associated with an 11 : 14 translocation involving the IgH locus on chromosome 14 and the cyclin DI locus on chromosome 11.
  • This leads to increased expression of cyclin D 1, which promotes GI to S phase progression during the cell cycle.
  • 65 years old man with splenomegaly, lymphodenopathy CD-23 negative and CD-5 positive B-cell suggest the diagnosis of mantle cell lymphoma.

Clinical features of mantle cell lymphoma

  • It is usually present in fifth to sixth decade with male preponderance.
  • The most common presentation is painless lymphodenopathy.
  • Splenomegaly may occur.
  • Occasionally, multifocal mucosal involvement of the small bowel and colon produces lymphomatoid polyposis→ of all forms of NHL, mantle cell lymphoms is most likely to spread in this fashion.

Q. 38

In Burkitts lymphoma, translocation seen is chromosome‑

 A

12 – 14 translocation 

 B

8 – 14 translocation

 C

4 – 8 translocation

 D

12- 18 translocation

Q. 38

In Burkitts lymphoma, translocation seen is chromosome‑

 A

12 – 14 translocation 

 B

8 – 14 translocation

 C

4 – 8 translocation

 D

12- 18 translocation

Ans. B

Explanation:

Ans. is ‘b’ i.e., 8-14 translocation 


Q. 39

Burkitt’s lymphoma is positive for ‑

 A

CD5

 B

CD 15

 C

CD 20

 D

CD 25

Q. 39

Burkitt’s lymphoma is positive for ‑

 A

CD5

 B

CD 15

 C

CD 20

 D

CD 25

Ans. C

Explanation:

Ans. is ‘c’ i.e., CD 20

  • Burkitt’s lymphoma is a tumor of mature B cells that express surface IgM, CD19, CD20, CD10, and BCL6, a phenotype consistent with a germinal center B-cell origin.
  • Unlike other tumors of germinal center origin, Burkitt lymphoma almost always fails to express the antiapoptotic protein BCL2
  • Burkitt’s lymphoma is a B-cell lymphoma
  • As this a tumor of mature B-cells it expresses IgM, CD 19, CD20, CD 10 and BCL 6 a phenotype consistent with a B-cell origin.
  • However, unlike other tumors of germinal center origin, Burkitt lymphoma almost always fails to express the anti­apoptotic protein BCL-2.
  • All forms of Burkitt lymphoma are associated with translocations of c-Myc gene on chromosome 8. 
  • The usual translocation is t (8 : 14).
  • Other less common translocations are t (2 : 8) and t (8 : 22).
  • Most of the patients in United States with Burkitt’s lymphoma present with peripheral lymphadenopathy or an intro abdominal mass.
  • The disease is typically rapidly progressive and has a propensity to metastasize to CNS.
  • Chemotherapy is the treatment of choice in Burkitt’s Lymphoma.
  • Burkitt’s Lymphoma was one of the first cancers shown to be curable by chemotherapy.
  • Molecular pathogenesis of Burkitt’s lymphoma
  • All forms of Burkitt’s lymphoma are associated with translocation of the c-MYC gene an  chromosome 8.
  • The translocation partener is usually IgH locus on chromosome 14, i.e., t (8; 14); But may also be Igk on chromosome 2, i.e., t (2; 8) or IgX on chromosome 22, i.e., t (8; 22).

Q. 40

Most common ocular lymphoma ‑

 A

T-cell lymphoma 

 B

Hodgkin’s lymphoma

 C

B-cell NHL

 D

Pre T-cell lymphoma

Q. 40

Most common ocular lymphoma ‑

 A

T-cell lymphoma 

 B

Hodgkin’s lymphoma

 C

B-cell NHL

 D

Pre T-cell lymphoma

Ans. C

Explanation:

Ans. is ‘c’ i.e., B-cell NHL 



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