HEME - NON-HODGKIN LYMPHOMA (NHL) - RAD
ONC CLINICAL REVIEW 2025 QUESTIONS &
ANSWERS RATED 100% CORRECT!!
What is the *pathologic definition* of NHL?
Pathobiology Answer - Solid tumours of lymphoid cells:
- *Monoclonal expansion* of malignant B/T/NK cells
- Diverse group of malignancies
- Lacks the pathologic characteristics of Hodgkin disease (*no RS cells*)
- *Nodal/focal* involvement (vs more disseminated presentation of leukemias)
- No predictable
Notes:
- Complex process involving the accumulation of multiple genetic lesions
affecting POG and TSG
RS: Reed-Sternberg (Multinucleated cells)
POG: Proto-oncogen
NHL vs Hodgkin
How does the clinical presentation of NHL differ from that of HD? Answer - A)
NHL
- Tumor cells in majority
,- No predictable pattern of spread
- Extranodal presentation >40%
- Multiple peripheral nodes often involved
- Mesenteric nodes & Waldeyer ring commonly involved
- B symptoms <30%
- Can occur in adults and children
- Prognosis more strongly affected by histologic subtype than HD
- Age: Older more likely to be NHL than HL
- Rare to have stage I NHL (10%)
B) HD:
- Tumor cells in minority
- Orderly spread: Node group to node group → Spleen → Liver → BM
- Extranodal involvement uncommon
- Greater involvement of single axial node group
- B symptoms 40%
- Contains abnormal B cells (Reed-Sternberg)
- Bimodal distribution (young adulthood and >55)
Epidemiology NHL Answer - - Most common hematologic malignancy
- Rising incidence (HIV)
Groups:
- Older patients: Follicular, SLL, Diffuse (wide range)
- Older men: Mantle cell
- Burkitt Lymphoma: Children & young adults
,- White >Black/Asian
Non-Hodgkin Lymphoma: T vs B cells Answer - A) B cell neoplasms (80-85%)
- Precursor B cell (i.e. acute lymphoblastic leukaemia/lymphoma = ALL)
- Peripheral B cell
B) T/NK cell neoplasms (10-15%)
- Precursor T/NK cell (i.e T-cell precursor ALL)
- Peripheral T/NK cell
Pathobiology NHL (Cont)
A cell of origin has been proposed for each type of NHL (based upon
morphologic, immunophenotypic, and genetic features). Answer - B Cells:
- Majority derived from germinal center or post-germinal center B cells
- Genetic modifications during germinal center reaction of B cells (class-switch
recombination and somatic hypermutation)
- Changes place the cell at risk of additional mutations that may be oncogenic
T Cells (10-15%):
- Majority derived from post-thymic T cells
- Gene rearrangement of T cell receptors (essential for the development of a
highly diverse repertoire of TCRs)
- Also places the cell at risk for acquiring potentially oncogenic chromosomal
translocations
Infectious aetio-pathology Answer - Oncogenic viruses:
A) EBV:
, - Burkitt lymphoma (immunosuppression) Endemic in Africa (Also HIV)
- Primary CNS diffuse large B cell lymphoma
- Extranodal T cell/NK lymphoma
B) Human T cell lymphotropic virus I (HTLV-I):
- Adult T cell leukemia-lymphoma
C) HIV:
- DLBCL
- Burkitt lymphoma (Also EBV)
D) Hepatitis C (Lymphoplasmacytic lymphoma)
E) Helicobacter pylori (MALT)
F) Human Herpesvirus 8 (HHV-8):
- Body-cavity-based lymphomas (eg, primary effusion lymphoma)
Diffuse large cell lymphoma: HIV, EBV, HHV-8
Workup: History & PE Answer - A) Patient History:
- PS/Comorbidities
- B Symptoms (30%)
- Exposure to XRT
- Pregnancy status
- Airway obstruction symptoms (SVCO)
ONC CLINICAL REVIEW 2025 QUESTIONS &
ANSWERS RATED 100% CORRECT!!
What is the *pathologic definition* of NHL?
Pathobiology Answer - Solid tumours of lymphoid cells:
- *Monoclonal expansion* of malignant B/T/NK cells
- Diverse group of malignancies
- Lacks the pathologic characteristics of Hodgkin disease (*no RS cells*)
- *Nodal/focal* involvement (vs more disseminated presentation of leukemias)
- No predictable
Notes:
- Complex process involving the accumulation of multiple genetic lesions
affecting POG and TSG
RS: Reed-Sternberg (Multinucleated cells)
POG: Proto-oncogen
NHL vs Hodgkin
How does the clinical presentation of NHL differ from that of HD? Answer - A)
NHL
- Tumor cells in majority
,- No predictable pattern of spread
- Extranodal presentation >40%
- Multiple peripheral nodes often involved
- Mesenteric nodes & Waldeyer ring commonly involved
- B symptoms <30%
- Can occur in adults and children
- Prognosis more strongly affected by histologic subtype than HD
- Age: Older more likely to be NHL than HL
- Rare to have stage I NHL (10%)
B) HD:
- Tumor cells in minority
- Orderly spread: Node group to node group → Spleen → Liver → BM
- Extranodal involvement uncommon
- Greater involvement of single axial node group
- B symptoms 40%
- Contains abnormal B cells (Reed-Sternberg)
- Bimodal distribution (young adulthood and >55)
Epidemiology NHL Answer - - Most common hematologic malignancy
- Rising incidence (HIV)
Groups:
- Older patients: Follicular, SLL, Diffuse (wide range)
- Older men: Mantle cell
- Burkitt Lymphoma: Children & young adults
,- White >Black/Asian
Non-Hodgkin Lymphoma: T vs B cells Answer - A) B cell neoplasms (80-85%)
- Precursor B cell (i.e. acute lymphoblastic leukaemia/lymphoma = ALL)
- Peripheral B cell
B) T/NK cell neoplasms (10-15%)
- Precursor T/NK cell (i.e T-cell precursor ALL)
- Peripheral T/NK cell
Pathobiology NHL (Cont)
A cell of origin has been proposed for each type of NHL (based upon
morphologic, immunophenotypic, and genetic features). Answer - B Cells:
- Majority derived from germinal center or post-germinal center B cells
- Genetic modifications during germinal center reaction of B cells (class-switch
recombination and somatic hypermutation)
- Changes place the cell at risk of additional mutations that may be oncogenic
T Cells (10-15%):
- Majority derived from post-thymic T cells
- Gene rearrangement of T cell receptors (essential for the development of a
highly diverse repertoire of TCRs)
- Also places the cell at risk for acquiring potentially oncogenic chromosomal
translocations
Infectious aetio-pathology Answer - Oncogenic viruses:
A) EBV:
, - Burkitt lymphoma (immunosuppression) Endemic in Africa (Also HIV)
- Primary CNS diffuse large B cell lymphoma
- Extranodal T cell/NK lymphoma
B) Human T cell lymphotropic virus I (HTLV-I):
- Adult T cell leukemia-lymphoma
C) HIV:
- DLBCL
- Burkitt lymphoma (Also EBV)
D) Hepatitis C (Lymphoplasmacytic lymphoma)
E) Helicobacter pylori (MALT)
F) Human Herpesvirus 8 (HHV-8):
- Body-cavity-based lymphomas (eg, primary effusion lymphoma)
Diffuse large cell lymphoma: HIV, EBV, HHV-8
Workup: History & PE Answer - A) Patient History:
- PS/Comorbidities
- B Symptoms (30%)
- Exposure to XRT
- Pregnancy status
- Airway obstruction symptoms (SVCO)
