Lymphoma Basics for the Physician Assistant Exam

The lymphomas are malignancies that affect the lymphatic system and will be covered on the Physician Assistant Exam (PANCE). The two major groups of lymphoma that you should be familiar with are Hodgkin’s disease and non-Hodgkin’s lymphoma.

Hodgkin’s disease

Hodgkin’s disease (HD) is a type of lymphoma that affects young people, usually in the mid-teen years, but it also occurs in people into their late 40s. HD involves a unique type of cell called the Reed-Sternberg cell. It’s a huge cell that has a multilobed nucleus. The Reed-Sternberg cell is crucial in the diagnosis of Hodgkin’s disease.

Look at the key points about Hodgkin’s disease:

  • Clinical presentation can include lymphadenopathy, often along the cervical nodes. The adenopathy is usually painless. Type B symptoms and/or pruritus may be present.

  • In addition to lymphadenopathy, physical examination can reveal hepatosplenomegaly.

  • Staging is really important because Hodgkin’s disease is very curable in the early stages. CT scans are the key to staging this disease. Depending on the stage at the time of diagnosis, radiation and/or chemotherapy may be used.

The Ann Arbor staging system and the REAL/WHO staging system are two systems for staging Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma

Lymphomas that don’t contain the Reed-Sternberg cell are referred to as non-Hodgkin’s lymphomas (NHL). A lymph node biopsy is very important in NHL.

Although staging of NHL is important for diagnosis, perhaps even more important is the grade of the lymphoma. Non-Hodgkin’s lymphoma has three different grades: low, intermediate, and high.

  • Low grade: Examples of low-grade lymphomas include follicular lymphoma, mantle cell lymphoma, and mucosa-associated lymphoid tissue lymphoma (MALToma or MALT lymphoma).

  • Intermediate grade: An example of an intermediate-grade lymphoma is diffuse large cell lymphoma.

  • High grade: Examples of high-grade lymphomas include lymphoblastic lymphoma and Burkitt’s lymphoma.

Here are some key points on NHL:

  • Important connections link HIV, Sjögren’s syndrome, and NHL.

  • Especially with high-grade lymphoma, LDH levels are important markers of disease activity (for example, the degree of cell turnover).

  • Richter’s syndrome is a rare condition in which the CLL transforms into a high-grade lymphoma. The diagnosis is made by a lymph node biopsy.

  • The treatment regimen can include radiation, chemotherapy, and/or bone marrow transplant, depending on the type of lymphoma you’re dealing with.

MALTomas that affect the gastric area are caused by Helicobacter pylori, a Gram-negative bacterium. The treatment consists of using a proton pump inhibitor and antibiotics. This regimen has a pretty decent cure rate, although close follow-up is needed.

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