Lymphomas
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Direct answer
Lymphomas are solid neoplasms of lymphocytes, divided into Hodgkin lymphoma — Reed-Sternberg cells, contiguous nodal spread and B symptoms — and non-Hodgkin lymphomas, a heterogeneous, often extranodal group. FMGE favourites are the translocation-defined B-cell lymphomas: follicular with t(14;18), Burkitt with t(8;14) and starry-sky histology, mantle cell with t(11;14), plus diffuse large B-cell lymphoma and cutaneous T-cell disease. Plasma cell myeloma with CRAB features, punched-out lesions and Bence Jones proteinuria is examined alongside.
What you must remember
- Hodgkin lymphoma: bimodal age curve, painless cervical-supraclavicular nodes, contiguous spread; B symptoms include Pel-Ebstein fever; Reed-Sternberg cells are CD15- and CD30-positive binucleate owl-eye cells.
- Hodgkin subtypes: nodular sclerosis commonest (young women, mediastinal mass, lacunar cells); nodular lymphocyte-predominant disease has popcorn cells (CD20-positive, CD15 and CD30 negative) and the best prognosis; lymphocyte-depleted is worst.
- Non-Hodgkin favourites: follicular — commonest indolent adult lymphoma with anti-apoptotic BCL2 from t(14;18); diffuse large B-cell — commonest aggressive, treated with rituximab-CHOP; Burkitt — fastest-growing human tumour, starry-sky pattern, endemic African jaw disease in EBV-associated children, sporadic abdominal disease.
- Mantle cell: t(11;14) with cyclin D1 overexpression, CD5-positive, aggressive in older adults.
- Gastric MALT lymphoma is Helicobacter pylori-driven and may regress with eradication in early disease.
- T-cell: adult T-cell leukaemia/lymphoma from HTLV-1 with flower cells and hypercalcaemia; mycosis fungoides and Sézary syndrome — CD4 cutaneous lymphoma with Pautrier microabscesses and cerebriform cells.
- Myeloma: elderly patients with CRAB — hypercalcaemia, renal impairment, anaemia, bone lesions; punched-out skull lucencies, marrow plasmacytosis above 10 per cent, M spike, Bence Jones light chains, rouleaux, cast nephropathy and AL amyloidosis; proteasome-inhibitor regimens with autologous transplant in fit patients.
Common confusion
Hodgkin spreads contiguously, rarely involves extranodal sites and harbours Reed-Sternberg cells; non-Hodgkin lymphomas jump non-contiguously and go extranodal. Keep the translocations apart — t(14;18) follicular, t(8;14) Burkitt, t(11;14) mantle. Myeloma differs from Waldenström macroglobulinaemia, which secretes IgM causing hyperviscosity without lytic bone disease.
Exam-focused takeaway
FMGE converts histology to diagnosis: owl-eye binucleate cells (Hodgkin), starry-sky (Burkitt), Pautrier microabscesses (mycosis fungoides). Clinical stems describe the African jaw mass, an elder with back pain and punched-out skull films, or a young woman with a mediastinal mass. Learn entity as cell-or-pattern plus translocation or marker plus one scenario.
Frequently asked questions
What is a Reed-Sternberg cell?
A large binucleate owl-eye cell expressing CD15 and CD30, the diagnostic tumour cell of classical Hodgkin lymphoma, mostly of germinal-centre B-cell origin.
Which lymphoma carries t(8;14)?
Burkitt lymphoma, placing MYC beside the immunoglobulin locus, with very rapid proliferation and a starry-sky pattern of macrophages. The endemic jaw form is EBV-related.
Why does gastric MALT respond to antibiotics?
Early lymphoma remains antigen-dependent on Helicobacter pylori, so eradication removes the proliferative drive and induces durable regression. Deeper disease needs oncological therapy.
What are B symptoms?
Unexplained fever above 38 degrees, drenching night sweats and loss of more than 10 per cent body weight over six months — constitutional features that upstage lymphomas and worsen prognosis.
What is Bence Jones protein?
Monoclonal free light chains excreted in myeloma, damaging tubules as cast nephropathy. With lytic lesions and marrow plasmacytosis it defines symptomatic myeloma.
Which lymphoma presents with skin plaques?
Mycosis fungoides, a CD4-positive cutaneous T-cell lymphoma with Pautrier microabscesses; its erythrodermic, leukaemic variant is Sézary syndrome with circulating cerebriform cells.