# Lymphomas

> Lymphomas for FMGE Pathology, covering Hodgkin lymphoma with Reed-Sternberg cells, NHL translocations, mycosis fungoides and plasma cell myeloma with CRAB.

- Canonical URL: https://prepelephant.com/topics/fmge/pathology/lymphomas
- Exam / course: FMGE · Subject: Pathology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Lymphomas", PrepElephant, https://prepelephant.com/topics/fmge/pathology/lymphomas

## 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.