Devita, Hellman, and Rosenberg's Cancer

LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35

Chapter 30•Lymphomas 423

Question 30.40. The term “lymphocyte rich classic Hodgkin’s lymphoma” (LRCHL) has

been proposed in the Revised European–American Lymphoma (REAL)

classification for cases of HL with RS cells that appear classic by mor-

phology and immunophenotype and have a background infiltrate con-

sisting predominantly of lymphocytes, with rare or no eosinophils. True

statements about LRCHL include all of the following, EXCEPT:

A. LRCHL can closely resemble NLPHL morphologically, and

immunophenotyping may be required to differentiate the two enti-

ties. Cases of LRCHL have the same immunophenotype of cHL with

expression of CD15 and CD30 by the HRS cells. CD20 is coexpressed

in 3% to 5% of cases.

B. Follicular meshworks of follicular dendritic cells are seen with anti-

bodies to CD21 or CD35, and RS cells are found within the mantle

and interfollicular regions.

C. Patients with LRCHL usually lack bulky disease or B symptoms and

tend to present with early-stage disease. The clinical features at pre-

sentation seem to be intermediate between those of NLPHL and cHL.

D. OS of LRCHL is slightly better than that of NLPHL in the German

Hodgkin Study Group (GHSG) studies.

Question 30.41. All are true about the association of cHL with other lymphomas,

EXCEPT:

A. cHL can be associated with high-grade DLCBL, Burkitt’s, or Burkitt’s-

like lymphoma.

B. Cases of cHL associated with follicular lymphoma or DLCBL may

precede, follow, or occur simultaneously with the lymphoma.

C. B-cell CLL does not transform into HL.

D. Mediastinal gray zone lymphoma has features of both cHL and

DLCBL at diagnosis.

Question 30.42. Staging procedures for HL have become simpler and less invasive with

the advent of new staging modalities and the use of combined modality

treatment. Which of the following statements is TRUE?

A. Patients with large mediastinal adenopathy, mediastinal mass>50%

of the thoracic diameter at T5-6, or a ratio>50% of the transverse

diameter of the mediastinal mass over the diameter of the diaphrag-

matic thorax have increased risk of relapse (nodal or extranodal sites)

after RT alone.

B. For a patient with early-stage HL treated initially with chemotherapy,

if a PET scan is subsequently negative, there is good evidence that the

patient does not need adjuvant-involved field RT after chemotherapy.

C. Staging laparotomy has been replaced by FDG-PET scanning but

should be used in rare circumstances in early-stage HL, in which the

use of limited RT alone depends on pathologic staging.

D. Evidence of contiguous spread of HL is most convincing in patients

with LP disease.