LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35
Chapter 30•Lymphomas 433Answer 30.32. The answer is A.
Overall outcome in MF is correlated with clinical stage (skin involvement
and visceral stage). Staging for MF is based on estimating the degree
of skin involvement and the amount of infiltration of lymph nodes and
viscera. T1 and T2 are disease patches or plaques on less than 10% of the
skin surface, whereas T4 is erythroderma flat and patch-like with diffusely
infiltrated skin and thickening and fissuring of the palms and soles of the
feet. LN4 nodes are effaced by tumor cells and characterize patients with
poor prognosis.Answer 30.33. The answer is C.
The most common presentation of primary CNS lymphoma is the frontal
lobe and is associated with changes in personality and level of alertness.
Headaches and symptoms of increased intracranial pressure are seen fre-
quently. Many lesions are periventricular, allowing tumor cells to gain
access to the cerebrospinal fluid.Answer 30.34. The answer is B.
Optic nerve involvement can occur.Answer 30.35. The answer is D.
The risk of multifocal leukoencephalopathy is higher in older patients and
when chemotherapy and RT are overlapping. Radiation boost to affected
areas should be avoided. Most often chemotherapy is administered before
RT in PCNSL to avoid cognitive damage and decrease neurotoxicity. The
blood–brain barrier after completion of cranial RT may remain open
weeks to months, thereby increasing the risks of leukoencephalopathy
when drugs accumulate in brain tissue.Answer 30.36. The answer is D.
HRS cells express many cytokines and chemokines, thereby explaining the
inflammatory infiltrates seen in affected lymph nodes. IL-5 is expressed
in 95% of HRS cells and 63% of elaborate eotaxin, thereby providing
proliferation and chemotactic signals to recruit eosinophils to the site(s)
of HL. Genes like IL (IL-13, 6, 12, and 10), interferon-, tumor necrosis
factor (TNF)-, and IL-1 are expressed by HRS cells and mediate the B
symptoms and immune dysregulation seen in patients with HL at presen-
tation.Answer 30.37. The answer is C.
Mutations of IBwere found in 15 of 26 primary cHL cases, 11 of which
were EBV-negative.Answer 30.38. The answer is A.
HRS cells effectively escape the host immune system by modulating the
immune response in the direction of an impaired Th2 response. Sur-
rounding eosinophils inhibit an effective Th1 response in favor of a