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Self-Assessment Questions

Hematology

Lymphoma: Review Questions

Richard S. Stein, MD, FACP
Dr. Stein is Associate Professor of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN


Choose the single best answer for each question.

1. A 40-year-old woman has cervical lymphadenopathy. Results of a biopsy reveal non-Hodgkin’s lymphoma. A staging computed tomography (CT) scan of the chest shows no abnormalities. An abdominal CT scan reveals a mesenteric mass, which measures 5 x 5 cm in diameter. A bone marrow examination is performed and is negative for lymphoma. The patient’s chance of a cure will be greatest if which of the following types of lymphoma is present?
  1. Large B-cell lymphoma (large transformed cell lymphoma)
  2. Mantle cell lymphoma
  3. Peripheral T-cell lymphoma
  4. Small cleaved cell lymphoma
  5. Small noncleaved cell lymphoma (Burkitt’s lymphoma)
Click here to compare your answer.


2. The potential value of autologous stem cell or bone marrow transplantation is most severely compromised by potential bone marrow involvement in which of the following types of lymphoma?

  1. Anaplastic large cell lymphoma
  2. Hodgkin’s disease
  3. Large B-cell lymphoma (large transformed cell lymphoma)
  4. Peripheral T-cell lymphoma
  5. Small cleaved cell lymphoma
Click here to compare your answer.


  3. A 53-year-old woman undergoes endoscopy because of persistent dyspepsia. No mass lesions are seen, but a biopsy of an area of gastritis is obtained. Pathologic results report a mucosally associated lymphoid tumor (ie, gastric MALToma). A staging CT scan is performed, which shows no evidence of disease in the abdomen. A chest CT scan is also negative for lymphoma. Which of the following is the best therapy for this lesion?
  1. Antibiotic therapy directed against Helicobacter pylori
  2. CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone)
  3. COP chemotherapy (cyclophosphamide, vincristine, prednisone)
  4. Gastrectomy followed by radiation therapy
  5. Gastrectomy with lymph node dissection
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4. An 18-year-old woman with a right cervical lymph node has nodular sclerosing of Hodgkin’s disease. She is asymptomatic. Staging, limited to CT scans and a bone marrow biopsy, finds no other evidence of disease, and she receives radiation therapy to a mantle port for presumed stage IA disease. Three years later, she is found to have a mediastinal mass; results of mediastinoscopy confirm recurrent Hodgkin’s disease. She receives 6 cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) and achieves a second complete remission. Eight months later, an axillary node is noted on physical examination, and biopsy results show recurrent Hodgkin’s disease. Staging CT scans are negative for Hodgkin’s disease, as is a bone marrow examination. Which of the following is the most reasonable next step in treatment of this patient?

  1. Chemotherapy with a combination that is not cross resistant to ABVD chemotherapy, such as MOPP (mechlorethamine, vincristine, procarbazine, and prednisone)
  2. Chemotherapy with a single agent such as vinblastine or cyclophosphamide given with palliative intent
  3. High-dose chemotherapy in conjunction with autologous stem cell transplantation with curative intent
  4. Radiation therapy to the axilla
  5. No further treatment
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