07 Lymphadenopathy and lymphomas

Question 0

NHL

Answer 0

Non-Hodgkins lymphomas:
Follicular lymphoma
Diffuse Large B cell
Mantle Cell
Marginal Zone
Lymphoplasmacytic Lymphoma
Burkitt

Question 1

Suggestion of reactive vs. neoplastic

Answer 1

Reactive:

• Very quick growing lymphaednopathy
• Less than 1cm
• Tender
• mobile
• fever, chills, visible infection source

Question 2

Nodular/follicular Non Hodgkins BCL (small tumor size)

Answer 2

Follicular lymphoma, Mantle Cell (intermediate tumor size), Marginal Zone, CLL/SLL

Question 3

Follicular lymphoma

Answer 3

20% of all lymphomas
most t(14:18) BCL2 overepression (antiapoptotic- fairly indolent)
CD5(-), CD 10(+), (CD19,20 + mature BCLS)

EXTENSIVE GENERALIZED ADENOPATHY
Generally indolent in 60 yo males but can transform to Diffuse large B cell lymphoma, and burkitts.

Can treat with Chemo and Rituximab if patient is symptomatic

Question 4

Extranodal Marginal Zone lymphoma

Answer 4

Tumors of memory B cells at MALT sites: t(11;18), t(1;14),t(14;18)

Indolent disorder that may go away if inciting factor removed (i.e. H. pylori)

Can also be treated with chemo, rads, resection

Question 5

Mantle Cell Lymphoma

Answer 5

Naiive B cell tumor, t(11;14) IgH and Cyclin D1 fusion: cell cycle promoter-
CD5 (+) CD 23 (-), (CD19,20 + with IgMorD plus Cyclin D1 staining)

Moderately agressive- GENERALIZED LYMPHADENOPATHY in older males. 3-4 year surival: Poor prognosis

Question 6

Diffuse Non hodgkin BCLs (large tumor size)

Answer 6

Diffuse large BCL

Burkitts lymphoma

Question 7

Burkitts Lymphoma

Answer 7

Germinal center B cells t(8;14) c-MYC translocation (can also be 2:8, 8:22)
CD10(+), CD 19, 20 (+)

AGGRESSIVE EBV ASSOCIATED(especially in Africa- madibular mass)
In america adolescents or young adults with ileocecal masses
POST TRANSPLANT (immunosuppressed) 

Starry sky patternof diffuse lymphoid cells with large “tingable body macrophages” that have phagocytosed dead tumor cells.

Question 8

Diffuse Large B cell lymphoma

Answer 8

Aggressive rapidly growing mass with many chromosomal abnormalities (can be from a follicular lymphoma transformation)

Diffuse Lymphocytes with cells much larger than others

Treat with aggressive chemo

Question 9

T/NK cell Lymphomas

Answer 9

Peripheral T-cell lymphoma
Anaplastic Large-cell lymphoma
Extranodal NK/Tcell Lymphoma

Question 10

Anaplastic large cell lymphoma

Answer 10

CTL 2p23 rearrangements of ALK(TKR) gene t(2;5)
CD8 (+)

Agressive tumor in children and young adults

Good prognosis with treatment

Question 11

Extranodal NK/Tcell Lymphoma

Answer 11

NK or CTL(CD8+) cell neoplasm

EBV associated in Asia/ south america- Adult nasopharyngeal masses
Agressive with necrosis and angioinvasion

Poor prognosis

Question 12

Peripheral T cell lymphoma

Answer 12

CD4(+)
T cell lymphoma

Agressive T cell lymphoma in adults with lymphadenopathy,
Poor prognosis

Question 13

Classical Hodgkins Lymphoma

Answer 13

Inflammatory cells with REED STERNBERG CELLS- Large Eosinophilic "owl eye" nuclei.  B lineage neoplasm
CD 20 (-) ****,    CD15,30 (+)

Usually young adults and can be EBV associated
CONTIGUOUS SPREAD - mediastinal to cervical

Moderately aggressive with good response to chemo

Nodular sclerosing*, Mixed cellularity, Lymphocyte predominate, Lymphocyte depleted

Question 14

NLPHL

Answer 14

Nodular lymphocyte predominant HL (non-classical HL)
CD15,30 (-), CD20,45(+)

30-50 YO

Nodular popcorn cells
Indolent with relapses

Question 15

EBV associated neoplasms

Answer 15

Endemic/post transplant Burkitts
Post transplant Lymphoproliferative disorder
Extranodal NK/T cell Lymphoma
Classical Hodgkins
Diffuse large B cell Lymphoma, T cell lymphomas

Nasopharyngeal carcinomas