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120514 cases Flashcards

1
Q

how to differentiate reactive vs neoplastic LAD

A

duration? growth interval (rapid?)?
size? (1 cm is way too big)
location? (axilla, cervical, inguinal-if not these, then probably more concerning)

tender vs nontender? (tender means probably acute and infectious. nontender suggests more neoplastic)

fixed vs. mobile? (fixed is more concerning)

associated PE findings?

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2
Q

how to differentiate reactive vs neoplastic LAD with histology

A

LN architecture is intact or effaced (effaced suggests neoplastic)

dominant cell type? (heterogeneous in reactive LAD-has dark/light zones of germinal center)

atypia?

flow cytometry?

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3
Q

reactive causes of LAD?

A

infectious
autoimmune
drugs (phenytoin)
foreign body

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4
Q

LAD-neoplastic causes of it?

A

lymphoma
leukemic involvement
metastatic tumor

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5
Q

histologic patterns of reactive LAD

A

follicular hyperplasia (autoimmune, early HIV, toxoplasmosis)

paracortical hyperplasia (EBV, CMV, herpes, drugs)

sinus histiocytosis (draining tumors)

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6
Q

which non Hodgkin’s lymphomas are aggressive?

A

Burkitt
diffuse large B cell
mantle cell (moderate)

peripheral T cell, unspecified
anaplastic large cell
extranodal NK/T cell

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7
Q

Hodgkin’s lymphoma’s spread–what is important to note about it?

A

contiguous

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8
Q

tx for follicular lymphoma

A

chemotherapy and antiCD20 monoclonal antibody therapy

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9
Q

starry sky-what is it exactly?

A

sky is sea of tumor cells

starry part is the tingible body macrophages that eat the debris as cells turnover

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10
Q

starry sky is seen in

A

Burkitt lymphoma

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11
Q

t(11;14)

A

cyclin D1 gene (chromosome 11) translocates to Ig heavy chain gene on chromosome 14

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12
Q

t(11;14) is associated with

A

mantle cell lymphoma

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13
Q

CD5 positive

A

mantle cell lymphoma

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14
Q

t(14,18)

A

BCL2 gene translocates to Ig heavy chain gene on chromsome 14

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15
Q

BCL2 overexpression

A

follicular lymphoma

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16
Q

CD30+ and CD15+

A

Hodgkin’s lymphoma

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17
Q

Burkitt lymphoma immunophenotype

A

CD10+
CD19+
CD20+

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18
Q

extranodal marginal zone lymphoma (MALToma) immunophenotype

A

CD5-
CD10-
CD19+
CD20+

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19
Q

follicular lymphoma immunophenotype

A

CD5-
CD10+
CD19+
CD20+

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20
Q

mantle cell lymphoma immunophenotype

A

CD5+
CD10-
CD19+
CD20+

21
Q

MOA of rituximab

A

for therapy in FL–has improved survival for this disease

CDC
ADCC
apoptosis
ionizing radiation induced cell death

22
Q

course of follicular lymphoma

A

generally indolent

however 40% can turn into aggressive lymphomas (diffus large B cell lymphoma, Burkitt lymphoma)

23
Q

what can cause Burkitt lymphoma?

A

EBV

24
Q

diagnosing B cell non Hodgkin’s lymphoma-what should you consider?

A

architecture-nodular, follicular or diffuse?
tumor cells–are they small, medium, large? are they clefted/cleaved (FOLLICULAR LYMPHOMA), mantle, or marginal zone?

immunophenotype:
establish it’s B cell
small size lymphomas-CD5, CD10, CD23

cytogenetics:
t(14;18)–BCL2
t(11;14)–cyclinD1
t(8;14)–cMyc

25
Q

diffuse architecture for B-NHL suggests

A

more aggressive:
diffuse large B-cell lymphoma
Burkitt lymphoma

26
Q

what cytogenetics is assoc with Burkitt lymphoma

A

t(8;14) - common–c-myc translocation
t(2;8)
t(8;22)

27
Q

t(11;18)

A

marginal zone lymphoma

28
Q

chromosome 14 is of significance why?

A

has Ig heavy chain gene. this gene is heavily transcribed

29
Q

BCL-2 role

A

prevents cell from apoptosis (so when placed on chromsome 18, results in indolent course of disease, NOT aggressive)

30
Q

MALT sites- MALToma

A

extranodal marginal zone lymphoma

in MALT sites such as gastric, thyroid, lung

31
Q

clinical variants of Burkitt lymphoma

A

sporatic (ileocecal mass)
endemic (EBV, breast, jaw, ovary)
immunosuppression related (EBV)
transformation from follicular lymphoma

32
Q

EBV associated neoplasms

A

lymphomas (mostly B):
endemic Burkitt lymphoma
post transplant lymphoproliferative disorder
extranodal NK/T cell lymphoma

subsets of Hodgkin lymphoma, diffuse large B cell lymphoma, T cell lymphomas

nasopharyngeal carcinoma

33
Q

infectious EBV is transmitted how

A

in saliva, all the time, even in healthy people

34
Q

EBV symptoms

A

first decade of life-mild cold like symptoms

adolescence and beyond-infectious mononucleosis (massive expansion of CD8 T cells, increase in activated B cells with very few of those EBV infected)

35
Q

EBV reactivation from B cells is triggered by

A

B cell differentiation into plasma cell

poorly controlled reactivation (like if immunecompromised w/o cytotoxic T cells) is a significant risk factor for EBV-driven malignancies

36
Q

mechanisms of EBV-induced oncogenesis

A

direct transformation
hit and run
bystander effect
chronic inflammation

37
Q

owl eyed nuclei

A

Reed Sternberg cells in classic Hodgkin lymphoma

38
Q

what type of cells are Reed Sternberg cells

A

B lineage neoplastic cells, seen among an inflammatory cell milieu

39
Q

Hodgkin lymphoma (compared to NHL)

A

Hodgkin’s:
localized to a SINGLE axial group of nodes
orderly spread by contiguity
mesenteric nodes and Waldeyer ring (pharynx) rarely involved
extranodal involvement is uncommon
infrequent bone marrow involvement

40
Q

NHL (compared to Hodgkin’s lymphoma)

A 
more frequent involvement of multiple peripheral nodes
noncontiguous spread
mesenteric nodes, Waldeyer ring common
extranodal involvement common
frequent bone marrow involvement
41
Q

morphology of Reed Sternberg cell

A

large size
frequent binucleation
eosinophlic nucleoli (owl eye)

42
Q

classification of Hodgkin lymphoma

A

classical HL (nodular sclerosis HL-most common, mixed cellularity HL, etc)

nodular lymphocyte predominant HL

43
Q

popcorn cells

A

L&H cells in a sea of lymphocytes

nodular lymphocyte predominant HL

44
Q

nodular sclerosis HL is seen at what site

A

mediastinal

45
Q

classical HL immunophenotype

A

CD15, CD30 +

CD20, CD45 -

46
Q

nodular lymphocyte predominant (non-classic) HL’s immunophenotype

A

CD15, CD30 -

CD20, CD45 +

47
Q

dense sclerosis in HL suggests

A

nodular sclerosis-a type of classic HL

48
Q

classical HL: CD20 positive or neg?

A

negative

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