17. Flow Cytometry and Lymphoid Neoplasms

Question 1

Primary Lymphoid Tissue

Answer 1

Bone marrow = B Cells

Thymus = T Cells

Question 2

Secondary Lymphoid Tissues

Answer 2

• Lymph nodes
• Spleen
• Tonsils
• Appendix
• Submucosa of GI Tract
• Respiratory Tract
• Liver (Kupffer cells)
• Blood (lymphocytes)

Question 3

Monoclonal Antibodies

Answer 3

• made from hybridoma (fusion of myeloma cells w. B cells)

Question 4

Flowcytometry

Answer 4

• light from laser hits one cell at a time
• light defracts/scattters
• High angle scatter (
  Right angle): Reflection & refraction. Cell structure.
• Low angle scatter
  (Forward angle) : Diffraction. Cell size
• can be used to separate cells with monoclonal antibody

Question 5

Lymphoma vs. Leukemia

Answer 5

Lymphoma: Malignant neoplasm found predominantly in the lymphoreticular system

Leukemia: Malignancy of the bone marrow and peripheral blood

Question 6

B-cell CLL

Answer 6

Laboratory

• Persistent ↑WBC, ↑ “normal” looking lymphs, smudge cells
• (+) for B-cell markers, CD 5, Κ or λ, dim Sig

Clinical

• > 50 yo
• Anemia, Lymphadenopathy
• Slow progressing disease
• Prognosis good compared to other leukemias

Question 7

Hair Cell Lymphoma (HCL)

Answer 7

Laboratory

• ↑WBC, ↑ “hairy” lymphs
• (+) for B-cell markers, Κ or λ, bright SIg, TRAP+
• Negative for CD5

Clinical

• > 50 yo
• Anemia
• Splenomegaly, hepatomegaly, lymphadenopathy

Question 8

B cell Prolymphocytic Leukemia

Answer 8

Laboratory
- ↑WBC
- ↑ large lymphs
nucleolus
- (+) for B-cell markers, Κ or λ, bright Sig, negative CD5

Clinical

• > 50 yo
• Anemia
• Organomegaly

Question 9

Multiple Myeloma

Answer 9

• Plasma Cells Neoplasm
• Monoclonal B-cell proliferation
• Cytoplasmic Ig
• Free light chains
• Plasma cells
• Rouleaux, tear-drop cells
• Serum Protein Electrophoresis shows gamma globulin spike
• Hyperviscosity Syndrome

Question 10

Waldenstroms Macroglobulinemia (Lymphoplasmacytic Lymphoma)

Answer 10

• Plasma Cells Neoplasms
• Hyperviscosity syndrome
• Splenomegaly & lymphadenopathy (Uncommon <15%)
• Positive for B-cell markers: CD19, 20, 22, 79, FMC7.2
• IgM increases Rouleaux
• Cold agglutinin w/hemolytic anemia
• Treatment: Chemotherapy and plasmapheresis
• Survival 5-10 years

Question 11

Monoclonal Gammopathy of Unknown Significance (MGUS)

Answer 11

• Plasma cell disorder
• Benign disease
• Possible precursor to multiple myeloma (some Waldenstroms macroglobulinemia & Amyloidosis)
• Abnormal amount of a single immunoglobulin: Monoclonal spike or M component