263 - T Cell and Hodgkin Lymphoma

Question 1

Describe the cell morphology associated with Hodgkin Lymphoma

Answer 1

• Reed-Sternberg cells
  
  • Bi-lobed nuclei, prominent nucleoli
  • Notably CD20- (even though B origin), CD30+, CD15+
  • “owl eyes”

Question 2

In which T-cell lymphoma is the ALK gene relevant?

What does it tell you?

Answer 2

Anaplastic large cell lymphoma (ALCL)

ALK is a tyrosine kinase receptor

• ALK+
  
  • Better prognosis
  • More common in peds
  • Results from t(2;5) translocation
• ALK-
  
  • Poor prognosis
  • More common in elderly

Question 3

Describe the cell morphology associated with anaplastic large cell lymphoma (ALCL)

What are the relevant markers?

Answer 3

• Large cells
• Horse-shoe shaped nuclei
• Nucelar clearing
• CD30+, maybe ALK+

ALK status is important for tx; ALK- has worse prognosis

Question 4

What is the genetic hallmark of ALK+ anaplastic large cell lymphoma? (ALCL)?

Answer 4

t(2;5)

• ALK+ ALCL has a favorable prognosis, seen in peds*
• ALK- ALCL has a poor prognosis, seen in adults*

Question 5

What is the most common primary cutaneous T-cell lymphoma?

Answer 5

Mycosis Fungoides

• Comes from CD4+ T cells
• T cells will have “cerebriform nuclei”
• Loss of CD7
• indolent clinical course w/ slow progression
• can progress to Sezary Syndrome (T cell leukemia)

Question 6

What cell morphology is associated with mycosis fungoides / sezary syndrome?

Answer 6

Small to medium sized T-cells with cerebriform nuclei

Question 7

What is the classic triad of sezary syndrome?

Answer 7

1. Erythroderma (erythema, pruitis, and scaling)
2. Generalized lymphadenopathy
3. Peripheral blood involved w/ neoplastic cells with cerebriform nuclei

Question 8

What is the difference in expression of CD3 between NK cells and T cells?

Answer 8

• NK cells express cytoplasmic CD3
  
  • CD3- on flow cytometry, CD3+ on immunostain
• T cell express surface CD3

Question 9

What markers are associated with neoplastic cells in classic (nodular sclerosing) Hodgkin Lymphoma? (3)

Answer 9

Reed-Sternberg cells:

1. CD30+
2. CD15+
3. CD20-

Vs. nodular lymphocyte predominant HL will be CD30-, CD15-, CD20+

Question 10

What virus is most strongly associted with nasal-type extranodal NK or T-cell lymphoma?

Answer 10

EBV

Question 11

Which malignancy is caused by HTLV1?

Answer 11

Adult T-cell leukemia/lymphoma (ATLL)

Poor prognosis :(

Question 12

List the 4 pan T-cell antigens

Which are most often lost in T-cell lymphoma?

Answer 12

• CD2
• CD3
• CD5*
• CD7*

*Most often lost in T-cell lymphoma

Question 13

Answer 13

A. Classical hodgkin lymphoma - nodular sclerosing type

CD15+, CD30+ = Reed Sternberg cells –> Hodgkin’s Lymphoma

Question 14

Which lymphoma of B cell origin will be CD20-?

Answer 14

Classic hodgkin lymphoma

CD30+, CD15+

Question 15

Describe the cell morphology and relevant immunophenotype in adult T-cell lymphoma/leukemia

Answer 15

Flower-shaped nuclei

CD3+, CD7-

Cell of origin = peripheral CD4+ T cells

Question 16

Answer 16

• A. Anaplastic large ‘T cell lymphoma
  
  • has “hallmark cells” (large cells w/ horshoe shaped nuclei & perinuclear clearing)
  • t(2;5) leads to ALK+, which is more common in peds
  • ALK- more common in adults
    *

Question 17

What markers are associated with neoplastic cells in nodular lymphocyte-predominant Hodgkin Lymphoma? (3)

Answer 17

1. CD20+
2. CD30-
3. CD15-

Vs. classic (nodular sclerosing) will be CD30+, CD15+, CD20-