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Heme/Onc by Minnie: AH Update > 264 - Lymphoid Histology & B Cell Lymphoma > Flashcards

264 - Lymphoid Histology & B Cell Lymphoma Flashcards

1
Q

What is going o in each part of the lymph node follicle?

  • Mantle zone:
  • Germinal center:
  • Cortex:
A
  • Mantle zone:
    • Naive lymphocytes meet antigens
  • Germinal center:
    • Proliferating cells differentiate into antigen-specific cells
  • Cortex:
    • B cells home here
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2
Q

Which area of the lymph node has the most T cells?

A

Paracortex

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3
Q

Describe the Ann-Arbor staging system for lymphoma

A
  • I - single LN region or extranodal site
  • II - 2+ LN regions (or 1 extra nodal site and 1+ LN region
    • Same side of the diaphragm
  • III - LN regions (or extanodal sites) on both side of the diaphragm
  • IV - Any of the above with additional extranodal site OR 2+ extra nodal sites with lymph nodes

A if no sx, B if sx

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4
Q

Which translocation is associated with Burkitt lymphoma?

What is the product?

A

t(8;14)

Increased expression of c-kit

  • Burk-eight = 8;14 translocation*
  • bur-kit = C-kit*

May also involve IGH (chromosome 2) and IGL (chromosome 22)

Associated with EBV

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5
Q

In diffuse large B-cell lymphoma, what do MYC and BCL2 rearrangements indicate about prognosis?

A

Poor prognosis :(

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6
Q

Which lymphomas express high levels of BCL2? (4)

How does BCL2 affect the cell?

A
  • Follcular lymphoma t(14;18)
  • Diffuse large B cell lymphoma
  • CLL/SLL
  • Mantle zone lymphoma

BCL2 inhibits apoptosis

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7
Q

What is the cell of origin in extranodal marginal zone lymphoma?

A

Antigen-stimulated B cells

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8
Q

List 4 tumor markers that may be expressed in Burkitt lymphoma

A

CD20

CD10

BCL6

MYC

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9
Q

What translocation (and product) is associated with mantle cell lymphoma?

A

t(11;14)

Cyclin D1 - Cyclin D1 is fused with the IGH promoter

  • > promotes cell progression through G1/S checkpoint
  • > cell growth
  • This translocation is diagnostic of mantle cell lymphoma*
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10
Q

What is the most common translocation (and product) in follicular lymphoma?

A

t(14;18)

BCL2/IgH

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11
Q

Describe the presentaiton of diffuse large B-cell lymphoma

A

Rapidly enlarging, symptomatic mass in 1 or several sites

Usually in adults 50+, can occur in any age

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12
Q

Which lymphoma is associated with Ki67?

A

Mantle cell lymphoma

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13
Q

B lymphocytes home to which region of the lymph node?

A

Cortex

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14
Q

What 2 factors imact the prognosis of B cell lymphoma?

A

Tumor biology

Stage

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15
Q

Which B cell malignancies might express CD5?

A

Mantle cell lymphoma

CLL/SLL

CD5 is usually a T-cell marker, but can appear in these B-cell malignancies

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16
Q

Which part of the lymph node contains plasma cells?

A

Medulla

17
Q

Which lymphoma has a germinal center origin and a follicular growth pattern?

A

Follicular lymphoma

18
Q

What markers are indicative of CLL/SLL? (2)

A

CD20+

CD5+

Weird because CD5 is a T-cell marker, but appears in this B-cell leukemia

19
Q

Which lymphoma is most associated with chronic inflammation?

A

Extranodal marginal zone lymphoma

  • Arises within and sustained by chronic inflammation*
  • May be associated with H. pylori induced gastritis*
  • Cell of origin = antigen-stimulated B cells*

Treating the inflammation will treat the neoplasm

20
Q

Which part of the lymph node contains memory B cells?

A

Marginal zone

21
Q

What is the major difference between chronic lymphocytic leukemia and small lymphocyte lymphoma?

A

CLL if >5000 peripheral blood neoplastic cells

SLL if more confined to tissue

Both can present with large, asymptomatic lymph nodes

22
Q

A patient with a single lymph node containg lymphoma who has a fever and night sweats would be staged as ____ based on the Ann Arbor staging system?

A

A patient with a single lymph node containg lymphoma who has a fever and night sweats would be staged as 1B based on the Ann Arbor staging system?

23
Q

What is the most common type of non-Hodgkin Lymphoma in the US?

A

Diffuse large B cell lymphoma

24
Q

Which lymphoma is associated with a “starry sky” pattern?

A

Burkitt lymphoma

25
Q

What cell markers are associated with non-Hodgkin Lymphoma with a t(14;18) translocation?

A

CD20+

Other B cell markers (CD19+)

Germinal B markers (CD10+, BCL6+)

This is follicular lymphoma; treat with anti-CD20 ab and BCR signaling inhibitor

26
Q

How can we use the ratio of kappa:lambda B cells to determine if a population is clonal?

What would a clonal population indicate?

A

Kappa:lamba should be about 1:1

Large deviations indicate the presence of a clonal population

Clonal population is bad; implies lymphoma

  • Note: Dr. Gao’s lecutre (264) says ~1:1, and Dr. Wolniak’s lecture (266) says ~2:1*
  • Wikipedia says normal is 0.26 - 1.65 so pick your poison here I guess!*
  • Thank you @Nathan Shlobin!*

Heme/Onc by Minnie: AH Update (36 decks)

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