265 - Hodgkin's Disease, T-Cell Disorders

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+*

Question 2

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

What does it tell you?

Answer 2

Anaplastic large cell lympoma (ALCL)

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

ALK is a tyrosine kinase receptor

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 / sezary syndrome

• Comes from CD4+ T cells*
• Loss of CD7*

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

Erythroderma

Generalized lymphadenopathy

Peripheral blood involved w/neoplastic cells with cerebriform nuceli

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, 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

CD30+

CD15+

CD20-

Vs. nodular lymphocyte predominant 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 malignany 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

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

CD7-

Cell of origin = peripheral CD4+ T cells

Question 16

Answer 16

A. Anaplastic large T cell lymphoma

• t(2;5) leads to ALK+*
• More common in ped*s (ALK- more common in adults)

Question 17

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

Answer 17

CD20+

CD30-

CD15-

Vs. classic will be CD30+, CD15+, CD20-