6-5, 6-6, 6-7: Lymphoma & Hodgkin Lymphoma Flashcards
LAD or lymphadenopathy refers to:
Seen when? And important finding?
enlarged lymph nodes
seen wtih acute infection = PAINFUL
seen with chronic inflammation metastatic carcinoma, or lymphoma = PAINLESS
what part of lymph node(LN) experiences hyperplasia with rhuematoid arthritis?
the follicles
what part of lymph node(LN) experiences hyperplasia with viral infection?
the paracortex (this is where the t-cells live)
what part of lymph node(LN) experiences hyperplasia with LN that drain cancer?
sinus histiocytes (deep in sinus of medula)
what part of lymph node(LN) experiences hyperplasia with early HIV?
the follicles (contains some CD4 t-cells)
The cortex of a LN contains what type of cells?
B-cells
Lymphoma definition and where occurs?
- neoplastic proliferation of lymphoid cells that forms a mass
- in LN or soft tissue (extranodal tissue)
Types of lymphomas:
- Hodgkin - 40%
- Non-Hodgkin - 60% - mostly B-cell
Non-hodgkin lymphoma classification criteria:
- cell type (B or T-cell)
- cell size (small, med, large?)
- pattern of cell growth (diffuse sheet? or follicles?)
- expression of surface markers
- cytogenic translocations
LN histology - Cortex
- what are the areas?
- What types of cancers arise?
Cortex has follicles –> surrounded by mantle –> surrounded by Margin
EACH has its own cancer type: follicular, mantle cell and margin zone = Lymphomas
(one other lymphoma = CLL when it gets into a lymph node)
Cortex has the B-cells
follicular lymphoma
- proliferation what cells?
- when does it present?
- neoplastic small B-cells (CD20) that make follicle-like nodules
- presents in late adulthood with painless LAD
What genetic even drives follicular lymphoma?
- t(14,18) - BCL2 on 18 translocates to Ig heavy chain locus on 14
- ==> overexpression of BCL2 (role is to stabilize mitochondrial membrane to prevent leakage of CytC) which inhibits apoptosis
Tx of follicular lymphoma:
- only for patients who are symptomatic
- Low-dose CTX or rituximab (anti CD20 antibody)
Complications of follicular lymphoma
- progression to diffuse large B-cell lymphoma
- Presents as an enlarging lymph node
Follicular hyperplasia vs follicular lymphoma
- follicular lymphoma distrupts normal LN architecture
- lack of tingible body macrophages in the germinal center - B-cells ARE NOT dying in the center of LN bc no BCL2 overactivated so NO macrophages come to clean up bc no dead apoptosed B-cells (as opposed to infection where B-cells would die)
- expression of BCL2 in follicles in lymphoma
- monoclonality - Kappa to lamda light chain - neoplasia ratio would be 20:1 instead of normal 3:1
Mantle cell lymphoma
- what cells involved
- presentation when?
- neoplastic small b-cells (CD20) that expand the mantle zone
- clinically presents in late adulthood with painless LAD
Genetic driving factor of mantle cell lymphoma?
- t(11,14) - cyclin D1 on 11 translocates to Ig heavy chain locus on 14
- over expression of cyclin D1 promotes G1/S transition in cell cycle
*Cyclin D1 involved with which lymphoma? and Why?
- mantle cell lymphoma
- cyclin D1 promotes G1/S transition in cell cycle
Marginal zone lymphoma
-what cells involved
-neoplastic small B-cells (CD20) that expand marginal zone
Marginal zone lymphoma-
- associated with what? examples?
- associated with chronic inflammatory states
- ex) Hashimoto’s thyroiditis, Sjogren syndrome, H pylori gastritis
- associated with chronic inflammatory states
- ex) Hashimoto’s thyroiditis, Sjogren syndrome, H pylori gastritis
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formed after post-germinal center B-cells are activated aka during chronic inflammatory states
MALToma occurs where? and because of what?
- occurs in mucosal sites (stomach ex)
- condition improved by fixing causative factor IE H Pylori
Small cell B-lymphomas list:
- follicular
- mantle cell
- marginal zone (includes MALToma)
Intermediate sized b-cell lympomas list:
-Burkitt lymphoma
