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Pathoma Ch 6 - WBC Pathologies > 6-5, 6-6, 6-7: Lymphoma & Hodgkin Lymphoma > Flashcards

6-5, 6-6, 6-7: Lymphoma & Hodgkin Lymphoma Flashcards

1
Q

LAD or lymphadenopathy refers to:

Seen when? And important finding?

A

enlarged lymph nodes

seen wtih acute infection = PAINFUL

seen with chronic inflammation metastatic carcinoma, or lymphoma = PAINLESS

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2
Q

what part of lymph node(LN) experiences hyperplasia with rhuematoid arthritis?

A

the follicles

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3
Q

what part of lymph node(LN) experiences hyperplasia with viral infection?

A

the paracortex (this is where the t-cells live)

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4
Q

what part of lymph node(LN) experiences hyperplasia with LN that drain cancer?

A

sinus histiocytes (deep in sinus of medula)

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5
Q

what part of lymph node(LN) experiences hyperplasia with early HIV?

A

the follicles (contains some CD4 t-cells)

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6
Q

The cortex of a LN contains what type of cells?

A

B-cells

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7
Q

Lymphoma definition and where occurs?

A
  • neoplastic proliferation of lymphoid cells that forms a mass
  • in LN or soft tissue (extranodal tissue)
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8
Q

Types of lymphomas:

A
  • Hodgkin - 40%

- Non-Hodgkin - 60% - mostly B-cell

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9
Q

Non-hodgkin lymphoma classification criteria:

A
  • 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
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10
Q

LN histology - Cortex

  • what are the areas?
  • What types of cancers arise?
A

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

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11
Q

follicular lymphoma

  • proliferation what cells?
  • when does it present?
A
  • neoplastic small B-cells (CD20) that make follicle-like nodules
  • presents in late adulthood with painless LAD
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12
Q

What genetic even drives follicular lymphoma?

A
  • 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
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13
Q

Tx of follicular lymphoma:

A
  • only for patients who are symptomatic

- Low-dose CTX or rituximab (anti CD20 antibody)

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14
Q

Complications of follicular lymphoma

A
  • progression to diffuse large B-cell lymphoma

- Presents as an enlarging lymph node

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15
Q

Follicular hyperplasia vs follicular lymphoma

A
  • 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
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16
Q

Mantle cell lymphoma

  • what cells involved
  • presentation when?
A
  • neoplastic small b-cells (CD20) that expand the mantle zone
  • clinically presents in late adulthood with painless LAD
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17
Q

Genetic driving factor of mantle cell lymphoma?

A
  • 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
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18
Q

*Cyclin D1 involved with which lymphoma? and Why?

A
  • mantle cell lymphoma

- cyclin D1 promotes G1/S transition in cell cycle

19
Q

Marginal zone lymphoma

-what cells involved

A

-neoplastic small B-cells (CD20) that expand marginal zone

20
Q

Marginal zone lymphoma-

- associated with what? examples?

A
  • associated with chronic inflammatory states

- ex) Hashimoto’s thyroiditis, Sjogren syndrome, H pylori gastritis

21
Q
  • associated with chronic inflammatory states
  • ex) Hashimoto’s thyroiditis, Sjogren syndrome, H pylori gastritis

???????????????????????????????????????

A

formed after post-germinal center B-cells are activated aka during chronic inflammatory states

22
Q

MALToma occurs where? and because of what?

A
  • occurs in mucosal sites (stomach ex)

- condition improved by fixing causative factor IE H Pylori

23
Q

Small cell B-lymphomas list:

A
  • follicular
  • mantle cell
  • marginal zone (includes MALToma)
24
Q

Intermediate sized b-cell lympomas list:

A

-Burkitt lymphoma

25
Q

Burkitt lymphoma-

  • what cells involved?
  • associated with what virus?
  • classical presentation?
A
  • neoplastic intermediate-sized B-cells (CD20)
  • associated with EBV
  • extranodal mass in child or young adult
26
Q

*African form of burkitts usually involves what body part?

A

*the JAW

27
Q

*Sporadic form of Burkitts usually involves which body part?

A

*ABDOMEN

28
Q

genetic driving factor for Burkitt?

A
  • t(8,14) most common

- C-myc gene translocated to Ig heavy chain clocus on 14 = overexpression of c-myc ==> promotes cell growth

29
Q

*Starry sky appearance histology?

A

*Burkitts lymphoma - due to high mitotic rate

30
Q

Large B-cell lymphoma cancers?

A

Diffuse large B-cell lymphoma

  • diffuse bc it doesnt occur in any particular LN area
31
Q

Most common form of non-hodgkin lymphoma?

A

Large b-cell lymphoma

32
Q

Large b-cell lymphoma

-involved cells?

A
  • neoplastic large b-cells (CD20) that grow diffusely in sheets
  • clinically aggressive!
33
Q

Large b-cell lymphoma develop from what? what age group?

A
  • can arise sporadically or from follicular lymphoma transformation
  • presents in late adulthood as enlarging LN or extranodal mass
34
Q

Hodgin Lymphoma - general concept

A

you dont have enlargement/mass bc of a whole bunch of cells growing but rather you have one cell (reed sternberg cell) that secretes ctytokines that brings in other kinds of inflammatory cells to create the mass

35
Q

Reed-sternberg cell characteristic of what?

A

Hodgkin lymphoma

36
Q

Hodgkin lymphoma-

  • cell type involved
  • Markers present?
A
  • neoplastic prolifertion of reed-sternberg cells = large B-cell with multilobed nuclei and prominent nucleoli
  • CD15 and CD30
37
Q

Hodgkin lymphoma-

-clinical issues and why?

A
  • reed sternberg cells secrete cytokines which may result in B-symptoms (FEVER, CHILLS, NIGHT SWEATS)
  • attrack reactive lymphocytes, plasma cells, macrophages, and eosinophils
  • may lead to FIBROSIS
38
Q

What are subtypes of hodgkin lymphoma based on?

Name subtypes:

A

-REACTIVE INFLAMMATORY CELL = classification bc they make up the bulk of the tumor

  • nodular sclerosis (70%)
  • lymphocyte rich
  • mixed cellularity (especially eosinophils)
  • lymphocyte depleted
39
Q

Nodular Sclerosis

  • classic presentation:
  • biopsy shows?
A
  • most common type
  • enlarging cervical neck or mediastinal LN in a young adult - usually female
  • LN on biopsy is divided by bands of fibrosis and Reed sternberg cells are present in LAKE-LIKE spaces (LACUNAR CELLS)
40
Q

lymphnode rich: important stuff to remember

A

BEST PROGNOSIS

41
Q

mixed cellularity: important stuff to remember

A

associated with IL-5 and eosinophils

42
Q

lymphocyte-depleted: important stuff to remember

A
  • worst prognosis

- seen in elderly and HIV+

43
Q

IL-5 calls in what cell type? What cancer?

A

EOSINOPHILS!

MIXED CELLULARITY

Pathoma Ch 6 - WBC Pathologies (6 decks)

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