Ch. 20: Lymphoid Disorders 1 Flashcards
A 65 year old male presents to your office complaining of joint pain. On examination you notice swollen MCP and DIP joints with ulnar deviation of the MCP joints. You also palpate enlarged lymph nodes in this patient. What is a likely explanation for enlarged LN in this patient?
Reactive lymphadenopathy due to follicular hyperplasia and interfollicular plasmacytosis. Commonly found in those with rheumatoid arthritis.
An 18 year old female presents with bilateral cervical lymphadenopathy , fever, leukocytosis, and hypergammaglobulinemia. On LN biopsy, you notice several histiocytes containing intact lymphocytes (emperipolesis) in the lymph node sinuses. What is the likely diagnosis?
Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease)
A 5 year old male presents with severe joint pain and what you suspect is bone pain. On exam you find organomegaly, and the child seems a bit confused. You decide to order blood work and you find that your patient is anemic, neutropenic, and thrombocytopenic. On a peripheral blood smear you notice several purple stained cells with a high nuclear to cytoplasmic ratio that also stain with TdT. What is the likely diagnosis?
Precursor B-Cell Acute Lymphoblastic Leukemia (ALL).
A 12 old male presents to you with organomegaly, and dyspnea. On exam you discover a pleural effusion and prominent lymphadenopathy. A CT of the chest reveals a mediastinal mass. Peripheral blood smear shows TdT positive lymphoblasts that express CD7 and CD3. What is your diagnosis?
Precursor T-cell Acute Lymphoblastic Lymphoma
Most common type of lymphoma in the Western World?
Mature (Peripheral) B-cell lymphomas
A lymph node biopsy of one of your patients shows several lymphocytes of almost the exact same size with almost no sign of any transformed cells or centroblasts. On further examination, you discover that the cells are CD5+, and that they contain an 11:14 chromosomal translocation. What is the likely mechanism facilitating neoplastic proliferation in these cells?
Overexpression of cyclin D1 promoting G1/S cell cycle progression.
Dx: Mantle Cell Lymphoma
Multifocal mucosal involvement of the GI tract in Mantle cell lymphoma…
lymphomatous polyposis
A 67 year old man presents with a fairly large neck mass. On biopsy you determine that the majority of cells in the mass are CD20+, TdT negative, and immunohistochemical staining is negative for cyclin D1. On CT of the abdomen, you notice several lesions along the GI tract. You notice immunoglobulin light chain restriction. What is your diagnosis?
Diffuse Large B-Cell Lymphoma
A 23 year old male presents with malaise and abdominal pain. On CT of the abdomen, a large ileocecal mass is noticed and you diagnose Burkitts lymphoma. What oncogene is activated in this disease, and what is the likely pathogenesis? If you were to look at these neoplastic cells under the microscope, what would you notice? If your patient with this disease was a 6 year old African male, where would they most likely present with a lesion?
c-myc; chromosomal translocation (usually 8:14)
“Starry sky” appearance with high mitotic index
Jaw and other facial bones with some abdominal visceral involvement.
A 53 year old female from Arizona presents with generalized adenopathy and is diagnosed with follicular lymphoma. What is the likely pathogenesis in these neoplastic cells? What is the proper management of this patient?
t(14:18) resulting in overproduction of Bcl-2 which inhibits apoptosis (you want apoptosis in the lymph node follicle! this is where B-cells are selected)
Most FL’s take an indolent course, and since it is incurable, Tx is not always indicated at diagnosis.
Low dose chemo and rituximab can be used for symptomatic patients.
The most common form of adult leukemia in the Western World. Can sometimes undergo “Richter transformation”.
B-cell Chronic Lymphocytic Leukemia (CLL)
A 60 year old female patient presents with xerostomia, and xerophthalmia. Lab tests are positive for anti-Ro and anti-La. You are quite sure of the diagnosis, but being the astute resident that you are having read Rubin’s pathology in full as a medical student, you continue your investigation and order an abdominal CT (to the dismay of your attending). Your attending is surprised to learn that the CT revealed several enlarged lymph nodes along the GI tract. Intestinal biopsy reveals lymphoepithelial lesions with B-cells that are CD20+ (negative for CD10, and CD5). What is the likely diagnosis?
Marginal Zone Lymphoma. It’s unlikely to be follicular lymphoma bc it was CD10 negative, and its unlikely to be Mantle cell lymphoma bc it is CD5 negative. Marginal Zone lymphoma is often secondary to chronic inflammatory states such as Sjogren’s syndrome (as in this patient, which you knew since you read Rubin’s, way to go!), which lead you to further your investigation. Bc of this and bc you were right, your attending rewarded you with a trip to Faegan’s on them! Keep on keepin’ on! aka. keep reading Rubins
