Chapter 13: Hodgkin Lymphoma and Myeloid Neoplasms Flashcards
What are the role of Reed-Sternberg cells in Hodgkin Lymphoma?
Release factors that induce the accumulation of reactive lymphocytes, macrophages, and granulocytes
Activation of which TF is a common event in class Hodgkin Lymphoma?
NF-kB
The lacunar variant of Reed-Sternberg cells are associated with what subtype of HL?
Nodular sclerosis subtype
What markers are expressed by Reed-Sternberg cells in the “classical” subtypes of HL vs. the lymphocyte predominant subtype?
- Classical = CD15+ and CD30+ and PAX5+
- Lymphocyte predominant = CD20+ and BCL6
The nodular sclerosis type of HL has a propensity to involve which strucutres; most commonly in whom?
Lower cervical, supraclavicular, and mediastinal nodes of adolescents and young adults
Which 3 subtypes of HL are most often associated with EBV?
- Mixed cellularity type
- Lymphocyte depletion type
- Lymphocyte-rich
Which subtype of HL has the worst overall prognosis?
Lymphocyte depletion type
The mixed cellularity type of HL arises most often in what age groups and has a predominance for what sex?
- Biphasic age distribution (peaks in young adults and then older adults)
- Male predominance
Common presenting features of mixed cellularity type of HL?
Commonly has systemic sx’s, such as night sweats and weight loss
How is the lymphocyte-rich type of HL distinguished from the lymphocyte predominant subtype?
By presence of mononuclear variants and diagnostic Reed-Sternberg cells w/ a “classical” immunophenotypic profile
The lymphocyte depleted type of HL occurs most frequently in whom?
More common in older males, HIV-infected, and developing countries
Describe the morphology of the Reed-Sternberg cell variants found in the lymphocyte predominant type of HL.
- Multilobed nucleus resembling popcorn kernel (“popcorn cell”)
- Known as lymphohistiocytic variant
Majority of patients with lymphocyte predominant type of HL are what sex/age; how do they present?
Typically males, usually <35 y/o presenting w/ cervical or axillary LAD
Which 2 subtypes of HL are more likely to be (stage III-IV) and present with sx’s such as fever, night sweats and weight loss?
- Mixed-cellularity type
- Lymphocyte depletion type
What is the most important prognostic variable for HL with current treatment protocols?
STAGE
How is stage II vs. stage III HL and NHL classified?
- Stage II: involvement of 2+ LN regions on same side of diaphragm
- Stage III: involvement of LN regions on both sides of diaphragm
Diagnosis of Acute Myeloid Leukemias (AML) is based on what?
Presence of >20% myeloid blasts in the bone marrow
What are the 2 most common chromosomal rearrangements seen in AML?
t(8;21) and inv(16)
Acute promyelocytic leukemia (APL - M3) is associated with what translocation?
t(15;17)
What is seen morphologically in Acute promyelocytic leukemia (APL); high incidence of what complication?
- Numerous Auer rods, often in budles within individual progranulocytes
- Primary granules very prominent
- High incidence of DIC
AML with what genetic aberration is associated with a poor prognosis?
Translocations involving MLL on chromosome 11q23
AML with t(11q23;v); diverse MLL fusion genes usually shows some degree of what differentiation?
Monocytic
How does AML with t(8;21) differ from those with inv(16) rearrangements in terms of morphology?
- t(8;21): shows full range of myelocytic differentiation; Auer rods easily found = AML w/ myelocytic maturation (M2 subtype)
- inv(16): myelocytic and monocytic differentiation; abnormal eosinophilic precursors w/ abnormal basophilic granules = AML w/ myelomonocytic maturation (M4 subtype)
Prognosis of AML w/ MDS-like features?
Poor
AML with monocytic maturation is characterized by what clinically?
High incidence of organomegaly, LAD, and tissue* infiltration
Which type of AML is represented by the FAB class M1, M2, M3, and M4?
- M1 = AML without maturation; ≥3% blasts MPO (+)
- M2 = AML with myelocytic maturation - t(8;21)
- M3 = Acute Promyelocytic leukemia - t(15;17) - P and 3
- M4 = Acute myelo-monocytic leukemia - inv(16) - has 4 letters
How do myeloblasts differ from monoblasts in terms of staining?
- Myeloblasts = MPO (+) = have Auer rods
- Monoblasts = nonspecific esterase (+) = lack Auer rods
Which CD markers are positive on myeloid blasts?
CD34(+) and CD33 (+)