Haematolymphoid

Question 1

DDx Plasma cells in Lymph Nodes

Answer 1

Infection: syphilis, EBV, HIV

Reactive / inflammatory: RA, SLE, IgG4 disease

Neoplastic: myeloma, LPL, MSL, plasmacytic differentiation in CLL

Plasma cell variant of Castleman’s disease

Question 2

DDx High Grade B Cell Lymphoma

Answer 2

BL: CD20 / CD10 / BCL6+, BCL2 -, MYC++, Ki67+++

Blastoid mantle cell: cyclin D1 / SOX11 +

Lymphoblastic lymphoma: tdt +

Double or triple hit HG BCL if MYC / BCL2 / BCl6 altered via FISH…otherwise DLBCL (GC vs. non GC)

Question 3

DDx Eosinophils in Lymph Nodes

Answer 3

Non-Neoplastic:
Parasites / filarial lymphadenitis
Drug induced lymphadenitis
LCH
Kimura disease
…Epithelioid haemangioma

Neoplastic:
CHL
AITL
Myeloid disease

Question 4

Difference Between Flow / ISH / IPX

Answer 4

Flow: expression of surface immunoglobulin

ISH: expression of mRNA

IPX: expressed protein

Question 5

Diagnostic Algorithin High Grade B Cell Lymphoma

Answer 5

1. Exclude blastoid mantle cell lymphoma (cyclinD1, SOX11)
2. Exclude lymphoblastic lymphoma (TdT, CD34, PAX5, CD3)
3. IPX: BCL2 -, MYC +, Ki67 ~ 100% = Burkitt Lymphoma -> confirm with FISH for IgH:MYC rearrangement
   4a. Hann Algorithim to separate GC from Non-GC phenotype (CD10, MUM1, BCL6)
   4b. FISH for BCL2 / BCL6 / MYC rearrangements to determine double versus triple hit versus DLBCL NOS

Question 6

Molecular Rearrangements in B Cell Lymphomas

Answer 6

Mantle Cell Lymphoma: t(11:14) CCND1-IGH

Follicular Lymphoma: t(14:18) IGH-BCL2

Lymphoplasmacytic lymphoma: MYD88 mutation

Hairy Cell Leukaemia: BRAFV600E mutation

Burkitt Lymphoma: t(8:14) MYC-IGH, also MYC-IGL and MYC-IGK

Question 7

Immunoprofile Classic Hodgkin Lymphoma vs. NLPHL

Answer 7

CHL: Reed-Sternberg cells

CD45 negative

CD30 / CD15 + (Golgi staining pattern)

Pan B cell markers weak: PAX5, BOB1, OCT2

NLPHL: LP cells or Popcorn cells

CD45 positive

CD30 / CD15 negative

Pan B cell markers strongly positive: PAX5, BOB1, OCT2

Question 8

Lymphoid Proliferations with a Nodular Growth Pattern

Answer 8

Follicular lymphoma

Nodular lymphocyte predominant Hodgkin lymphoma

Lymphocyte rich classical Hodgkin lymphoma

Nodular Mantle cell lymphoma

PTGC

Reactive lymphoid follicles

Question 9

Classification of Hodgkin Lymphoma

Answer 9

Classic Hodgkin Lymphoma

Nodular sclerosis HL

Mixed cellularity HL

Lymphocyte rich HL

Lymphocyte depleted HL

Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)

Probably not really a form of Hodgkin’s - due for a name change (NLP B cell lymphoma..)

Question 10

Presentation and Staging of Hodgkin Lymphoma

Answer 10

Presentation

Peripheral adenopathy

B symptoms (fevers, night sweats, weight loss)

Fatigue and pruritis

Staging - Lugano Classification

(Derived from Ann Arbor Classification)

One or more lymph node groups involved

Involvement of lymph node groups above and below the diaphragm

Widespread disease with involvement of multiple organs