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Heme > Hematological Malignancies: B-cell > Flashcards

Hematological Malignancies: B-cell Flashcards

1
Q

What is a common marker between B cells and T cells?

A

Tdt

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2
Q

Name the defining PLASMA CELL surface markers.

A

CD38
CD138
CD20(-)

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3
Q

What cell surface markers can you use to differentiate a population of proliferating T-cells from B-cells?

A

B-Cells:
CD20
CD19
CD10

T-cells:
CD3
CD4
Any C less than 10

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4
Q

You have a clonal expansion of IMMATURE B-CELLS. What cell surface markers will be detected?

A

TdT
CD10
CD20
CD19

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5
Q

There is a clonal expansion of Mature B-cells (NOT plasma cells). What cell surface markers indicate this?

A

CD19
CD20
CD10

(No TdT)

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6
Q

You apply a CD5 monoclonal antibody to a paraffin-embedded tissue sample of a lymph node. What cells will you tag and where in the lymph node will you see them?

A

CD5 is less than 10, so you’ll be tagging T-cells!

They will be visualized in the paracortex.

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7
Q

Where are the 3 Ig promoters located in the human genome?

A

IgH (14q32)

Ig lambda (22q11)

Ig kappa (2p12)

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8
Q

If the bloodstream is the main physical location of a cancer, what is it called?

A

Leukemia

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9
Q

If the lymphoid tissues are the main physical location of a cancer, what is it called?

A

Lymphoma

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10
Q

Burkitt’s Lymphoma predominately affects what tissue?

A

The GI tract - MALT

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11
Q

CLL/SLL stands for what and is derived from what type of cell?

A

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

is derived from Memory B-cells.

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12
Q

What is peripheral smear buzzword for CLL/SLL?

A

SMUDGE CELLS

Small lymphocytes with little cytoplasm.

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13
Q

Name the 3 sites you’ll find CLL/SLL.

A

Peripheral blood > bone marrow > lymph nodes

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14
Q

What is the morphology of a lymph node with CLL/SLL?

A

Peudofollicular (GOOGLE THIS)

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15
Q

What is the odd Immunophenotype of CLL/SLL?

A

CD20+ (weak)

CD5+ (usually a T-cell marker)

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16
Q

If CLL/SLL (Chronic lymphocytic leukemia/Small lymphocytic lymphoma) has a certain immunophenotype, its prognosis is bad. What are these 2 markers?

A

Zap 70

CD38

These are markers of somatic hypermutation status.

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17
Q

Genetics of CLL/SLL:

What is the prognosis for a 13p deletion?

17p deletion?

A

13p deletion only = good

17p deletion (p53) = BAD

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18
Q

If you see 17p deletion, what should you automatically think?

A

p53 deletion - BAD PROGNOSIS

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19
Q

What is CLL easily confused with and how can you tell them apart?

A

CLL is easily confused with MANTLE CELL LYMPHOMA.

Difference: There are no proliferation centers in the lymph nodes in MCL

Smears are the same (smudge cells)

Immunophenotype:
CLL- CD20 weak
CD5+

MCL- CD20 strong
CD5+
CD23 -

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20
Q

Describe the lymph node appearance in MCL (Mantle Cell Lymphoma)

A

Homogenous effacement. “Starry sky” appearance.

21
Q

What genetic event causes Mantle Cell Lymphoma? What test detects it?

A

Translocation (11;14)(q13q32)

(IgH: CyclinD1)

Overexpression of Cyclin D1 pushes cell through the cell cycle.

DETECTED BY FISH

22
Q

Which is more aggressive? CLL/SLL or MCL?

A

MCL - rapid proliferation

23
Q

What stain indicated a high mitotic rate?

A

Ki-67 immunostain

Can be used to detect Mantle Cell Lymphoma

24
Q

An elderly patient comes in and has increased total protein and Rouleaux on the peripheral smear. What type of cancer do they have?

A

Plasma cell neoplasm

25
Q

Where are plasma cell neoplasms primarily located?

A

Mostly in the bone marrow. (MYELOMA)

26
Q

What is a Rouleaux?

A

Poker chip stacks of RBCs on peripheral smear.

27
Q

What will the bone marrow of a person with a plasma cell neoplasm look like?

A

Tons of plasma cells everywhere.

28
Q

Immunophenotype of a plasma cell neoplasm.

A 
CD38+++
CD138+++
CD19-
CD20-
light chain restricted
29
Q

What is the disease course of a plasma cell lymphoma?

A

MGUS - Monoclonal gammopathy of uncertain significance

1% of people per year transition to MULTIPLE MYELOMA.

30
Q

What’s the mnemonic for plasma cell neoplasms?

A

Rouleaux formation on peripheral smear looks like poker chips.

The more poker chips you have, the More Money you have.

Multiple Myeloma.

31
Q

What is the difference between MGUS monoclonal gammopathy of uncertain significance and multiple myeloma?

A

MGUS is mild, and a precursor to Multiple Myeloma, the clinically active form of plasma cell neoplasms.

32
Q

What is the messed up cell type in Follicular B-Cell lymphoma?

A

Can be centrocytes or centroblasts. (the more Centroblasts involved, the more aggressive the disease)

Goes with the general rule: The more differentiated a cell population is, the less aggressive the cancer.

33
Q

What is the pathophisiology associated with Follicular B-cell lymphoma?

A

Normally, germinal center B cells have a 99% apoptosis rate. In Follicular Lymphoma, the B-cells over express Bcl-2, an anti-apoptotic protein, therefore CAN”T UNDERGO APOPTOSIS.

34
Q

How does the over expression of Bcl-2 in Follicular B-cell Lymphomas occur?

A

A centroblast translocates Bcl-2 to an IgH promotor region.

35
Q

What does the lymph node histology look like in Follicular B-Cell Lymphoma?

A

Tons of follicles, lymph node enlargement, and the germinal center (follicles) lack Tingible Body Macrophages.

Lack of mitotic figures.

36
Q

What immunostain do you do if you suspect follicular B-cell Lymphoma?

A

Bcl-2 immunostain

Normal follicles will not stain because their B-cells don’t express Bcl-2.

Cancerous ones will stain.

Google it.

37
Q

Immunophenotype of Follicular B-cell Lymphoma.

A 
CD19+
CD20+
CD10+
Bcl-2+
Bcl-6+
38
Q

What is the translocation of Follicular B-cell Lymphoma? (in genetic form)

A

t(14;18)(q32;q21)

39
Q

Where is the Bcl-2 gene located on the genome?

A

18q21

40
Q

What cancer can Follicular B-Cell Lymphoma transform into?

A

Diffuse Large B-cell Lymphoma

30% of cases

41
Q

What is the grade of Follicular B-Cell Lymphoma based on?

How is prognosis related to grade, in this case?

A

The cells present.
Grade 1 - lots of CentroCYTES

Grade 2 - Centrocytes/blasts

Grade 3 -
Centroblasts (aggressive)

Prognosis worsens with increasing grade.

42
Q

You see Reid/Sternberg cells on a peripheral smear. Describe the cells. What does the patient have?

A

The cells have “owl eyes” - blinucleate mirror images.

There is NO Ig expression on the cells.

Patient has classical Hodgkins Lymphoma

43
Q

What does a lymph node with Hodkins Lymphoma look like?

A

Depends on the type. Google it. Nodular sclerosing (worse prognosis) and Lymphocute rich HL (best prognosis)

44
Q

Immunophenotype of Hodkins Lymphoma.

A

2 owl eyes x15 = 30

CD15+
CD30+
Pax5+

Pax5+ is a B-cell transcription factor.

45
Q

YOU CAN’T TEST FOR HODGKINS LYMPHOMA WITH FLOW CYTOMETRY.

Why?

A

The Reed-Sternberg cells are large and fragile, and don’t survive when the lymph node is diced up and prepped.

46
Q

What form of Hodgkins lymphoma has cells that DO express Ig and normal B-cell markers?

A

Nodular Lymphocyte Predominant Hodgkins Lymphoma (NLPHD)

47
Q

How can you tell the difference (histologically) between Classical and Nodular Lymphocyte Predominant Hodgkins Lymphomas?

A

Classical has Reed-Sternberg cells.

Nodular Lymphocyte Predominate form has POPCORN CELLS with surface Igs and normal B-cell markers.

48
Q

What is the immunophenotype of Nodular Lymphocyte Predominate Hodgkins Lymphoma? (NLPHD)

A

CD15+
CD30+
Pax5+ (B-cell TF)
CD20+

NORMAL B-CELL MARKERS

Heme (9 decks)

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