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Path II > Hematopath II > Flashcards

Hematopath II Flashcards

1
Q

What is the majority of lymphocytes in the blood?

A

T-cells

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2
Q

Where to T-cells reside?

A

Paracortical areas of lymph nodes

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3
Q

What resides int eh periarteriolar lymphoid sheets of spleen?

A

T cells

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4
Q

What is the function of T cells?

A

To participate in cell mediated immunity

Regulate B cells

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5
Q

Where to B cells reside?

A

Cortex and lymphoid follicles of lymph nodes

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6
Q

What forms the white pulp of the spleen?

A

B cells

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7
Q

What is in the Peyer’s patches in mucosa of GI?

A

B cells

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8
Q

What may cause lymphadenitis or lymphocytosis?

A

When B or T cells are exposed to antigens, THEY will have a more prominent nucleoli

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9
Q

What do lymphomas, leukemias, and multiple myeloma have in common?

A

They are monoclonal proliferations

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10
Q

Where can lymphomas originate from?

A

Lymph nodes or in lymphoid tissue presented in other organs

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11
Q

What are characteristics of lymphomas?

A

Low grade: 10 years survival but not curable

Intermediate and high grade are potentially curable and but are more aggressive

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12
Q

What are Reed-Sternberg cells and what is their importance?

A

They are from a background of immune cells

SIGNIFY HODGKINS LYMPHOMA

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13
Q

What are the most common lymphadenopathies?

A

Reactive lymphoid hyperplasia

infection, viral, bacterial, protozoal

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14
Q

What are secondary lymphoid tissues?

A

LN, Spleen, MALT

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15
Q

What happens to T cell precursors in the bone marrow?

A

They head to the THYMUS

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16
Q

What markers of B cells are seen in early precursor?

A

CD34
CD19
CD10

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17
Q

What is added/lost in pre B cell?

A

Added: CD 20

LOST : CD34

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18
Q

What is seen in mature B Cell?

A

CD19
CD20
CD21
CD22

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19
Q

What are common markers on T cells?

A

CD 3

CD2

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20
Q

What differeniates T cells?

A

CD 8: Cytotoxic

CD4: Helper

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21
Q

What is CD 34?

A

A myeloid and lymphoid precursor marker

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22
Q

What are some thymic disorders?

A

Thymic hyperplasia

Thymoma

Lymphomas (mainly T cell»»B cell)

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23
Q

What is MALT tissue of the nasooropharynx?

A

Waldeyer’s Ring: adenoids, tonsils

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24
Q

What is MALT tissue of the GI?

A

Peyers Patches

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25
Q

What is MALT tissue of the Lung?

A

BALT

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26
Q

What are M cells of MALT?

A

M cells are antigen uptake cells (soluble proteins to intact bacteria)

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27
Q

What are some disorders of MALT?

A

Lymphoid hyperplasia

Marginal Zone Lymphoma

Low Grade Lymphoma

Plasma cell myeloma (igA)

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28
Q

What are the spleens functions?

A

Filtration
Margination (reservoir)
Immunologic
Hematopoietic

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29
Q

What are disorders of the spleen?

A

Splenomegaly (shows systemic disease)

Reactive

Congestive (cirrhosis, CHF)

Infiltrative (deposits of cellular elements)

Hypersplenism

Hematopoetic neoplasm

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30
Q

What causes white pulp expansion of the spleen?

A

B cell lymphoma or Lymphoid hyperplasia

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31
Q

What causes Red pulp expansion of spleen?

A

COngestion or Leukemia or Autoimmune

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32
Q

What causes nodular lesions of the spleen?

A

Hodkins or DLBCL

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33
Q

What do centroblasts become and where do those go?

A

Centroblasts are divided into centrocytes that go to the light zone of the GC

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34
Q

What are the steps of B cell when they encounter an antigen?

A

Transform in Interfollicular area

Migrate to primary follicles (clonal expansion, somatic hypermutation)

Final stage: Plasma cells and memory b cell

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35
Q

What are TBM?

A

Tingible body macrophages, eat the dying or failed B cells

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36
Q

What markers to memory cells have?

A

CD27, IgD

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37
Q

What is the difference between lymphadenitis or lymphadenopathy?

A

Lymphadenitis is a reaction to infection/drugs

Lymphadenopathy is unknown cause

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38
Q

What types of reactive lymphoid hyperplasia be?

A

Follicular, Diffuse, SInus, Granulomatous

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39
Q

What is a critical features of RLH?

A

Freely movable enlargement

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40
Q

What are the immunophenotype of Reactive lymphoid hyperplasia?

A

Has CD20, CD10, bcl-6

Does NOT HAVE bcl-2

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41
Q

What may be seen in atypical lymphoid hyperplasia?

A

Large coalescing germinal centers

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42
Q

What may be seen in atypical lymphoid hyperplasia?

A

Large coalescing germinal centers

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43
Q

What is the most important feature distinguishing RLH?

A

BCL-2 NEG

HAS TBM

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44
Q

RLH is most common in which group?

A

Children

Tender, soft, freely movable

Polarized follicles

High mitotic activity

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45
Q

What is the pattern seen in infection mononucleosis?

A

MIxed pattern (diffuse and follicular)

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46
Q

What can you seen sometimes in EBV infection?

A

Necrosis

REED STERNBERG like cells

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47
Q

What is the marker that lets you know this is EBV?

A

EBV encoded RNA stain

-Shows the infection

48
Q

What is the clinical triad of EBV?

A

Fever, Pharyngitis, Lymphadenopathy

Also seen is absolute lymphocytosis in peripheral blood

49
Q

What is the binding site for EBV?

A

CD21 (you must be 21 to enter)

50
Q

What are complications of EBV?

A

Splenomegaly to rupture
Fulminant hepatic Failure (check LFTs)
Virus associated hemophagocytic syndrome/lymphoproliferative disroders (PTLD, BURKITTS)

51
Q

What tests are for EBV?

A

Monospot test

52
Q

What is the DDx for EBV?

A

CMV
Toxoplasma
Non-Hodgkin/Hodgkin lymphoma
ALCL

53
Q

What is the DDx for EBV?

A

CMV
Toxoplasma
Non-Hodgkin/Hodgkin lymphoma
ALCL

54
Q

What is a feature of cat-scratch lymphadenitis?

A

Geographic necrosis

55
Q

What causes cat scratch lymphadenitis?

A

Bartonella Henselae

56
Q

What is the age of most patients of cat scratch?

A

55% less than 18 yo

57
Q

What is a feature of lymphadenopathy of Cat Scratch?

A

Unilateral enlargement, may have fever, malaise, headache, and bone aches

58
Q

What are the histo features of Cat Scratch?

A

Multinucleated Giant cells

Clumps of pleomorphic bacilli (silver stain)

Could mimic TB or Kikuchi

59
Q

What is the feature of toxoplasma lymphadenitis?

A

MIxed pattern

Most common parasitic infection

LN Tender or Painless

Persist up to 1 year

Test for IgG, IgM
IgM >1:80 is diagnostic

60
Q

What are the histo features of toxoplasma?

A

Follicular hyperplasia

Clusters of epitheloid histiocytes

Proliferation of B cells

Absence of necrosis, fibrosis, granulomas, neutrophils, eosinos

61
Q

What is the most common cause of LN enlargement in adults?

A

Neoplasm

62
Q

What are LN neoplasma in children young adults?

A

Hodgkins and Burkitts

63
Q

What LN neoplasm is seen in adults?

A

DLBCL, Follicular, CLL/SLL lymphoma, Marginal zone lymphoma, Mantle cell lymphoma

64
Q

What are possible causes of lyumphoma?

A

Viral (EBV: Burkitt, hodkins)

HTLV: T cell leukemia/lymphoma

HHV8: Kaposis, Castlman

H. pylori: MALT lymphoma

B.burgoreferi: cutaneous marginal zone lymphoma

65
Q

How do you diagnose lymphoma?

A

Morphology

Immunophenotype (flow cytometry)

Genotype

66
Q

When do you take a biopsy?

A

LN large

LN enlargement greater than 4-6 weeks

Lymph node gets bigger

67
Q

How does the WHO classify lymphoma?

A

Add clinical information to diagnosis criteria

68
Q

What is more common T cell or B cell disroders?

A

b cells

69
Q

What are some T cell lymphoma?

A

Anaplastic large cell lymphoma

Hodgkin lymphoma

Classical HL

70
Q

What is the most common B cell neoplasm?

A

DLBCL

Next is follicular lymphoma

71
Q

What are some characteristics of Follicular lymphoma?

A

6th decade

Asymptomatic LN enlargement

2/3 present with stage III

PET scan used to determine involvement

72
Q

What are some histo findings in FL?

A

Back to back follicles

NO TBMs

No polarization

73
Q

What cells make up FL?

A

Centroblasts and centrocytes

74
Q

What is positive in FL?

A

CD20
Bcl 2!!!!
CD10

NO CD3

75
Q

What is the translocation commonly seen in FL?

A

t(14:18) 70 to 90% (bcl-2 rearrangement)

76
Q

How do you grade FL?

A

number of centroblasts in HPF

0-15 is grade 1-2

Grade III: >15 centroblasts
IIIB: SOLID SHEET

77
Q

What is the mitotic activity of FL?

A

Low mitotic activity

78
Q

What is the mitotic activity of FL?

A

Low mitotic activity

79
Q

What are some features of DLBCL?

A

7th decade

M>F

Rapidly enlarging NODAL or Extranodal

Some patients had previous low grade lymphoma: CLL/SLL, FL, MALT/MZL

80
Q

What is the immunophenotype of DLBLC?

A

CD19, CD20

Bcl-6

Monoclonal sIg

81
Q

What are cytogenetics of DLBCL?

A

IgH and Light chain gene rearrangement

Somatic mutation of IgV

Sometimes see t(14:18)

3q27: bcl-6

Mutation of 5’ non-coding region of BCL-6: extranodal DLBCL

82
Q

What are the features of DLBCL Germinal or Activated?

A

Germinal better survival

Germinal: MUM1 -

Activated: MUM1+

83
Q

What are potential cures for DLBCL?

A

Rituximab (anti CD20) and BMT

84
Q

What is the epidemiology of Burkitt lymphoma?

A

Edemic: Equatoial Africa

Present as jaw or orbit mass

85
Q

What is the epidemiology of Burkitt lymphoma?

A

Edemic: Equatoial Africa
Present as jaw or orbit mass

Sporadic: Mainly children/young adult
Abdominal mass

Immunodeficient associated:
Nodal Sites

86
Q

What are some clinical features of Burkitts?

A

High tumor burder
High LD, Uric acid

Tumor lysis syndrome: Hyperkalemia, cardiac arrest, renal failure

87
Q

How to cure Burkitts?

A

Aggressive chemo

88
Q

What is the morphologic presenation of burkitts?

A

Monomorphic with distinct nucleoli

High apoptotic and mitotic rate

Starry SKY (marcophages with deposited debris)

89
Q

What is the immunophenotype of burkitts?

A

CD19, CD20

CD10, bcl-6

Neg: bcl-2, CD5, TdT

Transposition of MYC with IgH

90
Q

What is the t(8:14) seen in ?

A

Burkitts lymphoma

91
Q

What are the characteristics of Mantle Cell lymphoma?

A

Older Adults

usually Stage III, IV with EN involvement (GI, Kidney, BM, PB

92
Q

What are the immune markers for MCL?

A

CD19, CD20, CD5

CYCLIN D: bcl-1

93
Q

What is the cytogenetic arrangement for MCL?

A

t(11:14) bcl-1:igH

94
Q

What stain do you use for MCL?

A

Cyclin D1

95
Q

What are the prognositic factors of MCL?

A

Growth pattern

Morphology

Proliferation index

96
Q

What is marginal zone lymphoma (MZL)

A

Associated with H.pylori

97
Q

What is the immunophenotype for MZL?

A

CD19, CD20

May transform into DLBCL

98
Q

What do you stain for MZL?

A

CD20+, no CD10 or bcl2

99
Q

What are the types of classical hodgkins lymphoma?

A

Nodular sclerosis NSCHL

MIxed celluarity MCCHL

Lymphocytic rich LRCHL

Lymphocyte depleted LDCHL

Nodular lymphocyte predominant (NLPHL

100
Q

How do you stage Hodgkinds lymphoma?

A

Stage 1: LN on one side of diaphragm

Stage 2: Involvement of two lymphoid regions same side of diaphragm

Stage 3: Both sides of diaphragm

Stage 4: Present at extranodal sites

101
Q

How do you stage Hodgkinds lymphoma?

A

Stage 1: LN on one side of diaphragm

Stage 2: Involvement of two lymphoid regions same side of diaphragm

Stage 3: Both sides of diaphragm

Stage 4: Present at extranodal sites

102
Q

What is the most common type of Hodgkins?

A

NSCHL

Age 28

103
Q

What is the old people one?

A

LRCHL

104
Q

What are the features of hodgkin lymphoma?

A

CD30, CD15

NOT CD45

High cure rate with chemo

105
Q

What cell distinguishes Hodgkins?

A

Reed sternberg

106
Q

What are features of CLL/SLL lymphoma?

A

Snickerdoodle cell

Interstitial nodular diffuse BM involvement

Diffuse tissue infiltration

107
Q

What is Richter Transformation?

A

It is the abrupt transformation of CLL/SLL to DLBCL

108
Q

What is the immunophenotype of CLL/SLL?

A

CD19, CD20

ALso CD5 CD23

Absence: CD10, CD79b, FMC7

109
Q

What makes a good prognosis for CLL/SLL?

A

Deletion 13q14

Deletion 6q21

110
Q

What makes a poor prognosis CLL/SLL?

A

Trisomy 12

DELETION: 17p13, 11q22
-HIgher survival if IgV mutated with these deletions

Expression of CD38, ZAP 70

111
Q

What are the most common translocations?

A

FL: t(14:18)

BL: t(8:14)

MCL: t(11:14): CYCLIN D1

112
Q

What is common for most lymphomas?

A

CD20 Positive

113
Q

What CD distinguishes CLL/SLL

A

CD23

CD20, CD23, CD5

114
Q

What CD distinguishes BL?

A

CD20, CD10

115
Q

What CD distinguishes FL?

A

CD20, CD10

116
Q

What CD distunishes MCL?

A

CD5, CD20

117
Q

What CD distinguishes MZL?

A

CD20

Path II (11 decks)

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