Hematopath II Flashcards
1
Q
What is the majority of lymphocytes in the blood?
A
T-cells
2
Q
Where to T-cells reside?
A
Paracortical areas of lymph nodes
3
Q
What resides int eh periarteriolar lymphoid sheets of spleen?
A
T cells
4
Q
What is the function of T cells?
A
To participate in cell mediated immunity
Regulate B cells
5
Q
Where to B cells reside?
A
Cortex and lymphoid follicles of lymph nodes
6
Q
What forms the white pulp of the spleen?
A
B cells
7
Q
What is in the Peyer’s patches in mucosa of GI?
A
B cells
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
9
Q
What do lymphomas, leukemias, and multiple myeloma have in common?
A
They are monoclonal proliferations
10
Q
Where can lymphomas originate from?
A
Lymph nodes or in lymphoid tissue presented in other organs
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
12
Q
What are Reed-Sternberg cells and what is their importance?
A
They are from a background of immune cells
SIGNIFY HODGKINS LYMPHOMA
13
Q
What are the most common lymphadenopathies?
A
Reactive lymphoid hyperplasia
infection, viral, bacterial, protozoal
14
Q
What are secondary lymphoid tissues?
A
LN, Spleen, MALT
15
Q
What happens to T cell precursors in the bone marrow?
A
They head to the THYMUS
16
Q
What markers of B cells are seen in early precursor?
A
CD34
CD19
CD10
17
Q
What is added/lost in pre B cell?
A
Added: CD 20
LOST : CD34
18
Q
What is seen in mature B Cell?
A
CD19
CD20
CD21
CD22
19
Q
What are common markers on T cells?
A
CD 3
CD2
20
Q
What differeniates T cells?
A
CD 8: Cytotoxic
CD4: Helper
21
Q
What is CD 34?
A
A myeloid and lymphoid precursor marker
22
Q
What are some thymic disorders?
A
Thymic hyperplasia
Thymoma
Lymphomas (mainly T cell»»B cell)
23
Q
What is MALT tissue of the nasooropharynx?
A
Waldeyer’s Ring: adenoids, tonsils
24
Q
What is MALT tissue of the GI?
A
Peyers Patches
25
What is MALT tissue of the Lung?
BALT
26
What are M cells of MALT?
M cells are antigen uptake cells (soluble proteins to intact bacteria)
27
What are some disorders of MALT?
Lymphoid hyperplasia
Marginal Zone Lymphoma
Low Grade Lymphoma
Plasma cell myeloma (igA)
28
What are the spleens functions?
Filtration
Margination (reservoir)
Immunologic
Hematopoietic
29
What are disorders of the spleen?
Splenomegaly (shows systemic disease)
Reactive
Congestive (cirrhosis, CHF)
Infiltrative (deposits of cellular elements)
Hypersplenism
Hematopoetic neoplasm
30
What causes white pulp expansion of the spleen?
B cell lymphoma or Lymphoid hyperplasia
31
What causes Red pulp expansion of spleen?
COngestion or Leukemia or Autoimmune
32
What causes nodular lesions of the spleen?
Hodkins or DLBCL
33
What do centroblasts become and where do those go?
Centroblasts are divided into centrocytes that go to the light zone of the GC
34
What are the steps of B cell when they encounter an antigen?
Transform in Interfollicular area
Migrate to primary follicles (clonal expansion, somatic hypermutation)
Final stage: Plasma cells and memory b cell
35
What are TBM?
Tingible body macrophages, eat the dying or failed B cells
36
What markers to memory cells have?
CD27, IgD
37
What is the difference between lymphadenitis or lymphadenopathy?
Lymphadenitis is a reaction to infection/drugs
Lymphadenopathy is unknown cause
38
What types of reactive lymphoid hyperplasia be?
Follicular, Diffuse, SInus, Granulomatous
39
What is a critical features of RLH?
Freely movable enlargement
40
What are the immunophenotype of Reactive lymphoid hyperplasia?
Has CD20, CD10, bcl-6
Does NOT HAVE bcl-2
41
What may be seen in atypical lymphoid hyperplasia?
Large coalescing germinal centers
42
What may be seen in atypical lymphoid hyperplasia?
Large coalescing germinal centers
43
What is the most important feature distinguishing RLH?
BCL-2 NEG
HAS TBM
44
RLH is most common in which group?
Children
Tender, soft, freely movable
Polarized follicles
High mitotic activity
45
What is the pattern seen in infection mononucleosis?
MIxed pattern (diffuse and follicular)
46
What can you seen sometimes in EBV infection?
Necrosis
REED STERNBERG like cells
47
What is the marker that lets you know this is EBV?
EBV encoded RNA stain
| -Shows the infection
48
What is the clinical triad of EBV?
Fever, Pharyngitis, Lymphadenopathy
Also seen is absolute lymphocytosis in peripheral blood
49
What is the binding site for EBV?
CD21 (you must be 21 to enter)
50
What are complications of EBV?
Splenomegaly to rupture
Fulminant hepatic Failure (check LFTs)
Virus associated hemophagocytic syndrome/lymphoproliferative disroders (PTLD, BURKITTS)
51
What tests are for EBV?
Monospot test
52
What is the DDx for EBV?
CMV
Toxoplasma
Non-Hodgkin/Hodgkin lymphoma
ALCL
53
What is the DDx for EBV?
CMV
Toxoplasma
Non-Hodgkin/Hodgkin lymphoma
ALCL
54
What is a feature of cat-scratch lymphadenitis?
Geographic necrosis
55
What causes cat scratch lymphadenitis?
Bartonella Henselae
56
What is the age of most patients of cat scratch?
55% less than 18 yo
57
What is a feature of lymphadenopathy of Cat Scratch?
Unilateral enlargement, may have fever, malaise, headache, and bone aches
58
What are the histo features of Cat Scratch?
Multinucleated Giant cells
Clumps of pleomorphic bacilli (silver stain)
Could mimic TB or Kikuchi
59
What is the feature of toxoplasma lymphadenitis?
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
What are the histo features of toxoplasma?
Follicular hyperplasia
Clusters of epitheloid histiocytes
Proliferation of B cells
Absence of necrosis, fibrosis, granulomas, neutrophils, eosinos
61
What is the most common cause of LN enlargement in adults?
Neoplasm
62
What are LN neoplasma in children young adults?
Hodgkins and Burkitts
63
What LN neoplasm is seen in adults?
DLBCL, Follicular, CLL/SLL lymphoma, Marginal zone lymphoma, Mantle cell lymphoma
64
What are possible causes of lyumphoma?
Viral (EBV: Burkitt, hodkins)
HTLV: T cell leukemia/lymphoma
HHV8: Kaposis, Castlman
H. pylori: MALT lymphoma
B.burgoreferi: cutaneous marginal zone lymphoma
65
How do you diagnose lymphoma?
Morphology
Immunophenotype (flow cytometry)
Genotype
66
When do you take a biopsy?
LN large
LN enlargement greater than 4-6 weeks
Lymph node gets bigger
67
How does the WHO classify lymphoma?
Add clinical information to diagnosis criteria
68
What is more common T cell or B cell disroders?
b cells
69
What are some T cell lymphoma?
Anaplastic large cell lymphoma
Hodgkin lymphoma
Classical HL
70
What is the most common B cell neoplasm?
DLBCL
Next is follicular lymphoma
71
What are some characteristics of Follicular lymphoma?
6th decade
Asymptomatic LN enlargement
2/3 present with stage III
PET scan used to determine involvement
72
What are some histo findings in FL?
Back to back follicles
NO TBMs
No polarization
73
What cells make up FL?
Centroblasts and centrocytes
74
What is positive in FL?
CD20
Bcl 2!!!!
CD10
NO CD3
75
What is the translocation commonly seen in FL?
t(14:18) 70 to 90% (bcl-2 rearrangement)
76
How do you grade FL?
number of centroblasts in HPF
0-15 is grade 1-2
Grade III: >15 centroblasts
IIIB: SOLID SHEET
77
What is the mitotic activity of FL?
Low mitotic activity
78
What is the mitotic activity of FL?
Low mitotic activity
79
What are some features of DLBCL?
7th decade
M>F
Rapidly enlarging NODAL or Extranodal
Some patients had previous low grade lymphoma: CLL/SLL, FL, MALT/MZL
80
What is the immunophenotype of DLBLC?
CD19, CD20
Bcl-6
Monoclonal sIg
81
What are cytogenetics of DLBCL?
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
What are the features of DLBCL Germinal or Activated?
Germinal better survival
Germinal: MUM1 -
Activated: MUM1+
83
What are potential cures for DLBCL?
Rituximab (anti CD20) and BMT
84
What is the epidemiology of Burkitt lymphoma?
Edemic: Equatoial Africa
Present as jaw or orbit mass
85
What is the epidemiology of Burkitt lymphoma?
Edemic: Equatoial Africa
Present as jaw or orbit mass
Sporadic: Mainly children/young adult
Abdominal mass
Immunodeficient associated:
Nodal Sites
86
What are some clinical features of Burkitts?
High tumor burder
High LD, Uric acid
Tumor lysis syndrome: Hyperkalemia, cardiac arrest, renal failure
87
How to cure Burkitts?
Aggressive chemo
88
What is the morphologic presenation of burkitts?
Monomorphic with distinct nucleoli
High apoptotic and mitotic rate
Starry SKY (marcophages with deposited debris)
89
What is the immunophenotype of burkitts?
CD19, CD20
CD10, bcl-6
Neg: bcl-2, CD5, TdT
Transposition of MYC with IgH
90
What is the t(8:14) seen in ?
Burkitts lymphoma
91
What are the characteristics of Mantle Cell lymphoma?
Older Adults
usually Stage III, IV with EN involvement (GI, Kidney, BM, PB
92
What are the immune markers for MCL?
CD19, CD20, CD5
CYCLIN D: bcl-1
93
What is the cytogenetic arrangement for MCL?
t(11:14) bcl-1:igH
94
What stain do you use for MCL?
Cyclin D1
95
What are the prognositic factors of MCL?
Growth pattern
Morphology
Proliferation index
96
What is marginal zone lymphoma (MZL)
Associated with H.pylori
97
What is the immunophenotype for MZL?
CD19, CD20
May transform into DLBCL
98
What do you stain for MZL?
CD20+, no CD10 or bcl2
99
What are the types of classical hodgkins lymphoma?
Nodular sclerosis NSCHL
MIxed celluarity MCCHL
Lymphocytic rich LRCHL
Lymphocyte depleted LDCHL
Nodular lymphocyte predominant (NLPHL
100
How do you stage Hodgkinds lymphoma?
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
How do you stage Hodgkinds lymphoma?
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
What is the most common type of Hodgkins?
NSCHL
| Age 28
103
What is the old people one?
LRCHL
104
What are the features of hodgkin lymphoma?
CD30, CD15
NOT CD45
High cure rate with chemo
105
What cell distinguishes Hodgkins?
Reed sternberg
106
What are features of CLL/SLL lymphoma?
Snickerdoodle cell
Interstitial nodular diffuse BM involvement
Diffuse tissue infiltration
107
What is Richter Transformation?
It is the abrupt transformation of CLL/SLL to DLBCL
108
What is the immunophenotype of CLL/SLL?
CD19, CD20
ALso CD5 CD23
Absence: CD10, CD79b, FMC7
109
What makes a good prognosis for CLL/SLL?
Deletion 13q14
| Deletion 6q21
110
What makes a poor prognosis CLL/SLL?
Trisomy 12
DELETION: 17p13, 11q22
-HIgher survival if IgV mutated with these deletions
Expression of CD38, ZAP 70
111
What are the most common translocations?
FL: t(14:18)
BL: t(8:14)
MCL: t(11:14): CYCLIN D1
112
What is common for most lymphomas?
CD20 Positive
113
What CD distinguishes CLL/SLL
CD23
CD20, CD23, CD5
114
What CD distinguishes BL?
CD20, CD10
115
What CD distinguishes FL?
CD20, CD10
116
What CD distunishes MCL?
CD5, CD20
117
What CD distinguishes MZL?
CD20
