Hematopathology II Flashcards
What are the 3 classes of chronic lymphoid neoplasms?
- Chronic Leukemias
- Lymphomas
- Plasma Cell Disorders
What are the most common chronic leukemias?
- Chronic lymphocytic leukemia (CLL)
- Small lymphocytic lymphoma (SLL)
What are the rarer types of chronic leukemias?
Hairy cell leukemia
What do B-cell neoplasms tend to express as biomarkers?
CD20, CD5 (pan T-cell marker) and CD23
What is the most common leukemia of adults in the Western world?
CLL
What is the typical patient of CLL/SLL?
Older patients - around 60 years of age
What mutation indicates a favorable outcome for CLL/SLL?
IGH
What is seen on microscopic evaluation of CLL and SLL?
Peripheral blood shows typical small lymphocytes with scant cytoplasm some smear may show disrupted tumor cells (smudge cells)
Why are there smudge cells on blood smear of CLL?
CLL cells are more fragile and will be smudged in the process of the smear
What is seen under the microscope in hairy cell leukemia?
Cells have cytoplasmic projections (hair like)
What is the most common patient population for hairy cell leukemia and what is their typical presentation?
Usually middle aged men presenting with pancytopenia, monocytopenia, splenomegaly(most common), hepatomegaly, infections
What does staining for hairy cell leukemia show?
Tartrate resistant acid phosphatase (TRAP)
What is the prognosis for hairy cell leukemia?
Excellent response to gentle chemotherapy
Where is Adult T-cell leukemia/lymphoma often seen?
Seen frequently in southern Japan , West Africa, and Caribbean
What is the typical presentation of Adult T-cell leukemia/lymphoma seen frequently in southern Japan , West Africa, and Caribbean?
Skin lesions, hepatosplenomegaly, lymphocytosis and hypercalcemia
What virus is associated with Adult T-cell leukemia/lymphoma?
HTLV-1
What cells are seen in the blood in Adult T-cell leukemia/lymphoma?
Floret cells (CD4+ lymphocytes)
What are the different classes of lymphomas?
Hodgkin
Non-Hodgkin
What are some examples of the etiologies of lymphomas?
- Chromosomal abnormalities
- Immune deficiencies: AIDS, Post-transplant, rheumatoid arthritis, - SLE, Sjogren’s syndrome
- Viruses: HTLV-I, EBV, HHV-8, Hepatitis C
- Bacteria: Helicobacter pylori in gastric MALT lymphoma - Iatrogenic (radiation)
Endemic Burkitt lymphoma Location
Africa
MALT lymphoma
Mediterranean
Adult T-cell leukemia lymphoma (HTLV-I positive)
Japan and Caribbean Islands
T-cell lymphoma leukemia
Asia and Japan
What is usually needed for the diagnosis of lymphoma?
Tissue or lymph node biopsy
What should be negative for lymphoma?
MPO
What are the main B cell markers?
CD19, CD20
What are the main T cell markers?
CD3
What are the main myeloid markers?
MPO
What does follicular lymphoma present with and who is typically affected?
Constitutes 40% of adult NHLs and it presents with painless lymphadenopathy (generalized)
What is seen in follicular lymphoma under microscopy?
Small cells with cleaved or irregular nuclei (centrocytes) and larger cells with open nuclear chromatin and several nucleoli (centroblasts)
Translocation of Follicular Lymphoma
t(14;18) [BCL2/IGH fusion]
What does the t(14;18) [BCL2/IGH fusion] in follicular lymphoma cause?
Causes BCL2 over-amplification (anti-apoptotic)
What are benign reactive follicles?
Where B cells normally mature and are selected for
How does follicular lymphoma alter the benign reactive follicles?
Follicles are all over the lymph nodes - back to back rather than having a lot of space
What does the detection of BCL2 show up as in the stain?
The follicles will stain a brown color
Who is mantle cell lymphoma typically seen in?
Older males
What biomarkers will be seen in mantle cell lymphoma?
CD19, CD20, CD5 positive
Translocation of Mantle Cell Lymphoma
t(11;14) [Cyclin D1–IGH fusion]
What does the t(11;14) [Cyclin D1–IGH fusion] translocation cause?
Causing Cyclin D1 over-amplification (increased proliferation)
Who is the patient population of Burkitt’s lymphoma?
• Children or young adults; aggressive disease
What are the sites of the tumors in Burkitt’s lymphoma?
• Mandible (endemic-African), abdomen (non-endemic)
What is the microscopy of Burkitt’s lymphoma described as?
“Starry sky pattern”
Translocation of Burkitt’s lymphoma
t(8;14) [MYC- IGH fusion]
What is the result of the t(8;14)[MYC-IGH fusion]?
Causes MYC over-amplification (increased proliferation)
