Hematopathology II

Question 1

What are the 3 classes of chronic lymphoid neoplasms?

Answer 1

• Chronic Leukemias
• Lymphomas
• Plasma Cell Disorders

Question 2

What are the most common chronic leukemias?

Answer 2

• Chronic lymphocytic leukemia (CLL)

- Small lymphocytic lymphoma (SLL)

Question 3

What are the rarer types of chronic leukemias?

Answer 3

Hairy cell leukemia

Question 4

What do B-cell neoplasms tend to express as biomarkers?

Answer 4

CD20, CD5 (pan T-cell marker) and CD23

Question 5

What is the most common leukemia of adults in the Western world?

Answer 5

CLL

Question 6

What is the typical patient of CLL/SLL?

Answer 6

Older patients - around 60 years of age

Question 7

What mutation indicates a favorable outcome for CLL/SLL?

Answer 7

IGH

Question 8

What is seen on microscopic evaluation of CLL and SLL?

Answer 8

Peripheral blood shows typical small lymphocytes with scant cytoplasm some smear may show disrupted tumor cells (smudge cells)

Question 9

Why are there smudge cells on blood smear of CLL?

Answer 9

CLL cells are more fragile and will be smudged in the process of the smear

Question 10

What is seen under the microscope in hairy cell leukemia?

Answer 10

Cells have cytoplasmic projections (hair like)

Question 11

What is the most common patient population for hairy cell leukemia and what is their typical presentation?

Answer 11

Usually middle aged men presenting with pancytopenia, monocytopenia, splenomegaly(most common), hepatomegaly, infections

Question 12

What does staining for hairy cell leukemia show?

Answer 12

Tartrate resistant acid phosphatase (TRAP)

Question 13

What is the prognosis for hairy cell leukemia?

Answer 13

Excellent response to gentle chemotherapy

Question 14

Where is Adult T-cell leukemia/lymphoma often seen?

Answer 14

Seen frequently in southern Japan , West Africa, and Caribbean

Question 15

What is the typical presentation of Adult T-cell leukemia/lymphoma seen frequently in southern Japan , West Africa, and Caribbean?

Answer 15

Skin lesions, hepatosplenomegaly, lymphocytosis and hypercalcemia

Question 16

What virus is associated with Adult T-cell leukemia/lymphoma?

Answer 16

HTLV-1

Question 17

What cells are seen in the blood in Adult T-cell leukemia/lymphoma?

Answer 17

Floret cells (CD4+ lymphocytes)

Question 18

What are the different classes of lymphomas?

Answer 18

Hodgkin

Non-Hodgkin

Question 19

What are some examples of the etiologies of lymphomas?

Answer 19

• 􏰁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)

Question 20

Endemic Burkitt lymphoma Location

Answer 20

Africa

Question 21

MALT lymphoma

Answer 21

Mediterranean

Question 22

Adult T-cell leukemia lymphoma (HTLV-I positive)

Answer 22

Japan and Caribbean Islands

Question 23

T-cell lymphoma leukemia

Answer 23

Asia and Japan

Question 24

What is usually needed for the diagnosis of lymphoma?

Answer 24

Tissue or lymph node biopsy

Question 25

What should be negative for lymphoma?

Answer 25

MPO

Question 26

What are the main B cell markers?

Answer 26

CD19, CD20

Question 27

What are the main T cell markers?

Answer 27

CD3

Question 28

What are the main myeloid markers?

Answer 28

MPO

Question 29

What does follicular lymphoma present with and who is typically affected?

Answer 29

􏰁Constitutes 40% of adult NHLs and it presents with painless lymphadenopathy (generalized)

Question 30

What is seen in follicular lymphoma under microscopy?

Answer 30

Small cells with cleaved or irregular nuclei (centrocytes) and larger cells with open nuclear chromatin and several nucleoli (centroblasts)

Question 31

Translocation of Follicular Lymphoma

Answer 31

t(14;18) [BCL2/IGH fusion]

Question 32

What does the t(14;18) [BCL2/IGH fusion] in follicular lymphoma cause?

Answer 32

Causes BCL2 over-amplification (anti-apoptotic)

Question 33

What are benign reactive follicles?

Answer 33

Where B cells normally mature and are selected for

Question 34

How does follicular lymphoma alter the benign reactive follicles?

Answer 34

Follicles are all over the lymph nodes - back to back rather than having a lot of space

Question 35

What does the detection of BCL2 show up as in the stain?

Answer 35

The follicles will stain a brown color

Question 36

Who is mantle cell lymphoma typically seen in?

Answer 36

Older males

Question 37

What biomarkers will be seen in mantle cell lymphoma?

Answer 37

CD19, CD20, CD5 positive

Question 38

Translocation of Mantle Cell Lymphoma

Answer 38

t(11;14) [Cyclin D1--IGH fusion]

Question 39

What does the t(11;14) [Cyclin D1--IGH fusion] translocation cause?

Answer 39

Causing Cyclin D1 over-amplification (increased proliferation)

Question 40

Who is the patient population of Burkitt's lymphoma?

Answer 40

• Children or young adults; aggressive disease

Question 41

What are the sites of the tumors in Burkitt's lymphoma?

Answer 41

• Mandible (endemic-African), abdomen (non-endemic)

Question 42

What is the microscopy of Burkitt's lymphoma described as?

Answer 42

"Starry sky pattern"

Question 43

Translocation of Burkitt's lymphoma

Answer 43

t(8;14) [MYC- IGH fusion]

Question 44

What is the result of the t(8;14)[MYC-IGH fusion]?

Answer 44

􏰁Causes MYC over-amplification (increased proliferation)