Hematopathology III Flashcards
What is the main difference in acute and chronic leukemias?
Acute will have blast cells and chronic will have more differentiated cells
What is the typical patient of Diffuse Large B-cell Lymphoma?
Older adults - median age is 60
How does Diffuse Large B-cell Lymphoma present?
Rapidly enlarging, symptomatic mass at single or extranodal site
What are the distinct subtypes of Diffuse Large B-cell Lymphoma?
Germinal Center B-cell (GCB)
Activated B-cell (ABC)
What is the difference in outcomes of Diffuse Large B-cell Lymphoma in GCB VS ABC?
GCB has much better survival and prognosis that ABC - different treatments are used for each type
Translocation of Diffuse Large B-cell Lymphoma
- t(14;18) in 30% of patients
- BCL6 rearrangement in 30-40%
VERY rare will have MYC translocations alongside one of the other two - “double hit”
What biomarkers will Diffuse Large B-cell Lymphoma express?
CD20
What is the appearance of the spleen in Diffuse Large B-cell Lymphoma?
“Fish flesh” appearance of a large expansile mass
What happens to the lymphocytes in Diffuse Large B-cell Lymphoma?
They become much larger than normal
What is the presentation of Peripheral T-Cell Lymphoma?
Lymphadenopathy, eosinophilia, pruritis, fever and weight loss
What is the biomarker of Peripheral T-Cell Lymphoma?
CD3+
What are the cells like in Peripheral T-Cell Lymphoma?
Polymorphic and heterogeneous often with eosinophilia
What are the patients of Hodgkin lymphoma?
Bimodal - in young adults and the in older adults
What is the spread of Hodgkin lymphoma?
Spreads in contiguous fashion thorough the lymphoid tissue
What is the characteristic cell of Hodgkin lymphoma?
Reed-Sternberg Cells
What type of cells does Hodgkin lymphoma arise from?
B cells
What is a common mechanism for the activation of classical Hodgkin lymphoma?
NF-kB activation can occur via infection by EBV is a common mechanism for Hodgkin lymphoma
What is the appearance of Reed-Sternberg cells?
Owl eyes - binucleated
What do the classical Hodgkin lymphoma cells have as biomarkers?
CD15/30
What are the biomarkers of nodular lymphocyte predominant Hodgkin lymphoma?
CD20/45
What is the most common class of Hodgkin lymphoma?
Nodular sclerosis
What are the classes of Hodgkin lymphoma?
- Lymphocyte rich
- Mixed cellularity
- Lymphocyte Depleted
- Nodular Sclerosis
- Nodular Lymphocyte Predominant
Lymphocyte rich Histology
Reactive small lymphocytes predominate, few mononuclear or classic Reed-Sternberg cells
Mixed cellularity
Reed-Sternberg cells and variants on a mixed cellular background including eosinophils, plasma cells, T- lymphocytes, histiocytes
Lymphocyte Depleted
Paucity of lymphocytes and relative abundance of Reed-Sternberg cells
Nodular Sclerosis
Fibrous nodular pattern, lacunar cells
Nodular Lymphocyte Predominant
Nodularity with predominance of mature lymphocytes and popcorn cell or L & H variant of RS cells
What morphology of cells are seen in nodular lymphocyte predominant Hodgkin lymphoma?
“Popcorn-like” cells
What is the most common plasma cell neoplasm?
Monoclonal Gammopathy of Undetermined Significance (MGUS)
Waldenstrom’s Macrogloobulinemia
High levels of IgM M-spike and symptoms due to hyperviscocity of blood from high protein levels in the blood (most commonly associated with lymphoplasmacytic lymphoma)
- Visual distrubances
- Bleeding
Multiple Myeloma
The presence of monoclonal plasma cell proliferation involving bone marrow and typically skeleton at multiple sites
What is the proliferation of plasma cells in MM dependent upon?
Cytokines - mainly IL-6
What are serum and urine indications of MM?
Monoclonal protein in serum
IgG or IgA in the urine
What can be found in the bone marrow in MM patients?
Bone marrow showing clonal plasmacytosis or presence of a plasmacytoma
What are the symptoms of MM? (CRAB)
hyperCalcemia, Renal insufficiency, Anemia, Bone lesions/Back pain
What is seen in the skull in MM?
Punched out regions due to secretions of cytokines that increase osteoclastic activity
How does electrophoresis tell you about the MM diagnosis?
It can show a single strong band which is indicative of a monoclonal protein - i.e. the monoclonal antibody of MM
What are some of the complications of MM?
- Bone resorption: hypercalcemia, fractures
- Suppression of humoral immunity leading to recurrent infections
- Renal insufficiency - Bence-Jones proteinuria of light chains which are toxic to renal tubular epithelium
- Amyloidosis
What is the main patient population of MM?
Elderly - over 70 years old
What is the patient population of Monoclonal Gammopathy of Undetermined Significance (MGUS)?
Older patients ~50 years
What is done for MGUS?
Nothing as most patients are asymptomatic - only 1% develop symptomatic plasma cell neoplasms within a year - only treat with symptoms
