Hematopathology III

Question 1

What is the main difference in acute and chronic leukemias?

Answer 1

Acute will have blast cells and chronic will have more differentiated cells

Question 2

What is the typical patient of Diffuse Large B-cell Lymphoma?

Answer 2

Older adults - median age is 60

Question 3

How does Diffuse Large B-cell Lymphoma present?

Answer 3

Rapidly enlarging, symptomatic mass at single or extranodal site

Question 4

What are the distinct subtypes of Diffuse Large B-cell Lymphoma?

Answer 4

Germinal Center B-cell (GCB)

Activated B-cell (ABC)

Question 5

What is the difference in outcomes of Diffuse Large B-cell Lymphoma in GCB VS ABC?

Answer 5

GCB has much better survival and prognosis that ABC - different treatments are used for each type

Question 6

Translocation of Diffuse Large B-cell Lymphoma

Answer 6

• 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”

Question 7

What biomarkers will Diffuse Large B-cell Lymphoma express?

Answer 7

CD20

Question 8

What is the appearance of the spleen in Diffuse Large B-cell Lymphoma?

Answer 8

“Fish flesh” appearance of a large expansile mass

Question 9

What happens to the lymphocytes in Diffuse Large B-cell Lymphoma?

Answer 9

They become much larger than normal

Question 10

What is the presentation of Peripheral T-Cell Lymphoma?

Answer 10

Lymphadenopathy, eosinophilia, pruritis, fever and weight loss

Question 11

What is the biomarker of Peripheral T-Cell Lymphoma?

Answer 11

CD3+

Question 12

What are the cells like in Peripheral T-Cell Lymphoma?

Answer 12

Polymorphic and heterogeneous often with eosinophilia

Question 13

What are the patients of Hodgkin lymphoma?

Answer 13

Bimodal - in young adults and the in older adults

Question 14

What is the spread of Hodgkin lymphoma?

Answer 14

Spreads in contiguous fashion thorough the lymphoid tissue

Question 15

What is the characteristic cell of Hodgkin lymphoma?

Answer 15

Reed-Sternberg Cells

Question 16

What type of cells does Hodgkin lymphoma arise from?

Answer 16

B cells

Question 17

What is a common mechanism for the activation of classical Hodgkin lymphoma?

Answer 17

NF-kB activation can occur via infection by EBV is a common mechanism for Hodgkin lymphoma

Question 18

What is the appearance of Reed-Sternberg cells?

Answer 18

Owl eyes - binucleated

Question 19

What do the classical Hodgkin lymphoma cells have as biomarkers?

Answer 19

CD15/30

Question 20

What are the biomarkers of nodular lymphocyte predominant Hodgkin lymphoma?

Answer 20

CD20/45

Question 21

What is the most common class of Hodgkin lymphoma?

Answer 21

Nodular sclerosis

Question 22

What are the classes of Hodgkin lymphoma?

Answer 22

• Lymphocyte rich
• Mixed cellularity
• Lymphocyte Depleted
• Nodular Sclerosis
• Nodular Lymphocyte Predominant

Question 23

Lymphocyte rich Histology

Answer 23

Reactive small lymphocytes predominate, few mononuclear or classic Reed-Sternberg cells

Question 24

Mixed cellularity

Answer 24

Reed-Sternberg cells and variants on a mixed cellular background including eosinophils, plasma cells, T- lymphocytes, histiocytes

Question 25

Lymphocyte Depleted

Answer 25

Paucity of lymphocytes and relative abundance of Reed-Sternberg cells

Question 26

Nodular Sclerosis

Answer 26

Fibrous nodular pattern, lacunar cells

Question 27

Nodular Lymphocyte Predominant

Answer 27

Nodularity with predominance of mature lymphocytes and popcorn cell or L & H variant of RS cells

Question 28

What morphology of cells are seen in nodular lymphocyte predominant Hodgkin lymphoma?

Answer 28

“Popcorn-like” cells

Question 29

What is the most common plasma cell neoplasm?

Answer 29

Monoclonal Gammopathy of Undetermined Significance (MGUS)

Question 30

Waldenstrom’s Macrogloobulinemia

Answer 30

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

Question 31

Multiple Myeloma

Answer 31

The presence of monoclonal plasma cell proliferation involving bone marrow and typically skeleton at multiple sites

Question 32

What is the proliferation of plasma cells in MM dependent upon?

Answer 32

Cytokines - mainly IL-6

Question 33

What are serum and urine indications of MM?

Answer 33

Monoclonal protein in serum

IgG or IgA in the urine

Question 34

What can be found in the bone marrow in MM patients?

Answer 34

Bone marrow showing clonal plasmacytosis or presence of a plasmacytoma

Question 35

What are the symptoms of MM? (CRAB)

Answer 35

hyperCalcemia, Renal insufficiency, Anemia, Bone lesions/Back pain

Question 36

What is seen in the skull in MM?

Answer 36

Punched out regions due to secretions of cytokines that increase osteoclastic activity

Question 37

How does electrophoresis tell you about the MM diagnosis?

Answer 37

It can show a single strong band which is indicative of a monoclonal protein - i.e. the monoclonal antibody of MM

Question 38

What are some of the complications of MM?

Answer 38

• 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

Question 39

What is the main patient population of MM?

Answer 39

Elderly - over 70 years old

Question 40

What is the patient population of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

Answer 40

Older patients ~50 years

Question 41

What is done for MGUS?

Answer 41

Nothing as most patients are asymptomatic - only 1% develop symptomatic plasma cell neoplasms within a year - only treat with symptoms