Heme Malignancy 3: CLL and B cell lymphomas Flashcards
What is the best diagnosis in the patient with the above peripheral smear? The cell population identified in the slide (arrow) comprises 60% of the peripheral blood leukocytes. There is an Auer rod in one cell.
A.Acute myeloid leukemia
B.Chronic myeloid leukemia
C.Acute lymphoblastic leukemia
D.Primary myelofibrosis
E. Essential thrombocythemia
A.
What is the most likely finding in the patient with the above peripheral smear? The cell population denoted in the second slide comprises 60% of the peripheral blood leukocytes
A.Positive for T(15;17)
B.No translocations
C.Positive for JAK2 mutation
D.Positive for t(9;22) translocation
E.Positive for NOTCH1 mutation
A.
What is the most likely diagnosis in the 15 yr old patient with a mediastinal mass and the above peripheral smear? Based on flow studies, the cells express CD2, CD3, CD7 and TdT
A.Chronic lymphocytic leukemia
B.T-acute lymphoblastic lymphoma/leukemia
C.B-acute lymphoblastic lymphoma/leukemia
D.Acute myeloid leukemia
B. (remember a T-ALL teenager with a thymic mass)
Label the following on the lymph node below:
Germinal center
Mantle zone
Secondary follicle
Paracortex
see image below
Label the CD markers in the regions marked below:
see below
**
CD10 is a specific germinal center marker
B cells in the germinal center are negative for Bcl2 (Bcl2 is expressed in cells everywhere else in the lymph node). Bcl2 is an anti-apoptotic protein so in the event that the B cells start to go awry, you would want them to die which is why Bcl2 is downregulated in the germinal center
Hodgkin’s lymphoma arises from B cells in the ___ of the lymph node and can be subdivided into ___ and ___ types
Hodgkin’s lymphoma arises from B cells in the germinal center of the lymph node and can be subdivided into classical and lymphocyte predominant types
A classical presentation of HL is ___ +/- B symptoms. The (presence/abscence) of B symptoms indicates a poor prognosis.
T/F: This cancer likes to travel to various parts of the body
A classical presentation of HL is lymphadenopathy +/- B symptoms. The presence of B symptoms indicates a poor prognosis.
Falsehood. HL tends to be limited to the lymph nodes (explains the lymphadenopathy) and tend to move in an orderly fashion from the LN >> spleen >> liver >> bone marrow
HL is characterized by the presence of ___, which are actually a small percentage of the total number of cells in the lymph node
HL is characterized by the presence of Reed-Stenberg cells, which are actually a small percentage of the total number of cells in the lymph node
The ___ subtype of Hodgkin’s lymphoma is characterized by B cell-derived cells that are __ and __ +ve (CD markers) and __ -ve despite being B cell derived. Some subtypes are also ___ +ve (a HHV that you will recall causes Hodgkin’s lymphoma)
The classical subtype of Hodgkin’s lymphoma is characterized by B cell-derived cells that are CD15 and CD30 +ve (CD markers) and CD20 -ve despite being B cell derived. Some subtypes are also EBV +ve (a HHV that you will recall causes Hodgkin’s lymphoma)
The ___ subtype of Hodgkin lymphoma is characterized by CD20+ cells (CD15/30 and EBV -ve) and the prognosis is generally good
The non-classical/lymphocyte predominant subtype of Hodgkin lymphoma is characterized by CD20+ cells (CD15/30 and EBV -ve), “popcorn” RS cells and the prognosis is generally good
Another characteristic symptom of Hodgkin’s lymphoma patients is __ if pts drink alcohol
Another characteristic symptom of Hodgkin’s lymphoma patients is extreme pain or itching if pts drink alcohol
Contrast Hodgkin and Non-Hodgkin lymphoma in the table below
___is a high grade form of Non-Hodgkin’s lymphoma that arises from cells in the germinal center or marginal zone
Diffuse B cell lymphoma is a high grade form of Non-Hodgkin’s lymphoma that arises from cells in the germinal center or marginal zone
Which Non-Hodgkin Lymphoma is characterized by the pathology below?
**Diffuse large B cell lymphoma**
Pleomorphism; large nuclei
Mitotic activity
Form sheets in whatever organ they grow in
Which gene abnormalities are seen in cases of DLBCL?
BCL2
BCL6
t(14;18)
Immunoficiency associated DLBCL is a viral-ass’d cancer which can be caused by infection with which 2 viruses?
HIV
EBV-driven
**bone marrow transplantation is also a state of malignancy so there’s that**
Primary effusin lymphoma is a type of DLBCL that arises from infection with ___ and is characterized by fluid involnement.
Primary effusion lymphoma is a type of DLBCL that arises from infection with HHV8/ HHV8+EBV co-infection and is characterized by fluid involnement (cancer usually involves pleural or perinotoneal fluid)
Another type of aggressive NHL is ___
Another type of aggressive NHL is Burkitt lymphoma
Burkitt lymphoma can be split into 3 subtypes, namely __ (all EBV+), ___ (more common in the Western hemisphere and generally EBV -) and ___ (may or may not be EBV+; its immunodeficient condition)
Burkitt lymphoma can be split into 3 subtypes, namely Endemic (all EBV+; more common in Africa), Sporadic (more common in the Western hemisphere and generally EBV -) and HIV+ (may or may not be EBV+; its immunodeficient condition)
___ lymphoma is characterized by medium-sized cells w/ moderate cytoplasm, a “starry sky” appearance of macrophages laden with dead cells, high rate of mitosis + a rapidly growing mass
Burkitt lymphoma is characterized by medium-sized cells w/ moderate cytoplasm, a “starry sky” appearance of macrophages laden with dead cells, high rate of mitosis + a rapidly growing mass
Which pathology is shown below?
Burkitt lymphoma
**The big cells with cytoplasm are macrophages that are eating up the dying cells as new ones proliferate rapidly**
Burkitt lymphoma is CD__ and ___ +ve, and Bcl2 -ve. It also shows high expression of __ (marker of high rate of mitosis)
Burkitt lymphoma is CD10 and 20 +ve, and Bcl2 -ve. It also shows high expression of Ki-67 (marker of high rate of mitosis or in this ki-tosis)
All forms of Burkitt Lymphoma has a translocation of the __ gene on chromosome 8
All forms of Burkitt Lymphoma has a translocation of the C-myc gene on chromosome 8.
t(8;14) – IgH locus: the gene translocates to and sits on the promoter of the Heavy chain locus
t(2;8) – Ig K (here the gene translocates to the Kappa promoter)
t(8;22) – Ig λ (gene translocates to the lambda promoter)
**know that C-MYC is a proto-oncogene**
Low grade NHL can be subdivided into small lymphocytic lymphoma, ___ lymphoma, follicular lymphoma and ___
**hint: all of these lymphomas describe WHERE in the lymph node the cancer is happening**
Low grade NHL can be subdivided into small lymphocytic lymphoma, mantle cell lymphoma, follicular lymphoma and marginal zone
**hint: all of these lymphomas describe WHERE in the lymph node the cancer is happening**
Small lymphocytic lymphoma can arise from the naïve B cell stage or the memory B cell stage in the marginal zone. Generally, the prognosis is worse with the ___ stage
Small lymphocytic lymphoma can arise from the naïve B cell stage or the memory B cell stage in the marginal zone. Generally, the prognosis is worse with the naïve B cell stage
CLL/SLL tends to involve the entire RES system and causes high WBC count
In the lymph node, disease is characterized by pale areas called ___ where the Ki-67 (mitotic rate) is higher than everywhere else
In the blood, disease is characterized by lymphocytosis and ___ cells
CLL/SLL tends to involve the entire RES system; causes high WBC count
In the lymph node, disease is characterized by pale areas called proliferation centers where the Ki-67 (mitotic rate) is higher than everywhere else
In the blood, disease is characterized by lymphocytosis and “smudge” cells
___ is a characteristic aberrant marker of CLL/SLL
The presence of ___ is a marker of favorable prognosis
CD5** is a characteristic aberrant marker of CLL/SLL
**also CD19 and CD20, CD23 +ve**
The presence of somatic hypermutation is a marker of favorable prognosis
Mantle cell lymphoma is characterized by lymphadenopathy and spread to extra nodal sites (___ in the tonsils, and ___ in the colon)
Mantle cell lymphoma is characterized by lymphadenopathy and spread to extra nodal sites (Waldeyer ring in the tonsils, and lymphomatous polyposis in the colon)
**Waldeyers ring: ringed arrangement of tonsils**
Mantle cell lymphoma is characteristically __ +ve and arises from a translocation involving ___ where the gene translocates to the promoter of the Ig heavy chain
**note that this disease is also CD5+ (and Cd19, 20 +ve)
Mantle cell lymphoma is characteristically Cyclin D1 +ve and arises from a translocation involving Cyclin D 1 where the gene translocates to the promoter of the Ig heavy chain
**note that this disease is also CD5+ (and CD19, 20 +ve)**
**t(11;14)
___ is a common indolent lymphoma that occurs in the lymph node germinal center
Follicular lymphoma is a common indolent lymphoma that occurs in the lymph node germinal center
Which pathology is indicated below?
Follicular lymphoma
What pathology is indicated below?
Follicular lymphoma
Follicular lymphoma is characterized by the presence of which two cell types?
Centrocytes: small cells with cleaved nuclei
Centroblasts: larger cells with prominent nucleoli
In follicular lymphoma, there is a translocation that keeps ___ turned on and prevents the killing of these neoplastic cells
In follicular lymphoma, there is a translocation that keeps Bcl2 turned on and prevents the killing of these neoplastic cells
**cells are Bcl2+, CD10, 19 and 20 +ve)
**t(14;18 translocation between bcl2 and the Ig heavy chain)
Marginal zone lymphoma is characterized by abnormal proliferation of post-follicular B cells, so you may occassionally see what cell population with this cancer?
What bacterial infection is this lymphoma ass’d with (hint: inflammation from this infection causes MALT lymphoma)?
Can occasionally see plasma cells ass’d with this lymphoma and is usually ass’d with H/ pylori infection (inflammation leads to MALT lymphoma)
If you treat with antibiotics, the lymphoma goes away
A characteristic finding of Marginal zone lymphoma is a __ lesion (neoplastic invasion of glandular tissue)
A characteristic finding of Marginal zone lymphoma is a lymphoepithelial lesion (neoplastic invasion of glandular tissue)
Fill in the blanks
