Hodgkin and non-hodgkin lymphoma Flashcards

Question 1

Q

Normal lymphoid structure

Which area of the lymph node has mixed population of cells but mostly T cells?

Question 2

Q

The normal lymph node

Mixed B cells in the light zone of the germinal center are called_______.

B cells in the dark zone of the germinal center are called_______.

Question 3

Q

What is a B specific cell marker?

What other markers are specific for B cells?

Answer

A

Cell markers for B cells: CD20 (in mantle zone and germinal center), CD19 and CD22

Cell markers for T cells are CD3 (positive in paracortical area)

and CD4, CD5, CD8.

Question 4

Q

_____ and _____ are two markers that are specifically expressed in normal germinal B-cells and derived lymphomas

Question 5

Q

Causes of lymphadenopathy (enlargement of lymph nodes):

Answer

A

-Reactive lymphoid hyperplasia due to:

oInfection (Viral, bacterial, fungal, parasitic)

oPost-vaccination

oAutoimmune disease (SLE, Kikuchi-Fujimoto)

oLocal/regional inflammatory disorders

Malignancy

oPrimary node neoplasms: Lymphoma

oDisseminated hematopoietic disease (acute leukemia involving lymph nodes)

o Metastatic non-hematopoietic neoplasms

Question 6

Q

Lymphoma, what is it?

Answer

A

Criteria Used for classification and Grading of Lymphoma:

Question 7

Q

Types of lymphoma

Which lymphoma is predominantly a B-cell lymphoma?

Answer

A

–>Non-Hodgkin’s lymphoma (NHL)

–Many types (***B-cell >**T-cell >*NK-cell)

–>Hodgkin lymphoma (HL): *B-cell lymphoma

oClassical HL

oNodular lymphocyte predominant HL

-->Lymphoblastic lymphoma/leukemia

Question 8

Q

Chronic Lymphocytic Leukemia /
Small Lymphocytic Lymphoma (CLL/SLL)

Which one is characterized by peripheral blood lymphocytosis?

Which one is predomimantly extramedullary?

Answer

A

CLL: Peripheral blood lymphocytosis ≥5 × 109/L for ≥ 3 months; monoclonal mature lymphocytes

SLL: Predominantly extramedullary involvement; similar morphology and immunophenotype to CLL.

CLL is the most common leukemia in the Western world and accounts for ~ 30% of all leukemia.
SLL accounts for ~7% of Non-Hodgkin lymphoma (NHL)
Median 65 years, male predominance, M:F=2:1
Most elderly patients with CLL are either asymptomatic (70% of cases) or only mildly symptomatic, whereas some patients may present with fatigue, infection, autoimmune hemolytic anemia, hepatosplenomegaly, lymphadenopathy, or extranodal involvement.

Question 9

Q

Peripheral presentations:

Answer

A

Lymphocytosis, ≥ 5 × 109/L
Typical CLL cells:

-Size: Small and monotonous

oNuclei: Round, condensed chromatin

oNucleoli: Inconspicuous

oCytoplasm: Scant and agranular

§Frequent smudge cells and basket cells

§Prolymphocyte (arrow): variable

oSize: larger

oNuclei: round, more fine chromatin

oNucleoli: prominent

Cytoplasm: abundant

Question 10

Q

Immunophenotype of CLL/SLL

–>Strongly positive _____, _____, ______.

–> Weakly positive_____, ______

Negative in ______, ________.

Answer

A

Strongly positive: CD5, CD19, CD23
Weakly positive: **CD20, **surface immunoglobulin
Negative: CD10, FMC7

Question 11

Q

Follicular lymphoma

What is it?

Where is it located mostly?

–80% cases have widespread stage_____ or _____ disease at diagnosis.

Answer

A

A lymphoma of germinal center B cell origin
Frequency: 40% of adult lymphomas in US, 20% worldwide
Age: mostly adults, median 60 years
Gender: male = female
Locations: mostly lymph nodes, also spleen, bone marrow, Waldeyer’s ring, GI tract, skin and soft tissue
Clinical presentations: more than 80% cases have widespread stage III or IV disease at diagnosis, 40% have bone marrow involvement; however, patients often asymptomatic except for lymphadenopathy.

Question 12

Q

Things see in Follicular lymphomas:

Question 13

Q

Follicular lymphoma

Answer

A

What is the function of BCL2?

Major function: To suppress apoptosis (programmed cell death).
BCL2 gene is down-regulated in the normal germinal center B-cells (so that to allow cells die during selection).
Therefore, normal reactive germinal center B-cells are negative for BCL2 protein

Question 14

Q

What is the translocaton?

Answer

A

IHG is strong promoter and makes producion of BCL2 increase.

The translocation happens between chromosome 14 and 18.

Question 15

Q

Immunophenotype of Follicular Lymphoma

Positive for markers______ and _______.

Positive for germinal center B- cell marker_______ and _____.

It is positive for ______, which is negative in reactive germinal center B-cells.

Negative for _____ and _____.

Answer

A

Positive for B-cell markers: CD19, CD20
Positive for germinal center B-cell markers: CD10, BCL6
Positive for BCL2, which is negative in reactive germinal center B-cells.
Negative: CD5*, CD23*

Question 16

Q

Mantle Cell Lymphoma (MCL)

Answer

A

Comprise approximately 3-10% of NHL
Median age 60 years, M:F=2:1
Location: mostly lymph nodes, also spleen and bone marrow; most common extranodal sites, gastrointestinal tract and Waldeyer’s ring**
Clinical presentations: Most patients present with stage III or IV with lymphadenopathy, hepatosplenomegaly; >50% of cases with massive splenomegaly and marrow involvement
In contrast to other small B-cell lymphoma that are mostly indolent, MCL is usually moderately aggressive

Question 17

Q

Mantle cell lymphoma

Question 18

Q

Immunophenotype of Mantle Cell Lymphoma

It is positve for ____, which is also positive in CLL/SLL.

Negative for _____, which is positive in CLL/SLL.

Negative for germinal center B cell markers ______ and ______

Positive for _____

Answer

A

Positive for B-cell markers: CD19, CD20
Positive for CD5, which is also positive in CLL/SLL
Negative for CD23, which is positive in CLL/SLL
Negative for germinal center B-cell markers: CD10, BCL6
Positive for cyclin D1 (BCL1), which is negative in most of other B-cell lymphomas.