Hodgkin Lymphoma/Plasma cell neoplasia and T cell malignancies Flashcards
What is a plasma cell neoplasia called?
(multiple) myeloma
What is a myeloma?
Abnormal clonal plasma cells in the bone marrow
What method detects monoclonal gammopathy?
Protein Electrophoresis - separates proteins by charge
An M spike of antibodies in the gamma region could indicate?
Myeloma
Monoclonal gammopathy
What heavy chains (class of antibody) are usually elevated with myelomas?
IgG - majority
IgA
Types of light chains of the antibodies?
Kappa
Lambda
1 way to diagnose myeloma is if there is > _____ plasmacytosis
> 60% plasmacytosis (increase in plasma cells)
MGUS
Monoclonal Gammopathy of Undetermined Significance
If MGUS is present, what other symptoms are needed to diagnose a myeloma?
CRAB and Marrow plasmacytosis
CRAB is seen with myelomas. What are those symptoms?
C - Elevated calcium
R - Impaired renal function
A - Anemia
B - Bone lesions
If elevated calcium is present, what are some potential signs?
Altered mental status
Constipation
Seizures
Cardiac rhythm changes
What causes impaired renal function with myelomas?
Due to the immunoglobins being filtered and the presence of Bence - Jones proteins
What are Bence - Jones proteins?
Ig - Renal glycoprotein CASTS
What do Bence - Jones proteins do?
Ig - Renal glycoprotein CASTS
- Clog and damage renal tubules = impaired renal function
Besides Bence - Jones proteins, what else can indicate impaired renal function with myelomas?
Light chains spilling into the urine
AL amyloid
What is the most common manifestation of a myeloma?
Anemia
What causes Anemia in association with myelomas?
Marrow infilration, IL-6, renal damage (decreased erythropoietin)
Bone lesions associated with Myeloma have what appearance?
Punched out appearance
Hyperviscosity is also present with myelomas. What does that cause?
Thromboembolic events - stroke, thrombosis, etc.
Rouleaux formation on peripheral blood smear
What is a Rouleaux formation on peripheral blood smear?
RBC stacking, seen with myelomas due to hyperviscosity and the stickiness of Ig’s
Monoclonal gammopathy + CRAB + plasmascytosis in marrow + hyperviscosity
Myeloma
Another name for lymphoplasmacytic lymphoma?
Waldenstrom’s Macroglobulinemia
Another name for Waldenstrom’s Macroglobulinemia?
Lymphoplasmacytic lymphoma
Waldenstrom’s Macroglobulinemia has elevated?
IgM
Elevated IgM could indiacte?
Waldenstrom’s Macroglobulinemia
Monoclonal gammopathy (with IgM) + hyperviscosity could indicate lymphoplasmacytic lymphoma. Describe the symptoms due to this hyperviscosity.
Neurologic manifestations
Visual impairment
Visual impairment with elevated IgM could indicate?
Waldenstrom’s Macroglobulinemia
Hodgkin Lymphoma, localized to a group or lymph nodes or not?
Yes, localized
Hodgkin Lymphoma, how does it spread?
Orderly based on nearby lymph nodes
How common is extranodal presentation and mesenteric node/waldeyer ring involvement for Hodgkin Lymphoma?
RARE
What cells are often seen with Classic Hodgkin Lymphoma?
Reed Sternberg cells
What cluster designations are (+) for Classic Hodgkin Lymphoma?
CD15, CD30, PAX-5
CD15, CD30, PAX-5 (+)
Classic Hodgkin Lymphoma
What cells are often seen with Nodular Lymphocyte Predominant Hodgkin Lymphoma?
Lymphohistiocytic cells (popcorn)
What cluster designations are (+) for Nodular Lymphocyte Predominant Hodgkin Lymphoma?
CD20
Nodular Lymphocyte Predominant Hodgkin Lymphoma can transform into?
Diffuse Large B cell Lymphoma
What are the only ways to diagnose types of Hodgkin Lymphomas?
Staining and Morphology
4 types of T cell lymphomas
- Anaplastic Large cell lymphoma (ALCL)
- Adult T cell Lymphoma/Leukemia
- Mycosis Fungoides
- Sezary syndrome
What can become constitutively activated with Anaplastic Large Cell Lymphoma (ALCL)?
ALK tryosine kinase
ALK (+) patient population and prognosis for Anaplastic Large Cell Lymphoma (ALCL)?
Younger patients with better prognosis
ALK (-) patient population and prognosis for Anaplastic Large Cell Lymphoma (ALCL)?
Older patients with worse prognosis
What is an Adult T cell Leukemia/Lymphoma associated with?
HTLV-1 infection
HTLV-1 infection is often seen with?
Adult T Cell Leukemia/Lymphoma
What types of cells are seen with an Adult T cell Leukemia/Lymphoma?
Cloverleaf cells = worse prognosis when in circulation
Physical signs of Adult T cell Leukemia/Lymphoma?
Skin involvement
- Lesions and nodules are common
Lesions and nodules on the skin + HTLV-1 infection correlates to what T cell lymphoma?
Adult T cell Leukemia/Lymphoma
Mycosis Fungoides is a?
T cell lymphoma with cutaneous manifestations
T cell lymphoma with cutaneous manifestations?
Mycosis Fungoides
Sezary Syndrome is a?
T cell lymphoma with erythroderma and leukemia
T cell lymphoma with erythroderma and leukemia?
Sezary Syndrome