Intro to Lymphomas

Question 1

reactive disorders

Answer 1

benign. cells responding appropriately to stimuli via a mixed polyclonal expansion.

Question 2

neoplasm

Answer 2

malignant clonal expansion of a single cell. autonomous to a stimulus, can’t be controlled and eventually leads to organ replacement, functional compromise, and death.

Question 3

leukemia

Answer 3

neoplasm that extensively involves the bone marrow and spills into the peripheral blood. Often cells native to the marrow and immature lymphocytes (lymphoblasts)

Question 4

lymphoma

Answer 4

tumors that form solid masses, typically involving lymph nodes or related sites (spleen, GI, skin). Composed of native cells, i.e. mature lymphocytes.

Question 5

CLL/SLL (chronic lymphocytic leukemia/small lymphocytic lymphoma)

Answer 5

low grade/indolent B cell neoplasm that always involves lymph nodes but usually has circulating peripheral blood component.

Question 6

acute

Answer 6

immature stage of differentiation. early undifferentiated state (blast cells)

Question 7

chronic

Answer 7

mature stage of differentiation. cyte cells.

Question 8

acute term for lymphoid lineage neoplasms

Answer 8

precursor

Question 9

chronic term for lymphoid lineage neoplasms

Answer 9

peripheral

Question 10

components for modern classification system for non hodgkin lymphomas

Answer 10

morphology, immunophenotype, genotype, putative cell of origin, clinical features

Question 11

where are lymphocytes derived from?

Answer 11

immature pluripotent cells in the bone marrow

Question 12

where does maturation of lymphoblasts take place?

Answer 12

bone marrow (b cells) and thymus (T cells)

Question 13

lymphatics in the bone marrow

Answer 13

none! clinically important because if lymphoma cells are found in the marrow, it is indicative of stage 4, widely disseminated disease

Question 14

difference between primary and secondary follicles

Answer 14

primary: aggregate of naive, unstimulated, mature B cells
secondary: stimulated B cells (develop following antigen exposure). consists of germinal center and mantle. antibodies are refined

Question 15

lymph node cortex

Answer 15

houses B and T lymphocytes. divided into perifollicular T cell rich zone and the B cell rich follicles

Question 16

lymph node medulla

Answer 16

location of plasma cells

Question 17

multiple myeloma

Answer 17

malignant plasma cells home in on bone marrow instead of staying confined to medulla

Question 18

what occurs within germinal centers?

Answer 18

antibody refinement via class switching and somatic hypermutation. expansion of CD10+BCL6+BCL2- B cells

Question 19

mantle of secondary follicles

Answer 19

rim of naive b cells surrounding germinal center. not antigen stimulated

Question 20

tangible body macrophages

Answer 20

histiocytes gobbling up dying cells within the germinal center and laden with cellular debris

Question 21

why don’t germinal center cells express BCL2?

Answer 21

need apoptosis to occur since so much growth and mitosis occurs within the germinal center

Question 22

centrocytes

Answer 22

smaller quiescent activated B cells that have modified their Ig loci. migrate from dark to light zone of germinal center to make contact with follicular dendritic cells.

Question 23

margin in secondary follicles

Answer 23

composed of B cells that have traversed the germinal center, refined their Ig’s and have become quiescent as memory or plasma cells. prominent in the spleen.

Question 24

vast majority of non hodgkin lymphomas are derived from what type of cell?

Answer 24

mature B cells. they undergo multiple rounds of DNA damage as they refine their antibodies

Question 25

why is Hodgkin lymphoma a classification of its own?

Answer 25

neoplastic cells don’t look like lymphocytes under the microscope and don’t resemble them immunophenotypically either. but is still of lymphoid origin (mature B cells).

Question 26

small lymphomas

Answer 26

size is the same as a resting lymphocyte

Question 27

large lymphoma

Answer 27

size is as big or bigger than nucleus of histiocyte

Question 28

nodular lymphomas

Answer 28

slower acting, derived mostly from germinal center B cells, low grade lesions

Question 29

diffuse lymphomas

Answer 29

high grade, less well differentiated

Question 30

indolent

Answer 30

slowly growing

Question 31

immunophenotype

Answer 31

the expression pattern of surface and intracellular protein markers in a given cell population

Question 32

how to assess immunophenotype

Answer 32

flow cytometry and immunohistochemistry

Question 33

markers of immature B cells

Answer 33

TdT, CD19

Question 34

markers of mature B cells

Answer 34

CD19, CD20

Question 35

markers of germinal center B cells

Answer 35

CD10, BCL6 (-BCL2)

Question 36

markers of immature T cells

Answer 36

TdT, CD1a, cCD3

Question 37

markers of mature T cells

Answer 37

CD2, sCD3, CD5, CD7

Question 38

markers of T cell subsets

Answer 38

CD4/8

Question 39

reason to karyotype lymphoma cells

Answer 39

look for translocations

Question 40

importance of IgH

Answer 40

tends to dysregulate whatever it is juxtaposed next to, so that a normal gene is massively over expressed after the translocation

Question 41

translocation of burkitts lymphoma

Answer 41

t(8;14). IgH/Myc. over expression of MYC

Question 42

translocation of follicular lymphoma

Answer 42

t(14;18). IgH/BCL2. over expression of BCL2

Question 43

what causes the symptoms of lymphomas (B symptoms)

Answer 43

cytokines released by the neoplasms (typically fevers, night sweats, weight loss)