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RHS > L24- WBC Pathology III > Flashcards

L24- WBC Pathology III Flashcards

1
Q

BL = (1):

  • (aggressive/benign) neoplasm of (3) cells
  • associated with (4) infection and (5) genetically
A 
1- Burkitt Lymphoma
2- aggressive
3- B-cells
4- EBV
5- t(8;14)
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2
Q

list the three types of BL

  • geographic area if applicable
  • EBV association if applicable
  • Sxs
A

(Burkitt Lymphoma)

  • all present with rapidly growing tumor masses
  • (1)/(2) mostly affect children / young adults

1) Endemic in parts of Africa: 100% EBV association, 50% with jaw / facial bone tumors (50-60%) and spreads to other sites (ovary, testis, kidney)
2) sporadically in other areas (non-endemic), 15% EBV association, abdominal masses in distal ileum / ilececal OR stomach +/- ascites
3) Immunodeficiency-Associated, mainly HIV pts, 25% EBV association, presents with Sxs related to underlying immunodeficiency

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3
Q

BL has a _______ appearance on histology

A

(Burkitt Lymphoma)

‘starry sky’ appearance, most from external sites

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4
Q

discuss BL prognosis

A

(Burkitt Lymphoma)
-although aggressive, good response to high dose chemotherapy

  • most children / young adults can be cured
  • older adults do a little worse
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5
Q

Hairy Cell Leukemia is a (common/rare) (fast/slow) growing neoplasm of (3) cells. It mainly affects (4- age, sex) group of people.

A

1- rare
2- slow / indolent
3- B-cells
4- older males (M:F, 4:1)

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6
Q

Hairy Cell leukemia mainly infiltrates (1) and (2)- indicate associated symptom. (3) is its hallmark characterization. Also note that (4) is rarely ever involved.

A

1- spleen (splenomegaly)
2- bone marrow (pancytopenia)
3- WBCs with fine, hair-like cytoplasmic projections
4- lymph nodes

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7
Q

Hairy Cell Leukemia diagnosis:

  • (1) PB presentation
  • (2) BM presentation
  • (3) spleen appearance
A

1- round / kidney shaped nuclei, pale blue cytoplasm, thread/bleb-like extensions

2- infiltrates of small lymphocytes w/ abundant cytoplasm (fried egg appearance), enmeshed in reticulin

3- red pulp infiltration => beefy red appearance

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8
Q

Hairy Cell Leukemia is positive for the following CDs markers (indicate which ones are unique to it)

A
  • CD20
  • CD25
  • ***CD11c
  • ***CD103
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9
Q

Plasma Cell Neoplasms are cancers of (1) cells, that will release abundant amounts of (2). (3) and (4) are the key tumor markers for these neoplasms.

A

1- B-cells (matured into plasma cells)
2- Ig or Ig fragments (heavy, light chains)
3- M-proteins in blood
4- Bence Jones proteins (monoclonal λ, κ light chains)

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10
Q

name the Plasma Cell Neoplasm relating to:

  • (1) IgG
  • (2) IgM
  • (3) heavy chains
  • (4) light chains
  • (5) other
A

1- Multiple Myeloma (multiple tumor sites) and Solitary Plasmacytoma (single tumor / bone site)
2- Waldenstrom Macroglobinemia
3- Heavy Chain Disease
4- primary amyloidosis (AL type)
5- MGUS, monoclonal gammopathy of undetermine significance

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11
Q

Multiple myeloma is a neoplasm of (1) cells located in (2). It commonly affects (3) age group and (4- sex, race) populations.

A

1- plasma cells
2- multiple bones
3- 65-70 y/o
4- males, African

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12
Q

Multiple Myeloma:

(1) is most frequent form
(2) is the other common form

A

IgG, 60%

IgA, 20%

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13
Q

Multiple Myeloma clinical presentation:
-(1) affect on bones, (2) is the appearance on X-Ray, (3) is the main effect as a result

-(4) is the main blood manifestation, leading to increased risk of (5)

A

1- pain –> destruction or fractures in axial skeleton (vertebrae > ribs > skull)
2- multiple lytic lesions
3- excess bone resorption –> hypercalcemia

4- cytopenias (b/c BM replacement)
5- infections (neutropenia + hypogammaglobulinemia)

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14
Q

Multiple Myeloma clinical presentation:

  • (1) is the main organ affected secondary to (2)
  • (3) is the other main sign seen in (4) organs
A

1- kidney –> renal insufficiency
2- hypercalcemia (Bence-Jones proteins + amyloid deposition)

3- organomegaly
4- spleen, liver, LNs, lung (late in disease course)

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15
Q

Mutiple Myeloma Dx:
-(1) is an absolute requirement seen in BM
(plus one of the following)
i) (2) is another possible requirement, suggested by the following signs: (3)
ii) (4) is another possible requirement, represented by (5) markers

A

1- clonal BM cells >10%

2- presence of organ/tissue impairment
3- hypercalcemia, renal insufficiency, anemia, bone lytic lesions

4- presence of malignancy via biomarker
5: 
>60% clonal plasma cells in BM, OR
>1 focal lesion on MRI, OR
involved:uninvolved serum free light chain >100
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16
Q

(1) is a sign of Mutiple Myeloma seen in urine, produced from (2)

A

1- M protein

2- IgG, IgA

17
Q

describe the key feature of multiple myeloma on bone marrow biopsy

A
  • multiple nuclei
  • many vacuoles
  • dec cytoplasm in comparison
18
Q

describe the electrophoresis pattern of Igs seen in multiple myeloma

A

i) gain of one Ig
ii) gain of one light chain (λ, κ)

iii) loss of all other Igs
iv) loss of the other light chain (λ, κ)

19
Q

Multiple Myeloma:

  • (1) is the predictor of prognosis
  • if untreated death result in (2)
  • (3) is the most common treatment with a median survival rate of (4)
  • younger patient may be candidates for (5), to yield a better prognosis
A 
1- cytogentic abnormalities
2- 1 yr
3- Alkylating Agent chemotherapy (60% remission)
4- 4-7 yrs
5- (<50 y/o) bone marrow transplant
20
Q
  • 90% of NHL affect (1) cells

- only 10% affect (2) cells

A

1- B cells

2- T cells (and NK cells)

21
Q

list some examples of T-cell lymphomas

A

(10% of all NHLs)

  • peripheral T cell lymphoma
  • anaplastic large cell lymphoma
  • angioimmunoblastic T cell lymphoma
  • extranodal T/NK cell lymphoma, nasal type
  • subcutaneous panniculitis-like T cell lymphoma
  • enteropathy associated T cell lymphoma
  • hepatosplenic T cell lymphoma
22
Q

Hodgkin’s Lymphoma:

  • (small/large) tumors involving (2) cells which are considered (3)
  • these cells are located in (4) and surrounded by (5)
A 
1- large
2- Reed-Sternberg cells (RS cells)
3- altered germinal center B lymphocytes
4- germinal centers
5- numerous non-neoplastic inflammatory cells (lymphocytes, plasma cells, eosinophils)
23
Q

Hodgkin’s Lymphoma:

  • (1) are mainly involved with a (2) character and possibly pain associated with (3)
  • systemic features, aka (4), include (5)
  • (6) is the main cutaneous presentation
A 
1- lymph nodes
2- painless rubbery enlargement
3- alcohol use
4- B-symptoms
5- fever, night sweats, weight loss
6- cuntaneous anergy = itching

Note- many other unusual presentations

24
Q

describe the types of HL, according to phenotype / WHO

A

Classical (more common):

  • CD15+. CD30+
  • CD45-

Variant (less common):

  • CD20+, CD45+
  • CD15-, CD30-
25
Q

list the types and subtypes on HL

A

Classical:

  • nodular sclerosis, 65%
  • mixed cellularity, 25%
  • lymphocyte rich, very uncommon
  • lymphcyte depleted, <5%

Variant:
-lymphocyte predominant, 5%

26
Q

(1) is the most common type of HL, mainly affecting (2- age, sex) populations. It commonly involves (3) area of the body and is at Stage (4) at presentation.

A

1- Nodular Sclerosis (classical type)
2- young adults / adolescents, M=F
3- mediastinum +/- neck nodes
4- I, II

27
Q

HL morphology:

  • (small/large) nodules surrounded by (2)
  • (3) type cells are most critical, called (4)
A

1- large nodules
2- thick fibrous collagen bands
3- Reed-Sternberg cells
4- lacunar RS cells

28
Q

briefly describe mixed cellularity HL

A

(classical type)
-diffuse nodal effacement, frequent RS cells, often EBV+

-systemic Sxs and advanced stage presentation

29
Q

briefly describe lymphocyte depleted HL

A

(classical type)
-abundant RS cells, very often EBV+, few lymphocytes and fibrosis in background

-elderly, HIV+, systemic sxs, advanced stage IV at diagnosis

30
Q

briefly describe lymphocyte rich HL

A

(classical type)
-has nodular growth pattern, RS cell present (possibly mononuclear)

-lymphocytes, histiocytes (rarely eosinophils, neutrophils) in background

31
Q

briefly describe lymphocyte predominant HL

A

(variant type)
-large nodules (few no collagen fibrosis), few RS cells

  • age <35, low stage at presentation, good prognosis but tends to recur
  • CD20+, CD45+, CD15-, CD30-
32
Q

describe the (Ann Arbor) staging of HL

A

I- single lymph node (or single extra-lymphatic site/organ)

II- >2 LNs in region, same side of diaphragm (mediastinum)

III- LNs on both sides of diaphragm (possibly spleen)

IV- multiple / disseminated involvement of 1 or more extra-lymphatic organs / tissues

33
Q

HL Tx and prognosis (what Tx, what is the biggest indicator of prognosis)

A

Tx: radiation +/- muti-agent chemotherapy (depends on stage)

Prognosis: depends on Stage

  • 90% survival stage I/II
  • 50% survival stage III/IV
  • long-term survivors are prone to secondary cancers
34
Q

HL:

  • tumor cells are in (majority/minority)
  • (2) describe spread / dissemination
  • extranodal involvement (un-/common)
  • most involvement of (4)
A

1- minority
2- node group –> spleen –> liver –> BM
3- uncommon
4- single axial node group

35
Q

NHL:

  • tumor cells are in (majority/minority)
  • (2) describe spread / dissemination
  • (3) extranodal involvement?
  • most involvement of (4)
A

1- majority
2- no predictable pattern
3- common, >40%
4- multiple peripheral nodes

RHS (35 decks)

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