LAD And Lymphoma

Question 1

Under what condition do we find painful LAD?

Answer 1

Draining a region of acute infection

Question 2

Under what 3 conditions do we find a painless LAD?

Answer 2

Chronic inflammation, metastatic carcinoma, or lymphoma.

Question 3

What part of the lymph node is enlarged due to RA and early HIV and why does early HIV enlarge this area?

Answer 3

Follicular enlargement

Because follicular cells are CD4 positive

Question 4

What condition would we see the paracortex enlarged?

Answer 4

Viral infections

Question 5

In what conditions would we see enlargement of the sinus histiocytes?

Answer 5

Draining a tissue with cancer

Question 6

How am I going to break up the lymphomas and talk about the 5 different lymphomas?

Answer 6

By size.
Small b cells: follicular lymphoma, mantle lymphoma and marginal lymphoma.
Intermediate B cells: burkitt lymphoma
Large B cells: diffuse B cell lymphoma

Question 7

How do we characterize follicular lymphoma and how does it present?

Answer 7

Proliferation of small B cells with cd 20 that form follicle like nodules in the LN.
Presents in late adulthood with painless LAD

Question 8

What is the cause of the lymphoma and explain how it works?

Answer 8

Translocation of 14;18. BCL2 on chromosome 18 translocates to the Ig heavy chain locus on chromosome 14 which results in over-expression of BCL2. Now, this is a problem because we don’t want BCL2 there. We want B cells to be able to undergo apoptosis after somatic hypermutation if they don’t produce antibody against antigen. Over-expression of BCL2 does not allow these B cells to die.

Question 9

Two treatments for symptomatic follicular lymphoma?

Answer 9

Chemo and Rituximab (anti cd20 drug)

Question 10

What is the complication of follicular lymphoma?

Answer 10

Progress to a diffuse large B cell lymphoma

Question 11

What are the 4 ways we distinguish follicular lymphoma from follicular hyperplasia?

Answer 11

Destruction of normal follicular architecture
Lack of macrophages because there is nothing to eat up because of so much BCL2 and no apoptosis
BCL2 expression
Monoclonality

Question 12

How do we characterize mantle cell lymphoma and how does it typically present?

Answer 12

Proliferation of small B cells that expand the mantle cell.

Late in adulthood with painless LAD

Question 13

What is the cause or what drives this lymphoma and how does it work?

Answer 13

T 11:14 where Cyclin D1 gene goes from chromosome 11 to Ig heavy chain on chromosome 14.
Cyclin D1 promotes G1 to S phase transition so the mutation is allowing proliferation like crazy.

Question 14

How do we characterize marginal zone lymphomas and what are the associated with?

Answer 14

Proliferation of small B cells in the marginal zone.

Highly associated with chronic inflammatory states such as hashimotos, sjogren syndrome, and h pylori gastritis

Question 15

What forms the marginal zone in a lymph node?

Answer 15

Post germinal center B cells

Question 16

What type of marginal zone lymphoma is formed associated with h pylori gastritis?

Answer 16

MALToma

Question 17

How do we characterize Burkitt Lymphoma and how does it typically present?

Answer 17

Proliferation of intermediate sized B cells associated with EBV.
Extranodal mass in a child or young adult.

Question 18

What are the two forms of burkitt lymphoma and what body part do they commonly involve?

Answer 18

African form involves the jaw

Sporadic form involves the abdomen

Question 19

What is driving the tumor?

Answer 19

T 8:14

C myc is translocated to chromosome 14 where Ig heavy chain is at and overexpressed resulting in tumor growth.

Question 20

What is the classic histo of a burkitt lymphoma and explain it?

Answer 20

Starry sky appearance.
Sky is all the blue cells because it is rapidly growing and the white stars here and there are macrophages eating up the dead cells because they are so rapidly growing and dieing.

Question 21

How do we characterize Diffuse Large B cell lymphoma?

Answer 21

Proliferation of large B cells diffusely

Question 22

2 important features of DLBCL?

Answer 22

Very aggressive, high grade.

Most common NHL

Question 23

What are the 2 ways DLBCL arise?

Answer 23

Sporadically

Transformation from follicular lymphoma

Question 24

How does DLBCLs typically present?

Answer 24

Late adulthood with an enlarging LN or extranodal mass

Question 25

How do we characterize a lymphoma and what are the two main types by percentage?

Answer 25

Proliferation of lymphoid cells that forms a mass.
NHL 60%
HL40%

Question 26

How do we characterize Hodgkin Lymphoma? What is the classic cell and what is it doing?

Answer 26

there are Reed Sternberg cells that are large B cells with multilobed nuclei. These RS cells secrete cytokines that will attract tons and tons of inflammatory cells to join the party and create a mass and cause problems.
These RS cells are cd 15 and 30

Question 27

3 effects of the cytokines produced by the RS cells?

Answer 27

Symptoms like fever, chills, night sweats
Attract lymphocytes, plasma cells, macrophages and eosinophils
Fibrosis

Question 28

What are the 4 main types of HLs and which one is most common? Which one has best prognosis? Which one has worst prognosis?

Answer 28

Nodular sclerosis - most common
Lymphocyte rich - best prognosis
Mixed cellularity
Lymphocyte depleted - worst prognosis

Question 29

What is classic presentation of nodular sclerosis type?

Answer 29

Young female presents with cervical mass or mediastinal mass

Question 30

What is the classic histo of nodular sclerosis type and what is the unique cell involved?

Answer 30

LN is divided by bands of sclerosis/fibrosis.

RS cells are sitting in lake like structures and they call these particular cells lacunar cells

Question 31

Which type is associated with eosinophils, which means what marker is present?

Answer 31

Mixed cellularity

IL5