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Hematopathology > Lymph Node I and II > Flashcards

Lymph Node I and II Flashcards

1
Q

Normal node location for IHC for BCL-6 and CD10?

CD21?

BCL-6?

IgD?

A

Germinal center: BCL-6 is nuclear staining and CD10 is cytoplasmic staining

CD21: Follicular dendritic network

BCL-2: Stains rim around germinal center of Mantle and Marginal zone B-cells

IgD: Mantle zone positive!

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2
Q

Rheumatoid lymphadenopathy shows?

Syphilitic lymphadenopathy shows?

A

Polytypic (polyclonal) plasma cells and neutrophils in sinuses

Syphilitic: Thick capsule with plasma cells

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3
Q

Follicular lymphoma vs hyperplasia?

A

Hyperplasia: Polymorphic, increased mites Ki-67; macrophages, BCL-2 (t14;18) -, Architecture preserved, GC size variation, No back to back follicles

Follicular lymphoma: Monotonous cells, decreased mites, decreased macrophages, BCL-2 t(14;18)+; architecture effaced, little variation in GC, back to back follicles

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4
Q

Lymph nodes with lots of small germinal centers or multiple in GCs in a follicle?

IHC’s?

Virus associated with Multicentric; other assocations?

A

Castleman’s!!!; Lollipop stem blood vessel; and/or lots of plasma cells

Increased dendridic cells (unicentric); CD21+, CD23+, CD35+ and Interfollicular plasmacytoid monocytes are CD123+

HHV8; Worse prognosis, assocaited with HIV, Wiskott-Aldrich, and POEMS (poly neuropathy organomegaly, endocrinopathy, Monoclonal gammopathy and skin lesions

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5
Q

Dysplastic cell in hyaline/unicentric Castleman’s?

Tx hyaine type?
Tx multicentric?

A

Increased dysplastic follicular dendritic cells

Surgery

Steroids

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6
Q

3 patterns of HIV related lymphadenopathy (progressive)?

HIV IHC stain in LN?

A

Follicular hyperplasia

Follicular involuation (regressed GC’s, thim mantle zones, histiocytes, immunoblasts)

Lymphocyte depletion: Small lymph nodes, no follicles, lots of fibrosis and histiocytes, erythophagocytosis

P24 can stain for HIV in node

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7
Q

Epithelioid histeocytes and monocytoid B-cell hyperplasia in sinuses (look like monocytes) and enlarged nodes?

Host organism?

A

Toxoplasmosis gondii!

Cat

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8
Q

Expansion of paracortical area can be from?

Immunoblasts in paracortex stain for?

A

T-cell response; Drugs (phenytoin and dilantin), vaccines, EBV

CD30+, large with vesicular chromatin and central nucleoli

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9
Q

Features of EBV H and E sinuses, paracortex?

IHC stains?

Peripheral blood cell that hints at EBV?

What are these cells?

A

Paracortex expansions of immunoblasts and RS like cells

Sinuses with monocytoid B cells

Can see necrosis and apoptosis

CD30+, LMP +, EBER +

Cell with cleared cytoplasm scalloping around RBCs

CD8+ T-cells that stop infected B-cells!

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10
Q
A
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11
Q

Dermatopathic lymphadenopathy?

Cell types?

IHCs?

DDx?

A

Pale paracortex!
Interdigitating dendritic cells, langerhan cells, and histeocytes

IDC: S100+, Fascin+, CDa1+

Langerhans: S100+. CD1a+, langrin/CD207, Birbeck

Histeocytes, CD4+, lysozymes with melanin, lipid (sudan black +) and iron (Prussian blue)+

DDX: Mycosis fungoides

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12
Q

Other name for Histiocytic necrotizing lymphadenitis and population

H and E and histiocyte shape?

Stains?

A

Kikuchi-Fujimoto in young Asians; self limited/cervical nodes with no other organisms or viruses

3 phases: proliferative, necrotizing (no acute inflammation) and xanthomatous

CD68+ (crescentic histiocytes)

Plasmacytoid dendritic cells: CD123+, CD303+, Td1+

Increased CD8+ cells

NO PLASMA CELLS

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13
Q

Cat scratch disease organism?
H and E?

Can also cause

A

B. Henselae (gram - bacillus)
Self limited

Stellate necrotizing granulomas; Neutrophils and monocytoid B-cells hyperplasia; See organism with Warthin-Stary stain, or Brown Hopps or IHC

Bascillary angiomatosis (lobular proliferation of capillaries)

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14
Q

Rosai Dorfmann population?

H and E?

Stains?

A

Teens with fever and bilateral cervical nodes

Large cells with emperiopoesis;low power: shows pink histiocytes cells in sinuses

S100+ in big cells but lymphocytes are negative, CD68+, lysozyme and PLAP +

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15
Q

Hemophagocytic lymphohistiocytosis?

H and E?

Genes?

A

Hemophagocytic syndrome with fever, splenomegaly, cytopenias, hypertriglyceridemia, elevated feratin, erythrophagocytosis; low NK activity, soluble CD25> 2400; pt can die!!

Erythrophagocytosis: Histeocytes that consume RED CELLS (vs. lymphocytes in RD disease)
PRF1, UNC13D, STX11

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16
Q

CLL?

H and E?

Stains?

A

B-cell neoplasm of monomorphic prolymphocytes and paraimmunoblasts

Proliferation centers!; spherical pale staining poorly defined pseduofollicles. No mantle zone!

CD20+, CD5+, CD23+, BCL2, LEF1 +, CD200+

CD10-, SOX11-, BCL1-

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17
Q

Basket and smudge cells in peripheral blood, assume?

CLL definition?

Favorable mutation/adverse mutations?

A

CLL

>5000 cells/uL; <5000 is monoclonal B cell lymphocytosis

<10% prolymphocytes (more common nuclei)

Favorable: CD38-, Zap70- (Post germinal center hypermutated IgVH)

Unfavorable: CD38+, Zap70+ (Pre germinal center; non mutated IgVH Needs chemo)

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18
Q

CLL genetics: Good vs Bad

Normal karyotype?

Del (13q)

Tri12
Del (11q)

Del (17p)

A

Normal karyotype: Normal

Del (13q): Good

Tri12: Atyp histology/ poor prognosis
Del (11q); poor

Del (17p); poor

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19
Q

Monoclonal B-cell lymphocytosis?

Low vs high count?

A

<5x10e9 monoclonal B cells with CLL or non CLL (CD5-) cells

Progresses to CLL

Low count MBL: <0.5e9; little change of CLL–no follow up

High count 0.5e9–5.0e9: Yearly follow up!

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20
Q

Follicular lymphoma H and E?

Stains?

Translocation?

What are BCL-2 -?

Peripheral blood

A

Nodular infiltrate in a lymph node with back to back/fused “follicles”

CD10+, BCL-2+ (if lost=higher grade or skin), BCL 6+, LMO2+, HGAL+, CD21+ meshwork

T(14;18)(q32;q21): not enough for dx

Cleaved buttock cells

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21
Q

Pediatric follicular lymphoma?
H and E?

Ki-67?

BCL2?

A

Large expansile highly proliferative follicles

near 100% Ki-67

BCL-2 protein present but gene rearrangments negative

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22
Q

Mantle cell?

H and E?

Important translocation?

Stains?

A

Agressive incurable naive B-cell; High mites are bad

Small B cells with hyalinized blood vessels and “naked germinal centers”; Blastoid (immature chromatin) and pleomorphic bad

t(11;14)(q13;32); CYCLIN D1 +; IgH-CCND1 (FISH Probe)

CD20+, CD5+, CD23-, BCL-1 (CyclinD1, PRAD1) +, SOX11 +, FMC-7 (+)

BCL and SOX tend to be opposite

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23
Q

Marginal Zone lymphoma H and E?

Can you see reactive germinal centers?

A

Monocytoid cells, plasmacytoid cells, Dutcher bodies (intranuclear), expanded confluent marginal zones, Lymphoepithelial lesions; can have plasmacytoid or Monocytoid changes

Also see Mantle zones extending into germinal center; CD21 broken up

Yes; but can see expanded pink marginal zone (out side of dark mantle zone)

24
Q

Classic Marginal Zone (MALT) transolcation?

Why do we care?

MALT associated with?

A

t(11;18) 25-50%;

Not in primary nodal zone or in MALT with DLBC

t(11;18)+ resistant to antibiotics (care about this stomach)

SjS, Hashimotos, Hep C, H. Pylori, B. Burgdorferi (skin), C. Jejuni (small bowel), Chlamydia (ocular/lacrimal)

25
Q

What is Waldenstrom macroblobulinemia/lymphoplasmacytic lymphoma?

Associated with?

Gene?

A

Lymphoplasmacytic lymphoma with bone marrow involvement and IgM monoclonal gammopathy (level not important)

Dutcher body and lymphocytes and plasma cells

MYD88 L265P; can be in other things like IgM Mgus, DLBCL (ABC subtybe and leg; GOOD ENOUGH WITH BM LPL

26
Q

Burkitt’s?

Endemic associated with?

Gene?

Stains?

Cytology?

A

“Stary sky” with effaced architecture with “white dots”; cobble stoning of lymphocytes

Endemic: Kids, jaw lesion, Malaria, EBV+

c-Myc, EBV+ (30% in sporatic; 90% ENDEMIC)

Ki-67: 100%

Blue cytoplasm with vacuoles

27
Q

Immunos for Burkitt?

Molcular (3 of them)?

What looks like Burkitt but lacks Myc, think)

A

CD20+, CD10+, BCL-6+, MYC+, Ki67 (PCNA) 100%, BCL 2- (20% neg)

t(8;14) IgH-MYC

t(2;8) MYC/ Kappa

t(8;22) MYC/lambda

Burkitt-like lymphoma, 11q aberration

28
Q

Two types of DLBCL?

Staining pattern/ Hans model?

A

Germinal center like (better prognosis): CD10+ (30%) or BCL6+ CD10-/MUM1-

Activated B-cell; all others (eg CD10-, BCL6-, MUM1+ or CD10-, BCL6+, MUM1+)

29
Q

3 Genes in DLBCL?

A

BCL2; bad px

BCL6 (most common) 3q; good px

MYC; poor px

30
Q

High grade B cell lymphoma with rearrangments of MYC and BCL2/and or BCL6?

If no MYC gene rearrangement but MYC and BCL2 expression by IHC?

A

Multiple molecular mutations; must have MYC

POOR PROGNOSIS

Called Double Expressor lymphoma; poor prognosis but better than above

31
Q

Primary DLBCL of CNS IHCs?
Genes?

Relapses in what body sites?

EBV+ DLBCL type IHCs?

Prognosis?

A

ABC (MUM1+, CD10-, BCL6-)

BCL6 translocation; not t(14;18)

Goes to testes and breast

EBV+: (MUM1+, CD10-, BCL6-)

No hx of immune deficiency or hx of lymphoma

Worse prognosis vs EBV-

32
Q

What is T-cell histiocyte rich large B cell lymphoma?

A

Scattered atypical B cells in BACKGROUND of T-cells

Large cells can mimic RS cells

CD20+, BCL6+, LCA+, CD30-, CD15-, NO FDC’s on CD21 (CD21+ in NLPHL)

33
Q

Primary cutaneous DLBCL, leg type?

H and E?

IHC?

A

Skin biopsies; can be found in legs and other sites; POOR PROGNOSIS

Immunoblastic cells with round cell morphology and nucleoli; can mimic follicular

CD10-, BCL2+ (unlike follicular lymphoma); MUM1+, FoxP1+, BCL6+, CD21-

34
Q
A
35
Q

Mediastinal (thymic) Large B-cell lymphoma?

H and E?

Stains/molecular?

A

Mediastinum; superior vena cava syndrome; W 20-40 yrs

H and E: Large B cells with fibrosis!; clear cytoplasm

B cell markers +, BCL2+, BCL6+, CD30+ (weak and clustered), CD15 rare +, MAL+

36
Q

Lymphomatoid granulomatosis?

H and E, virus?

Grading?

A

High grade B-cell; extranodal (skin/lung/brain)

EBV +; angiocentric and angiodestructive (BLOOD VESSELS WITH DESTRUCTION)

Grade: Based on EBV positive

37
Q

4 types of Hodgkins?

A

Nodular lymphocyte predominant

Classical: Nodular sclerosis, Mixed cellularity, Lymphocyte rich, lymphocyte depleted

38
Q

Nodular lymphocyte predominant Hodgkin, association?
H and E?

IHC?

Are eos and neuts present?

A

H and E: Node with nodular process with popcorn/LP (Polylobated nucleus with vesicular chorm) cells on high power; PTGC association

CD45+ (unlike classic), CD20+, Jchain +, EMA+, CD40+, IgD+, MUM1+, CD15 +/-, CD15+/-, CD21 shows expanded meshwork (vs no meshwork in T cell rich large B cell)

No PMN or eosinophils!!

39
Q

Classic Hodgkin staining?

Common thing to see in back ground?

Age?

A

RS cells (Binucleate with prominent nucleoli and lacunar); CD30+, CD15+, Fascin +, EBER +, PAX5+, MUM1+, CD20 sometimes+, CD45-, EMA- (vs NLPHL)

Background CD3+ cells

Bimodal: 5-35 yrs and 2nd late in life

40
Q

Classic HL subtype histologies?
Nodular Sclerosis?

Mixed?
Lymphocyte rich?
Lymphocyte depleted?

A

NS: Mediastinal, thick capsule/bands of fibrosis

Mixed: Periperhal; EBV associated, no fibrosis

Lymphocyte rich: Regressed germinal centers, RS cells in MANTLE ZONE, No eos, Background Small B-cells

LD: Retroperitoneum, higher stage

41
Q
A
42
Q

Peripheral T-cell NOS occurs where?
H and E?

Lennert Variant?

A

Lymph node; mature T-cells

Small to large T-cells, clear cytoplasm, Eosinophils, histiocytes, high endothelial venules

Lennert Variant: Histeocytes and epithelial lymphocyte

43
Q

Angioimmunoblastic T-cell; T-cells in this disease located where00?

H and E?

Clinical?

ICH?

A

Lymph nodes, CD4+ follicular helper T-cells (WITHIN FOLICLE)

H and E: Arborizing high endothelkial venules (branching GC’s) surrounded by maligant T-cells; polymorphous background

Clinical: Skin rash, **cyroglobulins (+ Coombs), hypergammaglobulinemia, RF antibodies, ASMA antibodies

IHC: CD3+, CD4+, CD10+, BCL6+, CXCL-13, PD-1, EBV (in B-cells), FDC around HEV (CD21,23)+**

44
Q

Analplastic large cell?

Gene?

H and E and classic cell?

IHC?

Transolocation if cytoplasmic and nulear ALK+?

A

Lymph node (chemo) or skin (excision) , CD30+ or T-cell or Null Cell (no T markers)

2p23 (ALK)

H and E: Effaced LN with “Hallmark” wreath/horse shoe like nuclei; lymphatic and sinusoidal pattern

IHC: CD3+, CD4+, CD8+, (ALK + in nodes, - in skin; EMA + skin, - in nodes

t(2;5)(p23;q35) ALK-NMP

45
Q

ALK (-) Anaplastic large cell?

Association?

Genes?

A

H and E similar to ALK large cell

Need ALK to be (-)

SILICONE BREAST IMPLANTS

DUSP22 and IRF4 and TP63

46
Q

Adult T-cell leukemia/lymphoma classic cell?

Virus associated?

IHC?

A

Flower cell in peripheral blood (Nucleus is polylobated)

HTLV1; regulatory T cells

CD25+, FOXP3+, CCR+, CD4+, CD8- (mostly), CD30+/-

47
Q

ATLL Clinical findings, world location?

A

Hypercalcemia, skin lesions, increased osteoclasts in bone marrow, LN invoves paracortial T- cell, Sub Saharan Africa, Japan, Caribean

48
Q

Large granular lymphocytic leukemia criteria?

Lab results

IHC?

Gene

A

Large cells with granules

LGL >2e9 cells in blood, >6 months

CYTOPENIA! Rheumatoid arthritis associated

CD3+, CD8+, CD56-, Cytotoxic Markers +

STAT3

49
Q

Enteropathy T-cell lymphoma:
Type 1 and Monomorphic epitheliotropic intestinal TCR assoc?

A

Type 1: Celiac associated, dermatitis herpetiformis (IgA), northern Europeans; CD3+, CD7+, CD103+, CD56-, TCR +/-, CD4-, CD8 +/-, CD5-

MEITCR: Not associated with celiac, monomorphic cells, Asians and hispanics, CD8+, CD56+, MATK+, CD4-

50
Q

Hepatosplenic and patient population?

Genes?

IHC?

A

Bone marrow, liver spleen, young men, NO MASS

Scattered cells in sinuses of liver or red pulp or bone marrow

Isoq7 (not specific)
IHC: CD56+, TCRgamm1+, CD4-, CD8- (not specific phenotype), CD3+

51
Q

Extranodal NK/T-cell Nasal type, population?

H and E?

IHC?

A

Common in nasal cavities; Young asian patients

Angiocentric and destructive

H and E: Angiocentric/angiodestructive growth, pleomorphic lymphocytes, necrosis, ulcerated epithelium

IHC: CD3+, CD56+, TIA-1+, GZM-b+, CD8+, EBER+

52
Q

Subcutaneous Panniculitis like T-cell?

Sign that disease no longer indolent?

H and E?

IHC?

A

Alpha beta T cells in subq tissue and fat; Gamma Delta reclassified

Normally indolent but hemophagocytic syndrome has 2 yr survival

H and E: In subq but spares septate and mostly in lobules; atypical T cells around fat lobules

CD3+, BF-1+, CD8+, CD4-

53
Q

How to DDx Cutanteous Gamma Delta from Sub Q paniculitis T-cell?

A

GD: Older with ulceraton and dermis/epidermis and B symptoms, Epidermis involved

CD8-, Cd56+, BF1-; POOR PROGNOSIS chemo and stem cell

SPLTCL: 30 yr olds without ulceration, less B symptoms, subq only

CD8+, Cd56-, BF1+; Good prognosis, tx Steroids and CHOP

54
Q

Mycosis fungoides location?
3 sequence?

Cells in blood called?

A

Skin with epidermatrophism

Patches (clear cell at DEJ)

Plaques (bigger and Pautrier microabscesses in epidermis)

Tumors; Gross masses with lost epidermotrophis (tumors in dermis)

Blood: Sezery syndrome; Cerebreform

55
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A
56
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Hematopathology (8 decks)

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