Lymph Node I and II Flashcards
Normal node location for IHC for BCL-6 and CD10?
CD21?
BCL-6?
IgD?
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!
Rheumatoid lymphadenopathy shows?
Syphilitic lymphadenopathy shows?
Polytypic (polyclonal) plasma cells and neutrophils in sinuses
Syphilitic: Thick capsule with plasma cells
Follicular lymphoma vs hyperplasia?
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
Lymph nodes with lots of small germinal centers or multiple in GCs in a follicle?
IHC’s?
Virus associated with Multicentric; other assocations?
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
Dysplastic cell in hyaline/unicentric Castleman’s?
Tx hyaine type?
Tx multicentric?
Increased dysplastic follicular dendritic cells
Surgery
Steroids
3 patterns of HIV related lymphadenopathy (progressive)?
HIV IHC stain in LN?
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
Epithelioid histeocytes and monocytoid B-cell hyperplasia in sinuses (look like monocytes) and enlarged nodes?
Host organism?
Toxoplasmosis gondii!
Cat
Expansion of paracortical area can be from?
Immunoblasts in paracortex stain for?
T-cell response; Drugs (phenytoin and dilantin), vaccines, EBV
CD30+, large with vesicular chromatin and central nucleoli
Features of EBV H and E sinuses, paracortex?
IHC stains?
Peripheral blood cell that hints at EBV?
What are these cells?
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!
Dermatopathic lymphadenopathy?
Cell types?
IHCs?
DDx?
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
Other name for Histiocytic necrotizing lymphadenitis and population
H and E and histiocyte shape?
Stains?
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
Cat scratch disease organism?
H and E?
Can also cause
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)
Rosai Dorfmann population?
H and E?
Stains?
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 +
Hemophagocytic lymphohistiocytosis?
H and E?
Genes?
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
CLL?
H and E?
Stains?
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-
Basket and smudge cells in peripheral blood, assume?
CLL definition?
Favorable mutation/adverse mutations?
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)
CLL genetics: Good vs Bad
Normal karyotype?
Del (13q)
Tri12
Del (11q)
Del (17p)
Normal karyotype: Normal
Del (13q): Good
Tri12: Atyp histology/ poor prognosis
Del (11q); poor
Del (17p); poor
Monoclonal B-cell lymphocytosis?
Low vs high count?
<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!
Follicular lymphoma H and E?
Stains?
Translocation?
What are BCL-2 -?
Peripheral blood
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
Pediatric follicular lymphoma?
H and E?
Ki-67?
BCL2?
Large expansile highly proliferative follicles
near 100% Ki-67
BCL-2 protein present but gene rearrangments negative
Mantle cell?
H and E?
Important translocation?
Stains?
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
Marginal Zone lymphoma H and E?
Can you see reactive germinal centers?
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)
Classic Marginal Zone (MALT) transolcation?
Why do we care?
MALT associated with?
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)
What is Waldenstrom macroblobulinemia/lymphoplasmacytic lymphoma?
Associated with?
Gene?
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
Burkitt’s?
Endemic associated with?
Gene?
Stains?
Cytology?
“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
Immunos for Burkitt?
Molcular (3 of them)?
What looks like Burkitt but lacks Myc, think)
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
Two types of DLBCL?
Staining pattern/ Hans model?
Germinal center like (better prognosis): CD10+ (30%) or BCL6+ CD10-/MUM1-
Activated B-cell; all others (eg CD10-, BCL6-, MUM1+ or CD10-, BCL6+, MUM1+)
3 Genes in DLBCL?
BCL2; bad px
BCL6 (most common) 3q; good px
MYC; poor px
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?
Multiple molecular mutations; must have MYC
POOR PROGNOSIS
Called Double Expressor lymphoma; poor prognosis but better than above
Primary DLBCL of CNS IHCs?
Genes?
Relapses in what body sites?
EBV+ DLBCL type IHCs?
Prognosis?
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-
What is T-cell histiocyte rich large B cell lymphoma?
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)
Primary cutaneous DLBCL, leg type?
H and E?
IHC?
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-
Mediastinal (thymic) Large B-cell lymphoma?
H and E?
Stains/molecular?
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+
Lymphomatoid granulomatosis?
H and E, virus?
Grading?
High grade B-cell; extranodal (skin/lung/brain)
EBV +; angiocentric and angiodestructive (BLOOD VESSELS WITH DESTRUCTION)
Grade: Based on EBV positive
4 types of Hodgkins?
Nodular lymphocyte predominant
Classical: Nodular sclerosis, Mixed cellularity, Lymphocyte rich, lymphocyte depleted
Nodular lymphocyte predominant Hodgkin, association?
H and E?
IHC?
Are eos and neuts present?
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!!
Classic Hodgkin staining?
Common thing to see in back ground?
Age?
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
Classic HL subtype histologies?
Nodular Sclerosis?
Mixed?
Lymphocyte rich?
Lymphocyte depleted?
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
Peripheral T-cell NOS occurs where?
H and E?
Lennert Variant?
Lymph node; mature T-cells
Small to large T-cells, clear cytoplasm, Eosinophils, histiocytes, high endothelial venules
Lennert Variant: Histeocytes and epithelial lymphocyte
Angioimmunoblastic T-cell; T-cells in this disease located where00?
H and E?
Clinical?
ICH?
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)+**
Analplastic large cell?
Gene?
H and E and classic cell?
IHC?
Transolocation if cytoplasmic and nulear ALK+?
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
ALK (-) Anaplastic large cell?
Association?
Genes?
H and E similar to ALK large cell
Need ALK to be (-)
SILICONE BREAST IMPLANTS
DUSP22 and IRF4 and TP63
Adult T-cell leukemia/lymphoma classic cell?
Virus associated?
IHC?
Flower cell in peripheral blood (Nucleus is polylobated)
HTLV1; regulatory T cells
CD25+, FOXP3+, CCR+, CD4+, CD8- (mostly), CD30+/-
ATLL Clinical findings, world location?
Hypercalcemia, skin lesions, increased osteoclasts in bone marrow, LN invoves paracortial T- cell, Sub Saharan Africa, Japan, Caribean
Large granular lymphocytic leukemia criteria?
Lab results
IHC?
Gene
Large cells with granules
LGL >2e9 cells in blood, >6 months
CYTOPENIA! Rheumatoid arthritis associated
CD3+, CD8+, CD56-, Cytotoxic Markers +
STAT3
Enteropathy T-cell lymphoma:
Type 1 and Monomorphic epitheliotropic intestinal TCR assoc?
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-
Hepatosplenic and patient population?
Genes?
IHC?
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+
Extranodal NK/T-cell Nasal type, population?
H and E?
IHC?
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+
Subcutaneous Panniculitis like T-cell?
Sign that disease no longer indolent?
H and E?
IHC?
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-
How to DDx Cutanteous Gamma Delta from Sub Q paniculitis T-cell?
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
Mycosis fungoides location?
3 sequence?
Cells in blood called?
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
