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AP reviewer > Lymph Nodes > Flashcards

Lymph Nodes Flashcards

1
Q

Reactive follicular hyperplasia in rheumatoid arthritis: Histology.

A

Following treatment with gold salts: Scattered non-birefringent crystals with foreign-body reaction.

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2
Q

Reactive follicular hyperplasia in Sjögren’s syndrome: Histology.

A

There may be aggregates of monocytoid B cells.

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3
Q

Reactive follicular hyperplasia in autoimmune disease: Proliferation.

A

Ki-67 stains more than 90% of cells in reactive germinal centers and about 5% in interfollicular areas.

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4
Q

Reactive follicular hyperplasia in autoimmune disease: PCR.

A

May show clonality of B cells, but this finding alone is not diagnostic of malignancy.

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5
Q

Syphilitic lymphadenopathy: Site.

A

Inguinal lymph nodes.

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6
Q

Syphilitic lymphadenopathy: Histology (3).

A

Thickening of capsule.

Marked plasmacytic infiltration.

Vasculitis.

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7
Q

Syphilitic lymphadenopathy: Locations of spirochetes (3).

A

Endothelial cells.

Blood vessels.

Germinal centers.

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8
Q

Early EBV lymphadenitis: Histology.

A

Expanded paracortex with many immunoblasts.

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9
Q

Follicular lymphoma: Histology of capsule.

A

Thickened and may appear split due to follicular proliferation.

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10
Q

Mantle-cell lymphoma: Association autoimmune diseases (2).

A

Sjögren’s syndrome.

Hashimoto’s thyroiditis.

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11
Q

Main cellular components of the ___.

A. Cortex.
B. Paracortex.
C. Medulla.
D. Sinuses.

A

A. B cells.

B. T cells.

C. Plasma cells.

D. Histiocytes.

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12
Q

Cytomegalovirus lymphadenitis: Early histology (2).

A

Reactive follicular hyperplasia.

Hyperplasia of monocytoid B cells.

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13
Q

Immunohistochemistry: All B lymphocytes (3).

A

Positive: CD20, CD79a, PAX5.

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14
Q

Immunohistochemistry of B cells ___.

A. Within the germinal centers (2,1).
B. Outside the germinal centers (1,2).

A

A. Positive: CD10, Bcl-6; negative: Bcl-2.

B. The inverse pattern.

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15
Q

Immunohistochemistry:

A. Follicular dendritic cells.
B. Antigen-presenting interdigitating dendritic cells.

A

A. Positive: CD21, CD23.

B. Positive: S100.

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16
Q

Cytomegalovirus lymphadenitis: Later histology (2).

A

Paracortical hyperplasia with immunoblasts.

Hypervascularity.

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17
Q

Cytomegalovirus lymphadenitis: Histology in the immunocompromised.

A

There may be necrosis.

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18
Q

Cytomegalovirus lymphadenitis: Best place to look for viral cytopathic effect.

A

In the collections of monocytoid B cells.

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19
Q

Cytomegalovirus lymphadenitis: Immunophenotype.

A

Infected cells may express CD15 (and possibly cause confusion with Hodgkin’s lymphoma).

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20
Q

Toxoplasma lymphadenitis: Histology (3).

A

Follicular hyperplasia.

Hyperplasia of monocytoid B cells.

Aggregates of epithelioid histiocytes in lymphoid follicles.

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21
Q

Toxoplasma lymphadenitis: Presentation.

A

Bilateral cervical lymphadenopathy, non-tender.

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22
Q

Toxoplasma lymphadenitis: Demonstration of organism (2).

A

Immunohistochemistry: Usually not helpful.

Serology: Better.

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23
Q

Toxoplasma lymphadenitis vs. leishmania lymphadenitis (2).

A

Leishmania lymphadenitis:

  • Granulomas with or without necrosis.
  • Amastigotes may be seen.
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24
Q

Toxoplasma: Reactivation of infection in AIDS patients.

A

Usually as encephalitis instead of lymphadenitis.

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25
Q

HIV-related lymphadenopathy: Presentation (2).

A

Mainly involves axillary, cervical, and occipital nodes.

Lymph nodes decrease somewhat in size after acute presentation.

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26
Q

HIV-related lymphadenopathy: Criteria of persistent generalized lymphadenopathy (3).

A

More than 3 months.

At least 2 noncontiguous nodal sites.

No other explanation.

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27
Q

HIV-related lymphadenopathy: Early histology of follicles (4).

A

Large, irregular germinal centers.

Many mitotic figures and tingible-body macrophages in the germinal centers.

Follicle lysis.

Attenuated mantle zones.

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28
Q

HIV-related lymphadenopathy: Other early histology (2).

A

Paracortex: Granulocytes, conspicuous vessels.

Sinuses: Histiocytosis, erythrophagocytosis.

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29
Q

HIV-related lymphadenopathy: Later histology (3).

A

Small, atrophic, hyalinized follicles.

Paracortex: More histiocytes and plasma cells; fewer lymphocytes.

More blood vessels.

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30
Q

HIV-related lymphadenopathy: Immunohistochemistry (3).

A

Reactive germinal centers: Many CD8-positive lymphocytes.

Interfollicular area: Fewer CD-positive lymphocytes; many S100-positive IDCs.

Advanced disease: Absence of CD21- and CD23-positive FDCs.

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31
Q

Kimura’s disease: Classic patient.

A

East Asian male with painless subcutaneous masses and lymphadenopathy of head and neck.

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32
Q

Kimura’s disease: Internal site.

A

Salivary gland (in 40% of patients).

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33
Q

Kimura’s disease: Laboratory findings (2).

A

Eosinophilia.

Elevated serum IgE.

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34
Q

Kimura’s disease: Histology (4).

A

Reactive follicular hyperplasia.

Many eosinophils.

Hypervascularity.

Eosinophilic proteinaceous deposits (IgE) in the germinal centers.

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35
Q

Kimura’s disease vs. drug-related lymphadenopathy (2).

A

Drug-related lymphadenopathy:

  • Paracortical proliferation of immunoblasts.
  • There may or may not be follicular hyperplasia.
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36
Q

Kimura’s disease vs. angiofollicular hyperplasia with eosinophilia (2).

A

Angiofollicular hyperplasia with eosinophilia:

  • Typically affects middle-aged white women.
  • Eosinophilic microabscesses are unusual.
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37
Q

Causes of increase in IgG4-positive lymphocytes (4).

A

IgG4-related disease.

Carcinoma.

Lymphoma.

Others.

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38
Q

IgG4-related lymphadenopathy: Classic presentation.

A

Autoimmune pancreatitis.

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39
Q

IgG4-related lymphadenopathy: Other frequently involved organs (5).

A

Kidney.

Lung.

Liver.

Gallbladder.

Ocular adnexa.

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40
Q

IgG4-related lymphadenopathy: Types.

A

I: Multicentric Castleman’s disease-like.

II: Follicular hyperplasia.

III: Paracortical expansion.

IV: Progressive transformation of germinal centers.

V: Inflammatory pseudotumor-like.

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41
Q

IgG4-related lymphadenopathy: Histology of type I (3).

A

Hyperplastic and atrophic follicles.

Interfollicular vascular proliferation.

Eosinophilia.

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42
Q

IgG4-related lymphadenopathy: Histology of type II (2).

A

Interfollicular and paracortical plasmacytosis.

Eosinophilia.

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43
Q

IgG4-related lymphadenopathy: Histology of type III (2).

A

Prominent high-endothelial venules.

Expansion of paracortex by various lymphocytes and eosinophils.

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44
Q

IgG4-related lymphadenopathy: Histology of type IV (2).

A

Enlarged follicles with expanded mantle zones.

Scattered interfollicular plasma cells.

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45
Q

IgG4-related lymphadenopathy: Clonality.

A

Stains for kappa and lambda light chains demonstrate polytypic plasma cells.

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46
Q

IgG4-related lymphadenopathy: Quantification (2).

A

Ratio of IgG4 to IgG is more than 40%.

Thee must be more than 100 IgG4-positive plasma cells in at least 3 hpf.

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47
Q

IgG4-related lymphadenopathy: Laboratory findings (3).

A

High serum IgG4.

Normal IL-6.

Normal CRP.

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48
Q

IgG4-related lymphadenopathy vs. inflammatory pseudotumor.

A

Inflammatory pseudotumor: No increase in IgG4-positive plasma cells.

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49
Q

IgG4-related lymphadenopathy: Putative causes.

A

Chronic infection.

Autoimmune disease.

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50
Q

IgG4-related lymphadenopathy: Treatment.

A

Patients respond well to steroids.

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51
Q

IgG4-related lymphadenopathy: Main histologic feature in non-lymphoid organs.

A

Sclerosis.

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52
Q

IgG4-related lymphadenopathy: Histology of type V.

A

Lymph node is focally replaced by fibrous tissue containing plasma cells and lymphocytes.

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53
Q

Progressive transformation of germinal centers: Typical patient.

A

Child or young adult with a single enlarged lymph node.

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54
Q

Progressive transformation of germinal centers: Histology

A

Massively expanded mantle zone with loss or fragmentation of the germinal center.

Typically follicular hyperplasia in the background.

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55
Q

Progressive transformation of germinal centers: Immunohistochemistry.

A

Mantle zones are reactive for Bcl-2 and IgD.

Germinal centers contain increased CD57+ cells.

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56
Q

Progressive transformation of germinal centers: Flow cytometry.

A

CD4+/CD8+ T lymphocytes may be detected.

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57
Q

Progressive transformation of germinal centers: Relation to NLP-HD.

A

PTGC may rarely precede, follow, or coexist with NLP-HD.

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58
Q

Infectious mononucleosis: Pattern of reactive hyperplasia.

A

Paracortical.

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59
Q

Infectious mononucleosis: Histology.

A

Expansion of paracortex by small, medium-sized, and large immunoblasts.

Increased mitotic activity.

Necrosis sometimes.

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60
Q

Infectious mononucleosis: Immunohistochemistry (2,1,2).

A

Positive: CD20, Mum-1.

Variable: CD30.

Negative: CD10, CD15.

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61
Q

Infectious mononucleosis: Molecular study.

A

In-situ hybridization for EBV (EBER).

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62
Q

Infectious mononucleosis vs. CMV lymphadenitis (2).

A

CMV lymphadenitis:

  • IHC demonstrates presence of CMV.
  • EBER negative.
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63
Q

Herpes simplex lymphadenitis: Presentation (2).

A

Localized or generalized.

Usually painful.

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64
Q

Herpes simplex lymphadenitis: Histology (3).

A

Paracortical hyperplasia with many immunoblasts.

Multifocal necrosis with neutrophils.

Typical viral cytopathic effect.

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65
Q

Herpes simplex lymphadenitis vs. other necrotizing lymphadenitides.

A

HSV lymphadenitis: No granulomas associated with the necrosis.

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66
Q

Dermatopathic lymphadenitis: Histology (2).

A

Paracortical expansion, diffuse or nodular.

Many interdigitating dendritic cells, Langerhans’ cells, and histiocytes that contain melanin.

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67
Q

Dermatopathic lymphadenitis vs. mycosis fungoides (2).

A

Mycosis fungoides:

  • Atypical lymphocytes present singly, in clusters, or in large aggregates.
  • PCR may be needed to exclude rearrangement of the T-cell receptor.
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68
Q

Dermatopathic lymphadenitis vs. Langerhans’ cell histiocytosis.

A

LCH: Langerhans’ cells fill the sinuses and are accompanied by eosinophils, neutrophils, plasma cells, and histiocytes.

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69
Q

Drug-related lymphadenopathy:

A. Timing.
B. Involved nodes.

A

A. Within 2 to 8 weeks after exposure to the drug.

B. Cervical lymph nodes or all nodes.

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70
Q

Drug-related lymphadenopathy: Causes (2).

A

Antiepileptics.

Allopurinol.

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71
Q

Drug-related lymphadenopathy: Histology.

A

Paracortical expansion with immunoblasts and eosinophilia.

Immunoblasts may form large aggregates.

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72
Q

Drug-related lymphadenopathy: Most powerful tool for diagnosis.

A

Clinical history of exposure to implicated drug.

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73
Q

Rosai-Dorfman disease: Typical patient.

A

Child or young adult with bilateral cervical lymphadenopathy.

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74
Q

Rosai-Dorfman disease: Other possible signs and symptoms

A

Fever.

Weight loss.

Leukocytosis.

Anemia.

Elevated ESR.

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75
Q

Rosai-Dorfman disease: Histology (2).

A

Histiocytes markedly expand the sinuses.

Small lymphocytes and abundant plasma cells accompany the histiocytes.

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76
Q

Rosai-Dorfman disease: Cytology

A

Histiocytes . . .

  • Nucleus: Round, with single nucleolus.
  • Cytoplasm: Abundant, eosinophilic.
  • Emperipolesis, especially of lymphocytes.
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77
Q

Rosai-Dorfman disease: Immunohistochemistry (4,2).

A

Positive: S100, CD14, CD68, CD163.

Negative: CD1a, langerin.

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78
Q

Lymph nodes draining prosthetic implants: Histology.

A

Sinus histiocytes containing coarse refractive matter.

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79
Q

Whipple’s disease: Initial presentation.

A

Migratory arthralgia.

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80
Q

Whipple’s disease: Histology.

A

Histiocytes distend the sinuses.

Lipogranulomas.

Non-necrotizing granulomas sometimes.

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81
Q

Whipple’s disease: Special stains (2).

A

Positive (histiocytes): PAS.

Negative: AFB.

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82
Q

Whipple’s disease: Best site of biopsy.

A

Small intestine.

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83
Q

Whipple’s disease: Ancillary studies (2).

A

Electron microscopy.

PCR of tissue, stool, or saliva.

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84
Q

Lymphadenopathy due to deposition of endogenous lipid material: Sites.

A

Nodes of porta hepatis.

Celiac lymph nodes.

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85
Q

Lymphadenopathy due to deposition of endogenous lipid material: Causes (5).

A

Mineral oil.

TPN.

Cholesterol.

Fat embolism.

Fat necrosis.

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86
Q

Lymphadenopathy due to deposition of endogenous lipid material: Histology (3).

A

Vacuolated sinus histiocytes.

Extracellular spaces.

Giant cells.

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87
Q

Lymphadenopathy due to deposition of endogenous lipid material: Special stain.

A

Negative: PAS.

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88
Q

Kikuchi’s disease: Synonym.

A

Histiocytic necrotizing lymphadenitis.

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89
Q

Kikuchi’s disease: Typical patient.

A

Young Asian woman.

However, the disease can affect either sex and any age or ethnic group.

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90
Q

Kikuchi’s disease: Typical presentation.

A

Cervical lymphadenopathy and fever.

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91
Q

Kikuchi’s disease: Histologic phases.

A

Proliferative.

Necrotizing.

Resolution.

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92
Q

Kikuchi’s disease: Histology of the proliferative phase (3).

A

Patchy nodal disease.

Paracortical expansion with immunoblasts, small lymphocytes, plasmacytoid dendritic cells, histiocytes.

Single-cell necrosis and granular débris.

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93
Q

Kikuchi’s disease: Histology of the necrotizing phase (4).

A

Extensive necrosis with karyorrhexis.

Immunoblasts and histiocytes surround necrosis.

Histiocytes with crescentic nuclei.

No neutrophils.

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94
Q

Kikuchi’s disease: Histology of the resolution phase.

A

Many foamy macrophages.

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95
Q

Kikuchi’s disease: Immunohistochemistry.

A

Plasmacytoid dendritic cells are reactive for CD123.

Very few B cells outside the germinal centers.

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96
Q

Kikuchi’s disease: Relationship to systemic lupus erythematosus (2).

A

Similar histologic features.

Some patients with Kikuchi’s disease develop lupus.

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97
Q

Kikuchi’s disease: Prognosis.

A

Usually self-limiting.

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98
Q

Lymphadenitis of Kawasaki’s disease: Histology (3).

A

Widespread necrosis with many neutrophils.

Fibrin thrombi in small vessels.

Arteritis with fibrinoid necrosis.

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99
Q

Lymphadenitis of systemic lupus erythematosus: Presentation (2).

A

Lymph nodes are soft and nontender.

Occurs at the onset of the disease or during an exacerbation.

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100
Q

Lymphadenitis of systemic lupus erythematosus: Histology (5).

A

Edema, hemorrhage, and necrosis surrounded by histiocytes and immunoblasts.

May show many plasma cells.

May show hematoxylin bodies.

May show the Azzopardi phenomenon.

May show marked follicular hyperplasia.

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101
Q

Tuberculous lymphadenitis: Most common site.

A

Cervical lymph nodes.

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102
Q

Tuberculous lymphadenitis: Causes of abdominal disease (2).

A

Ingestion of sputum or milk infected by M. tuberculosis or M. bovis.

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103
Q

Tuberculous lymphadenitis: Type of granuloma.

A

Usually caseating but can be non-necrotizing.

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104
Q

Atypical mycobacterial lymphadenitis: Causes (5).

A

Mycobacterium avium complex.

M. kansasii.

M. scrofulaceum.

M. malmöense.

M. haemophilum.

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105
Q

Atypical mycobacterial lymphadenitis: Typical immunocompetent patient.

A

Child of 1 to 5 years.

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106
Q

Atypical mycobacterial lymphadenitis: Typical site.

A

Submandibular nodes.

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107
Q

Atypical mycobacterial lymphadenitis: Histology in the immunocompetent

A

Necrotizing and non-necrotizing granulomas with Langhans’ -type giant cells.

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108
Q

Atypical mycobacterial lymphadenitis: Histology in the immunocompromised (2).

A

Poorly organized aggregates of histiocytes.

Rare: Mycobacterial pseudotumor consisting of foamy and spindled histiocytes.

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109
Q

Atypical mycobacterial lymphadenitis: Treatment in the immunocompetent.

A

Excision.

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110
Q

Leprosy: Countries of highest incidence.

A

Brazil.

Bangladesh.

India.

Indonesia.

Nigeria.

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111
Q

Lepromatous leprosy: Histology.

A

The paracortical area contains many foamy macrophages that are full of organisms.

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112
Q

Inflammatory pseudotumor of the lymph node: Infectious causes (3).

A

Atypical mycobacteria, Treponema pallidum, or EBV is detected in some cases.

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113
Q

Cat-scratch disease: Acquisition (3).

A

Flea bite.

Cat bite.

Cat scratch.

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114
Q

Cat-scratch disease: Presentation.

A

Tender nodes with overlying erythema.

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115
Q

Cat-scratch disease: Atypical presentation (3).

A

“B” symptoms.

Hepatosplenomegaly.

Abdominal lymphadenopathy.

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116
Q

Cat-scratch disease: Histology of the early stage (4).

A

Follicular hyperplasia.

Hyperplasia of monocytoid B cells.

Small foci of necrosis among monocytoid B cells.

Microabscesses in the germinal centers.

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117
Q

Cat-scratch disease: Histology of the late stage (2).

A

Large, stellate microabscesses.

Necrotizing granulomas with palisading histiocytes.

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118
Q

Bartonella henselae:

A. Typical locations in the lymph node (3).
B. Best stains (2).

A

A. Macrophages, endothelial cells, areas of necrosis.

B. Warthin-Starry, Steiner’s.

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119
Q

Cat-scratch disease: Other methods of diagnosis (3).

A

Serology.

Culture.

PCR.

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120
Q

Cat-scratch disease: Prognosis in the immunocompetent.

A

Resolution in 2 to 6 months.

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121
Q

Cat-scratch disease: Prognosis in the immunocompromised (3).

A

Can lead to

  • Widespread granulomatous inflammation.
  • Bacillary angiomatosis.
  • Bacillary peliosis.
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122
Q

Cat-scratch disease: Other bacteria that may cause histologically similar lymphadenitis (4).

A

Chlamydia trachomatis.

Francisella tularensis.

Haemophilus ducreyi.

Yersinia enterocolitica.

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123
Q

Sarcoidal lymphadenitis: Frequency.

A

Occurs in 40% of patients with sarcoidosis.

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124
Q

Sarcoidal lymphadenitis: Necrosis.

A

Not typical, but small foci of fibrinoid necrosis can be seen.

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125
Q

Sarcoidal lymphadenitis: Lymphoma that must be excluded.

A

Classic Hodgkin’s lymphoma: Granulomas may be seen in affected nodes and in benign ones.

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126
Q

Brucellosis:

A. Histology of lymphadenitis.
B. Diagnosis (2).

A

A. May mimic tuberculous or sarcoidal lymphadenitis.

B. Culture, serology.

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127
Q

Castleman’s disease: Types.

A

Hyaline-vascular: Most common.

Plasma-cell.

Multicentric.

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128
Q

Castleman’s disease, hyaline-vascular type:

A. Typical patient.
B. Typical presentation.
C. Typical site.

A

A. Young adult.

B. Incidental finding.

C. Mediastinal lymph node.

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129
Q

Castleman’s disease, plasma-cell type: Presentation.

A

Half of patients have

  • Anemia.
  • Increased ESR.
  • Increased gamma globulins in the serum.
  • Increased plasma cells in the bone marrow.
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130
Q

Castleman’s disease, multicentric type: Typical patient.

A

Middle-aged or older adult.

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131
Q

Castleman’s disease, multicentric type: Presentation (4).

A

Generalized peripheral lymphadenopathy.

Hepatosplenomegaly.

Frequent fevers.

Night sweats.

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132
Q

Castleman’s disease, multicentric type: Associated malignancies (3).

A

Kaposi’s sarcoma.

Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma.

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133
Q

Castleman’s disease, multicentric type: Additional association.

A

Polyneuropathy.

Organomegaly.

Endocrinopathy.

Monoclonal gammopathy.

Skin changes.

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134
Q

Castleman’s disease, hyaline-vascular type, histology:

A. Mantle zones (2).
B. Sinuses.
C. Interfollicular area.

A

A. “Onion-skin” pattern; one mantle zone may surround two or more germinal centers.

B. Obliterated.

C. Hypervascular.

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135
Q

Castleman’s disease, plasma-cell type, histology:

A. Germinal centers.
B. Sinuses.
C. Interfollicular area.

A

A. Some are atrophic, some hyperplastic.

B. May be patent.

C. Hypervascular; sheets of plasma cells.

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136
Q

Castleman’s disease, multicentric type, histology.

A

Similar to that of plasma-cell type, but occurring in many lymph nodes.

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137
Q

Castleman’s disease, plasmablastic type.

A

Type of multicentric Castleman’s disease in which plasmablast-like cells occupy germinal centers and the interfollicular area.

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138
Q

Castleman’s disease: Monoclonality (3).

A

Plasma-cell type: Plasma cells may be restricted to IgG-lambda or IgA-lambda.

Plasmablastic type: Plasmablasts are restricted to IgM-lambda.

No clonality of rearrangement of IgH.

139
Q

Castleman’s disease: Immunohistochemistry (2).

A

Regressed follicles: CD21 and CD23.

Multicentric type (up to 40%): HHV8.

140
Q

Castleman’s disease: Laboratory abnormality.

A

Increased IL-6 in the serum.

141
Q

Castleman’s disease vs. B-cell lymphoma: Molecular test.

A

B-cell lymphoma: IgH is clonality rearranged.

142
Q

Castleman’s disease vs. HIV-associated lymphadenopathy (3).

A

HIV-associated lymphadenopathy:

  • Attenuated mantle zones.
  • No “onion-skin” pattern.
  • No “lollipop” follicles.
143
Q

Castleman’s disease vs. angioimmunoblastic T-cell lymphoma.

A

AITCL: Atypical small to medium-sized lymphocytes with clear cytoplasm.

144
Q

Castleman’s disease vs. thymoma.

A

Thymoma: Epithelial cells (confirmable by IHC).

145
Q

Castleman’s disease vs. autoimmune lymphadenopathy.

A

Autoimmune lymphadenopathy can also show sheets of plasma cells.

Distinction requires clinical correlation.

146
Q

Castleman’s disease vs. plasma-cell neoplasm.

A

Plasma-cell neoplasm lacks the typical follicular changes of Castleman’s disease.

147
Q

SLL/CLL: Components of the proliferation centers (3).

A

Small lymphocytes.

Prolymphocytes.

Paraimmunoblasts.

148
Q

SLL/CLL: Flow cytometry (2,2,1).

A

Positive: CD5, CD23.

Dim: CD20, sIg.

Negative: FMC7.

149
Q

SLL/CLL: Chromosomal abnormalities (4).

A

del(13q14).

+12.

del(11q22).

del(17p13).

150
Q

SLL/CLL: Progression to DLBCL.

A

Occurs in 5-10% of patients.

151
Q

SLL/CLL: Expression of cyclin D1 (3).

A

Dim expression in the proliferation centers occurs rarely.

No t(11;14).

Should not cause a diagnosis of mantle-cell lymphoma.

152
Q

Follicular lymphoma: Involvement of extranodal lymphoid organs.

A

Occurs in most patients.

153
Q

Follicular lymphoma: Sites of primary extranodal disease (3).

A

Duodenum.

Breast.

Skin.

Other sites.

154
Q

Follicular lymphoma:

A. Mantle zones.
B. Capsule.

A

A. Attenuated.

B. May be ruptured, with extranodal extension of the lymphoma.

155
Q

Follicular lymphoma: Grading.

A

Grade 2 has 6-15 centroblasts per hpf.

Grades 1 and 2 are considered low grade.

Grade 3A: Centrocytes and centroblasts.

Grade 3B: Centroblasts only.

156
Q

Follicular lymphoma: Diagnosis of diffuse area consisting mainly of centroblasts.

A

An additional diagnosis of DLBCL is made.

157
Q

Follicular lymphoma: Expression of CD20 on flow cytometry.

A

Bright.

158
Q

Follicular lymphoma: IHC (3).

A

Positive: CD10, Bcl-2, Bcl-6.

159
Q

Follicular lymphoma: Immunochemical anomalies of high-grade tumors (2).

A

May lack CD10.

May lack Bcl-2.

May express Mum-1.

160
Q

Follicular lymphoma: Use of immunohistochemistry in grading.

A

Ki-67 . . .

  • Less than 20% of cells proliferate: Low grade.
  • More than 20%: High grade.
161
Q

Follicular lymphoma: Additional immunohistochemistry.

A

CD21 and CD23:

  • Reveal effaced germinal centers in follicular lymphoma.
  • Not so in DLBCL.
162
Q

Follicular lymphoma: Rearrangements (2).

A

t(14;18) :: IGH-BCL2 in most cases.

Rearrangement of BCL6 in some cases, esp. of grade 3B.

163
Q

Follicular lymphoma: Genotype of aberrant type.

A

Cases that lack t(14;18) and expression of Bcl-2 have postgerminal-center genes.

164
Q

Follicular lymphoma vs. reactive follicular hyperplasia: Proliferation rate.

A

Reactive follicular hyperplasia: Greater than 90%.

165
Q

Mantle-cell lymphoma: Frequency of extranodal disease at presentation.

A

Present in most patients.

166
Q

Mantle-cell lymphoma:

A. Median survival.
B. Presentation that may correlate with a better prognosis.

A

A. Three to four years.

B. Absence of nodal disease.

167
Q

Mantle-cell lymphoma: Non-malignant histologic features (2).

A

Hyalinized small vessels.

Scattered epithelioid histiocytes containing no nuclear débris.

168
Q

Mantle-cell lymphoma: Variants (2).

A

Blastoid:

  • Fine chromatin.
  • Twenty to thirty mitotic figures per 10 hpf.

Pleomorphic: Large, pleomorphic cells with large nucleoli.

169
Q

Mantle-cell lymphoma: Effect of proliferation of tumor cells on prognosis (2).

A

Each of these can worsen the prognosis:

  • Mitotic rate greater than 10 per hpf.
  • Proliferation rate of greater than 40% by Ki-67.
170
Q

Mantle-cell lymphoma: Newer immunohistochemical marker.

A

SOX11.

171
Q

Mantle-cell lymphoma: Translocation.

A

t(11;14) :: CCND1-IGH.

172
Q

Mantle-cell lymphoma: Immunophenotypic aberrations (2).

A

Rare: Absence of CD5, expression of CD23 or CD10.

Very rare: Absence of cyclin D1 and t(11;14).

173
Q

Mantle-cell lymphoma: How to recognize cases that lack expression of cyclin D1 and t(11;14).

A

They express SOX11.

174
Q

Nodal marginal-zone lymphoma: Presentation.

A

Asymptomatic lymphadenopathy but with disease in advanced stage.

175
Q

Nodal marginal-zone lymphoma: Architecture.

A

Cells surround reactive lymphoid follicles and often infiltrate them (follicular colonization).

176
Q

Nodal marginal-zone lymphoma: Cellular components.

A

Monocytoid B cells.

Plasma cells.

Immunoblasts.

177
Q

Nodal marginal-zone lymphoma: Immunophenotype (2,1,1).

A

Bright: CD20, sIg.

Usually positive: Bcl-2.

Variable (50%): CD43.

178
Q

Nodal marginal-zone lymphoma: Cytogenetics (2).

A

A few cases may show +3, +7, or +18.

Translocations involving BCL10 and MALT1 are not observed.

179
Q

Nodal marginal-zone lymphoma vs. reactive lymph node with hyperplasia of monocytoid B cells (3).

A

Reactive lymph node:

  • No expression of Bcl-2.
  • No clonality plasma cells.
  • No rearrangement of IGH by PCR.
180
Q

Nodal marginal-zone lymphoma vs. lymphoplasmacytic lymphoma (4).

A

LPL:

  • Usually arises in the bone marrow.
  • Increased IgM with hyperviscosity.
  • Preservation of nodal architecture.
  • Mutations in MYD88.
181
Q

Lymphoplasmacytic lymphoma: Typical presentation.

A

Weakness and fatigue due to anemia.

182
Q

Lymphoplasmacytic lymphoma: Neoplastic cellular components.

A

Small lymphocytes.

Plasma cells.

Plasmacytoid lymphocytes.

183
Q

Lymphoplasmacytic lymphoma: Non-neoplastic cells that may be seen (3).

A

PAS-positive (immunoglobulin-laden) macrophages in open sinuses.

Hemosiderin-laden macrophages.

Mast cells.

184
Q

Lymphoplasmacytic lymphoma: Mutation.

A

L265P in MYD88.

185
Q

Lymphoplasmacytic lymphoma: Relation to increased IgM in the serum (2).

A

Some lymphoplasmacytic lymphomas secrete IgG or IgA instead of IgM.

Marginal-zone lymphomas and CLL can secrete IgM.

186
Q

Diffuse large B-cell lymphoma: Frequency of disease in advanced stage at presentation.

A

About 60%.

187
Q

Diffuse large B-cell lymphoma:

A. Frequency of extranodal disease at presentation.
B. Leading extranodal site.

A

A. About 40%.

B. The gastrointestinal tract.

188
Q

Diffuse large B-cell lymphoma: Association with immunosuppression (3).

A

DLBCL is more common in patients with

  • HIV.
  • History of transplant.
  • Primary immunodeficiency.
189
Q

Diffuse large B-cell lymphoma: Infectious association.

A

EBV is present in most cases.

190
Q

EBV-positive diffuse large B-cell lymphoma of the elderly.

A

Occurs in patients over 50 years of age

May be associated with senescence of the immune system.

191
Q

Diffuse large B-cell lymphoma, centroblastic type: Cytology.

A

Nucleus: Round.

Nucleolus: Several, small.

Cytoplasm: Scant.

192
Q

Diffuse large B-cell lymphoma, immunoblastic type: Cytology.

A

Nucleus: Round.

Nucleolus: Single, large, central.

Cytoplasm: Moderate, basophilic.

193
Q

EBV-positive diffuse large B-cell lymphoma of the elderly: Histology (3).

A

Variably sized tumor cells.

Many admixed reactive cells.

Necrosis.

194
Q

Diffuse large B-cell lymphoma: Expression of B-cell markers (5,4).

A

Positive: CD20, CD79a, Pax-5, Oct-2, Bob.1.

Variable: CD10, Bcl-2, Bcl-6, Mum-1.

195
Q

Diffuse large B-cell lymphoma: Use in immunohistochemistry in classification.

A

The algorithms of Hans and Choi are not yet standardized for routine use.

196
Q

Diffuse large B-cell lymphoma: Rate of proliferation by Ki-67.

A

Over 40%

197
Q

Diffuse large B-cell lymphoma: Additional immunohistochemistry (2).

A

Some cases show

  • Expression of CD30.
  • Aberrant expression of CD5.
198
Q

EBV-positive diffuse large B-cell lymphoma of the elderly: Immunohistochemistry (1,2).

A

Positive: Mum-1.

Negative: CD10, Bcl-6.

199
Q

EBV-positive diffuse large B-cell lymphoma of the elderly: Additional ancillary test.

A

ISH for EBV.

200
Q

Diffuse large B-cell lymphoma: Mutation associated with a poor prognosis.

A

Translocation involving c-MYC, especially when associated with

  • Translocation of IGH with BCL2.
  • Break in BCL6.
201
Q

Classification of diffuse large B-cell lymphoma:

A. Basis.
B. Classes.

A

A. Gene-expression profiling by DNA microarrays.

B. Germinal-center type (better prognosis), activated-B-cell type.

202
Q

Diffuse large B-cell lymphoma: Type that can mimic classical Hodgkin’s lymphoma.

A

Anaplastic DLBCL.

203
Q

“Gray-zone” lymphoma:

A. Definition.
B. Most common location.

A

A. Lymphoma that shares features with DLBCL and classical Hodgkin’s lymphoma.

B. Mediastinum.

204
Q

Diffuse large B-cell lymphoma: Relevance of immunophenotype to treatment.

A

CD30-positive DLBCL may respond to brentuximab vedotin.

205
Q

Diffuse large B-cell lymphoma: Another type of “overlap” lymphoma.

A

One with features of DLBCL and Burkitt’s lymphoma.

206
Q

Lymphoblastic lymphoma: Types.

A

T-cell type: 90%, lymph nodes or mediastinum.

B-cell type: 10%, lymph nodes and extranodal sites.

207
Q

Lymphoblastic lymphoma: Rate of progression to leukemia.

A

About 50%.

208
Q

Lymphoblastic lymphoma: Prognosis.

A

Adults: T-LBL has better outcomes.

Children: T-LBL and B-LBL have similar outcomes.

209
Q

Lymphoblastic lymphoma: Architecture of nodal infiltrate.

A

Usually diffuse; rarely paracortical.

210
Q

Lymphoblastic lymphoma of T-cell lineage: Most commonly expressed markers (8).

A

TdT, CD2, CD3, CD5, CD7; CD1a, CD99, CD43.

211
Q

Lymphoblastic lymphoma of T-cell lineage: Less commonly expressed markers (2).

A

CD10 in 40% of cases.

CD34 in 20% of cases.

212
Q

Lymphoblastic lymphoma of T-cell lineage: Expression of CD4 and CD8.

A

Most cases are double positive.

A smaller proportion are double negative.

Rare cases express only one of these markers.

213
Q

Lymphoblastic lymphoma of B-cell lineage: Immunophenotype (5,2).

A

Positive: TdT, CD34, CD10, Pax-5, CD79a.

Negative: CD20, light chains.

214
Q

Lymphoblastic lymphoma: Aberrantly expressed antigens.

A

Some tumors express myeloid markers such as CD13, CD33, CD117.

215
Q

Lymphoblastic lymphoma: PCR.

A

T-LBL: Rearrangement of TCR-gamma.

B-LBL: Monoclonal IGH.

Some tumors show both mutations.

216
Q

Lymphoblastic lymphoma: Sanger sequencing.

A

About half of cases of T-LBL show activating mutations of the NOTCH1 gene.

217
Q

Lymphoblastic lymphoma vs. Burkitt’s lymphoma: Immunophenotype.

A

Burkitt’s lymphoma . . .

  • Positive: CD20 (bright).
  • Negative: CD34, TdT.
218
Q

Lymphoblastic lymphoma vs. T-cell-rich thymoma: Histology (

A

T-cell-rich thymoma:

  • Fibrous bands impart lobular architecture.
  • Immunohistochemistry demonstrates epithelial cells.
219
Q

Lymphoblastic lymphoma vs. T-cell-rich thymoma: Flow cytometry.

A

T-cell-rich thymoma may show various populations of T lymphocytes.

220
Q

Lymphocytic markers that may be expressed by myeloid sarcoma (6).

A

TdT.

CD4, CD7, CD43.

Pax-5, CD79a.

221
Q

Indolent T-lymphoblastic proliferation: Definition (2).

A

Polyclonal proliferation of T lymphoblasts.

No change in nodal architecture.

222
Q

Indolent T-lymphoblastic proliferation: Associations (3).

A

Castleman’s disease.

Various hematologic malignancies.

Carcinomas.

223
Q

Indolent T-lymphoblastic proliferation: Treatment.

A

None required.

224
Q

Lymphoblastic leukemia: Recommended blast count.

A

More than 25%.

225
Q

Burkitt’s lymphoma: Clinical forms.

A

Endemic.

Sporadic.

Immunodeficiency-associated.

226
Q

Burkitt’s lymphoma, endemic:

A. Geography.
B. Median age of patient.
C. Sites.

A

A. Equatorial Africa.

B. Six years.

C. Abdominal cavity, jaw.

227
Q

Burkitt’s lymphoma, sporadic:

A. Median age (2).
B. Sites (2).
C. Lymphadenopathy.

A

A. Eleven years in children, 30 in adults.

B. Gastrointestinal tract, genitourinary organs.

C. Localized.

228
Q

Burkitt’s lymphoma, immunodeficiency-associated:

A. Typical patient.
B. Sites (3).
C. Effect of HAART.

A

A. One with HIV and a relatively high CD4 count and no opportunistic infections.

B. Lymph nodes, bone marrow, CNS.

C. No effect on incidence of Burkitt’s lymphoma.

229
Q

Burkitt’s lymphoma: Prognosis.

A

Can be cured by means of extensive chemotherapy.

230
Q

Burkitt’s lymphoma: Immunophenotype (3,3).

A

Positive: B-cell antigens, CD10, Bcl-6.

Negative: Bcl-2, TdT, Mum1.

231
Q

Burkitt’s lymphoma: Relation to EBV.

A

ISH for EBV . . .

  • Endemic: Positive in nearly all cases.
  • Other types: Positive in many cases.
232
Q

Burkitt’s lymphoma: Cytogenetics.

A

Rearrangement of 8q24 involving MYC.

233
Q

Burkitt’s lymphoma: Clinical predictors of worse prognosis (3).

A

Older age.

Black race.

Advanced stage of disease.

234
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma: Typical patient.

A

Older adult with generalized lymphadenopathy or with extranodal disease.

235
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma: Behavior.

A

Very aggressive:

  • Presents in advanced stage.
  • Virtually no response to chemotherapy.
  • Poor prognosis.
236
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma: Histology (

A

Often show the starry-sky pattern.

In some tumors, cells are larger or more pleomorphic than those of Burkitt’s lymphoma.

In some tumors, the cells resemble those of Burkitt’s lymphoma but have a different karyotype.

237
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma: Immunophenotype.

A

Cases that resemble DLBCL:

  • Typical phenotype of Burkitt’s lymphoma.
  • Proliferation rate of more than 90%.

Cases that resemble Burkitt’s lymphoma:

  • Strong expression of Bcl-2, or
  • Proliferation rate of less than 90%.
238
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma: Mutations.

A

Cases that resemble DLBCL but have the immunophenotype of Burkitt’s lymphoma: Simple rearrangement of MYC.

Cases that resemble Burkitt’s lymphoma may have a complex karyotype or a rearrangement of MYC + rearrangement of BCL2 and/or BCL6.

239
Q

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt’s lymphoma:

A. “Double-hit” type.
B. “Triple-hit” type.

A

A. Rearrangement of (MYC) and (BCL2 or BCL6).

B. Rearrangement of all 3 genes.

240
Q

Examples of “double-hit” lymphomas with acquired mutations of MYC (4).

A

Diffuse large B-cell lymphoma.

Follicular lymphoma.

Lymphoblastic lymphoma.

Plasma-cell myeloma.

241
Q

“Double-hit” lymphoma arising from follicular lymphoma: Possible histologic features (6).

A

Diffuse growth.

Absence of centrocytes.

Blastoid growth.

Starry-sky pattern.

Very high proliferation.

Focal necrosis.

242
Q

Angioimmunoblastic T-cell lymphoma: Typical patient.

A

Elderly adult with organomegaly and “B” symptoms.

243
Q

Angioimmunoblastic T-cell lymphoma: Less common signs and symptoms (4).

A

Rash.

Polyarthralgia.

Pleural effusion, ascites.

244
Q

Angioimmunoblastic T-cell lymphoma: Prognosis.

A

Poor.

245
Q

Angioimmunoblastic T-cell lymphoma: Architecture (4).

A

Partial effacement of lymph node.

Paracortical location of tumor cells.

Paracortical vascular proliferation (high-endothelial venules).

Expansion of FDC meshworks (demonstrable by IHC for CD21, CD23).

246
Q

Angioimmunoblastic T-cell lymphoma: Cells (2).

A

Tumor cells: Atypical, small to medium-sized, moderate amount of clear cytoplasm.

Other cells: Reactive small lymphocytes, immunoblasts, eosinophils, plasma cells, histiocytes.

247
Q

Angioimmunoblastic T-cell lymphoma: Expession of T-cell antigens.

A

Positive: CD4.

Most of the other expected T-cell antigens are expressed, but loss of one or more is not uncommon.

248
Q

Angioimmunoblastic T-cell lymphoma: Additional markers (4).

A

Positive: CD10, Bcl-6, CXCL13, PD-1.

This is the immunophenotype of follicular T-helper cells.

249
Q

Angioimmunoblastic T-cell lymphoma: Association with EBV.

A

EBV is present in scattered immunoblasts in most cases.

250
Q

Angioimmunoblastic T-cell lymphoma: PCR (2).

A

Monoclonal rearrangement of TCR-gamma.

Ten percent of cases: Concurrent monoclonal rearrangement of IGH.

251
Q

Angioimmunoblastic T-cell lymphoma: Cytogenetics.

A

+3, +5, +X.

252
Q

Angioimmunoblastic T-cell lymphoma vs. peripheral T-cell lymphoma, NOS (4).

A

PTCL-NOS:

  • Tumor cells in the germinal centers or the mantle zones.
  • No enlarged FDC meshworks.
  • No large high-endothelial vessels.
  • Presentation is usually in an early stage.
253
Q

Anaplastic large-cell lymphoma: Epidemiology (2).

A

ALK-positive: Second and third decades, mostly males.

ALK-negative: Middle-aged and elderly, no predilection for gender.

254
Q

Anaplastic large-cell lymphoma: Typical presentation.

A

Lymphadenopathy, extranodal disease, systemic symptoms.

255
Q

Anaplastic large-cell lymphoma: Prognosis.

A

Better in ALK-positive tumors.

256
Q

Anaplastic large-cell lymphoma: Location of infiltrate.

A

The sinuses.

257
Q

Anaplastic large-cell lymphoma: Cytology.

A

Tumor cells are large and have eccentric reniform nuclei.

“Hallmark” cells have doughnut-shaped or wreath-like nuclei.

258
Q

Anaplastic large-cell lymphoma: Histologic variants (3).

A

Common: Pleomorphic large cells with “hallmark” nuclei.

Lymphohistiocytic: Many admixed histiocytes.

Small-cell: Most small- to medium-sized tumor cells.

259
Q

Anaplastic large-cell lymphoma: Expressed antigens (8).

A

Always: CD30.

Usually: CD45, EMA, Bcl-6, clusterin; TIA1, granzyme B, perforin.

260
Q

Anaplastic large-cell lymphoma: Usually unexpressed antigens (2).

A

CD3, Bcl-2.

261
Q

Anaplastic large-cell lymphoma: Expression of T-cell markers.

A

CD2, CD5, and/or CD4 is usually expressed.

262
Q

Anaplastic large-cell lymphoma: “Null-cell” type.

A

T-cell lineage is apparent only at the genetic level.

263
Q

Anaplastic large-cell lymphoma: Pattern of staining for ALK.

A

May be nuclear, cytoplasmic, or membranous, depending on the translocation.

264
Q

Anaplastic large-cell lymphoma: Aberrant expression of antigens.

A

Some tumors express myeloid antigens.

265
Q

Anaplastic large-cell lymphoma: Association with EBV.

A

None.

266
Q

Anaplastic large-cell lymphoma: Cytogenetics.

A

t(2;5)(p23;q35): 80% of tumors.

t(1;2).

inv(2).

267
Q

Anaplastic large-cell lymphoma: Examples of DLBCL that can mimic it (2).

A

ALK-positive, EMA-positive DLBCL . . .

  • Positive: CD138, cIg.
  • Negative: CD30, T-cell antigens.

CD30-positive DLBCL that resembles ALCL morphologically:

  • Positive: B-cell antigens.
  • Negative: T-cell antigens.
268
Q

Anaplastic large-cell lymphoma vs. peripheral T-cell lymphoma, NOS (2).

A

PTCL, NOS:

  • Better retention of T-cell antigens.
  • Usually no expression of EMA.
269
Q

Anaplastic large-cell lymphoma: Treatment.

A

Anti-CD30 (brentuximab vedotin) may help.

270
Q

Peripheral T-cell lymphoma, NOS: Typical patient.

A

Middle-aged or elderly male.

271
Q

Peripheral T-cell lymphoma, NOS:

A. Typical presentation.
B. Prognosis.

A

A. Advanced disease.

B. Poor.

272
Q

Peripheral T-cell lymphoma, NOS: Pattern of infiltrate.

A

Paracortical, follicular, or diffuse.

273
Q

Peripheral T-cell lymphoma, NOS: Tumor cells (3).

A

Medium-sized or large, pleomorphic, and monotonous.

Cells form sheets.

Clear cells or Reed-Sternberg cells may be visible.

274
Q

Peripheral T-cell lymphoma, NOS: Other cells (4).

A

Small lymphocytes, plasma cells, eosinophils, histiocytes.

275
Q

Peripheral T-cell lymphoma, NOS: Additional possible histologic feature.

A

Large high-endothelial venules.

276
Q

Peripheral T-cell lymphoma, NOS: Histologic variants (3).

A

Lymphoepithelioid (Lennert’s lymphoma): Small tumor cells are obscured by epithelioid histiocytes.

Follicular: Atypical clear cells in germinal centers or in mantle zones.

T-zone: Perifollicular growth with minimal cytologic atypia.

277
Q

Peripheral T-cell lymphoma, NOS: Expression of T-cell antigens (3).

A

Frequent loss of CD5 and CD7.

CD4 is usually expressed.

CD8 is more often expressed in Lennert’s lymphoma.

278
Q

Peripheral T-cell lymphoma, NOS: Expression of CD30.

A

Absent, weak, or focal.

279
Q

Peripheral T-cell lymphoma, NOS: Rate of proliferation.

A

High.

280
Q

Peripheral T-cell lymphoma, NOS: Association with EBV.

A

Present in the Reed-Sternberg-like cells.

281
Q

Peripheral T-cell lymphoma, NOS: Additional immunohistochemistry.

A

Some tumors (esp. the follicular variant) express markers of follicular T-helper cells:

  • CD10.
  • Bcl-6.
  • PD-1.
  • CXCL13.
282
Q

Peripheral T-cell lymphoma, NOS, T-zone variant: Differential diagnosis.

A

Reactive paracortical hyperplasia:

  • No loss of T-cell antigens.
  • Normal ratio of CD4-positive to CD8-positive lymphocytes.
283
Q

Peripheral T-cell lymphoma, NOS vs. angioimmunoblastic T-cell lymphoma.

A

AITCL: Expanded FDC networks.

284
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Proportion of all Hodgkin’s lymphomas.

A

5%.

285
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Epidemiology.

A

Young patients.

Strong male predominance.

286
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Typical presentation.

A

Localized lymphadenopathy.

287
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Names of large tumor cell.

A

Lymphocyte-predominant.

Lymphocytic and histiocytic.

Popcorn.

288
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: What should not be seen (4).

A

Neutrophils.

Eosinophils.

Fibrosis.

Necrosis.

289
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Antigens expressed by tumor cells (8).

A

CD45.

CD20, CD79a, Pax-5.

Bcl-6, EMA.

Both Oct-2 and Bob.1 are expressed.

290
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Antigens not expressed by tumor cells (4).

A

CD30, CD15, EBV, fascin.

291
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Antigens expressed by the T lymphocytes in the nodules (4).

A

CD3, CD4, CD57, PD-1.

292
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Additional immunohistochemistry (2).

A

CD21 and CD23 highlight the expanded FDC meshworks.

293
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma:

A. Flow cytometry.
B. PCR.

A

A. May reveal CD4/CD8 double-positive T cells.

B. Does not detect clonal rearrangement of IGH.

294
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma vs. T-cell/histiocyte-rich DLBCL

A

T-cell/histiocyte-rich DLBCL:

  • Diffuse, not nodular; complete effacement of architecture.
  • CD21 and CD23 reveal no expansion of FDC meshworks.
  • No rosettes of PD-1-positive T cells.
295
Q

Nodular lymphocyte-predominant Hodgkin’s lymphoma: Prognosis (3).

A

Cured if excised early.

Otherwise:

  • Relapses and recurrences are frequent.
  • Patients are predisposed to develop DLBCL.
296
Q

Nodular-sclerosis Hodgkin’s lymphoma: Most common sites.

A

Cervical lymph nodes.

Mediastinum (involved in 80% of cases).

297
Q

Nodular-sclerosis Hodgkin’s lymphoma: Variants of Reed-Sternberg cells (4).

A

Hodgkin’s cells: Mononuclear.

Wreath cells: Multinucleate.

Mummified cells: Condensed cytoplasm, pyknotic nuclei.

Lacunar cells: Due to formalin-induced retraction of cytoplasm.

298
Q

Nodular-sclerosis Hodgkin’s lymphoma: Non-neoplastic cells (5).

A

Small lymphocytes.

Histiocytes.

Eosinophils.

Plasma cells.

Neutrophils occasionally.

299
Q

Nodular-sclerosis Hodgkin’s lymphoma: Additional histologic features (2).

A

Broad bands of sclerosis.

Necrosis and granulomas in some cases.

300
Q

Reactive follicular hyperplasia in autoimmune disease: General histology (3).

A

Florid reactive follicular hyperplasia.

Sinus histiocytosis.

Markedly increased plasma cells in paracortex and medulla.

301
Q

Nodular-sclerosis Hodgkin’s lymphoma: Immunohistochemistry (4,2).

A

Positive: CD30, CD15, Pax-5, Mum-1.

Negative: CD45, EMA.

302
Q

Nodular-sclerosis Hodgkin’s lymphoma: Expression of CD20.

A

Usually negative but may be weak in some of the tumor cells in some cases.

303
Q

Nodular-sclerosis Hodgkin’s lymphoma: Expression of Oct-2 and Bob.1.

A

One or the other is positive, but not both.

304
Q

Nodular-sclerosis Hodgkin’s lymphoma: Expression of EBV.

A

Detectable by EBER in 10-40% of cases.

305
Q

Nodular-sclerosis Hodgkin’s lymphoma vs. HL of mixed-cellularity type.

A

Mixed-cellularity type:

  • Inconspicuous or absent fibrous bands.
  • Much stronger association with EBV.
306
Q

Nodular-sclerosis Hodgkin’s lymphoma vs. PTCL, NOS with true Reed-Sternberg cells.

A

In the latter, the T cells are morphologically (usually) and immunophenotypically aberrant.

307
Q

Nodular-sclerosis Hodgkin’s lymphoma vs. reactive immunoblasts.

A

Reactive immunoblasts express CD30 but not CD15.

308
Q

Nodular-sclerosis Hodgkin’s lymphoma: Best place to look for Reed-Sternberg cells.

A

Around the necrotic areas.

309
Q

Mixed-cellularity Hodgkin’s lymphoma:

A. Associations (3).
B. Median age at presentation.

A

A. Male sex, HIV, residence in developing country.

B. 38 years (older than that of NS-CHL).

310
Q

Mixed-cellularity Hodgkin’s lymphoma:

A. Most common site.
B. Prognosis.

A

A. Cervical lymph nodes; rarely involves mediastinum.

B. Excellent.

311
Q

Mixed-cellularity Hodgkin’s lymphoma: Immunohistochemistry.

A

Same as that of NS-CHL.

312
Q

Lymphocyte-rich Hodgkin’s lymphoma:

A. Median age.
B. Gender predilection.

A

A. Older than that of other subtypes of CHL.

B. Mainly affects males.

313
Q

Lymphocyte-rich Hodgkin’s lymphoma:

A. Typical site.
B. Prognosis.

A

A. Cervical lymph nodes; rarely involves mediastinum.

B. Excellent.

314
Q

Lymphocyte-rich Hodgkin’s lymphoma: Histology (4).

A

Small lymphocytes form nodules that contain

  • Small regressed germinal centers.
  • Scattered Reed-Sternberg cells.
  • Few or no granulocytes.
315
Q

Lymphocyte-rich Hodgkin’s lymphoma: Immunohistochemistry of tumor cells.

A

Same as that of NS-CHL.

316
Q

Lymphocyte-rich Hodgkin’s lymphoma: Other immunohistochemistry (2).

A

Small lymphocytes are mantle cells that express IgD.

Small regressed germinal centers express CD21 and CD23.

317
Q

Lymphocyte-rich Hodgkin’s lymphoma: Association with EBV.

A

Detectable by EBER in about half of cases.

318
Q

Langerhans’-cell histiocytosis: Age group of peak incidence.

A

One to three years.

319
Q

Langerhans’-cell histiocytosis: Pattern of infiltration.

A

Sinusoidal.

320
Q

Langerhans’-cell histiocytosis: Cellular components.

A

Langerhans’ cells.

Eosinophils, neutrophils, small lymphocytes.

321
Q

Langerhans’-cell histiocytosis: Cytology of tumor cells.

A

Nuclei: Irregular; nuclear groove sometimes; inconspicuous nucleolus.

Cytoplasm: Ill-defined, acidophilic.

322
Q

Langerhans’-cell histiocytosis: Immunohistochemistry (3).

A

S100: All Langerhans’ cells.

CD1a, langerin: Some Langerhans’ cells..

323
Q

Langerhans’-cell histiocytosis: Mutation.

A

V600E in BRAF in about half of cases.

324
Q

Langerhans’-cell histiocytosis vs. Rosai-Dorfman disease (3).

A

Rosai-Dorfman disease:

  • Large nucleoli.
  • Emperipolesis.
  • Absence of CD1a and langerin (but S100 is expressed).
325
Q

Langerhans’-cell histiocytosis vs. dermatopathic lymphadenopathy (2).

A

Dermatopathic lymphadenopathy:

  • Paracortical, not sinusoidal, infiltrate.
  • Langerhans’ cells are not accompanied by granulocytes or plasma cells.
326
Q

Langerhans’ cells:

A. Functions (2).
B. Origin.

A

A. Antigen presentation, phagocytosis.

B. The skin.

327
Q

Mixed-cellularity Hodgkin’s lymphoma: Histology.

A

Similar to that of NS-CHL, but without broad bands of collagen.

328
Q

Kaposi’s sarcoma: Locations in the lymph node (4).

A

Early:

  • Capsule.
  • Hilum.
  • Fat around the node.

Late: Entire node may be replaced.

329
Q

Kaposi’s sarcoma: Immunohistochemistry (5).

A

Positive: CD34, CD31, ERG, FVIII-related antigen, LANA (HHV8).

330
Q

Vascular transformation of lymph nodes: Histology

A

Congestion of all subcapsular and medullary sinuses.

Anastomosing network of small vascular channels lined by reactive endothelial cells.

331
Q

Kaposi’s sarcoma vs. vascular transformation of lymph node (2).

A

Vascular transformation of lymph node:

  • Sparing of capsule.
  • No hyaline globules.
332
Q

Extramedullary hematopoiesis: Locations in the lymph node (2).

A

Paracortex.

Sinuses.

333
Q

Extramedullary hematopoiesis: Immunohistochemical markers of megakaryocytes (2).

A

CD42b, CD61.

334
Q

Myeloid sarcoma: Clinical settings (4).

A

Established diagnosis of AML.

Harbinger of AML.

Sign of impending blast crisis in CML.

Sign of leukemic transformation of MDS.

335
Q

Extramedullary hematopoiesis: Sites (4).

A

Soft tissues.

Lymph nodes.

Skin.

Bones (lytic lesions).

336
Q

Extramedullary hematopoiesis: Histology.

A

Sheets of myeloblasts with or without maturation.

337
Q

Myeloid sarcoma: Aberrantly expressed antigens.

A

CD43, CD4, or CD7 may be expressed.

338
Q

Myeloid sarcoma: Clue to diagnosis.

A

High-grade neoplasm in the lymph node that does not express CD3, CD20, CD138, or cytokeratin.

339
Q

Mast-cell disease: Location in the lymph node.

A

May involve any compartment, but especially the paracortex.

340
Q

Mast-cell disease: Histology (3).

A

Sheets or small clusters of mast cells.

Fibrosis.

Eosinophils (sometime enough to obscure the infiltrate).

341
Q

Mast-cell disease: Aberrantly expressed markers (3).

A

CD2, CD25, CD30.

342
Q

Mast-cell disease: Mutation.

A

Activating point mutation in codon 816 of KIT.

343
Q

Mast-cell disease: Appearance in lymph node on routine stain.

A

Because their granules are inconspicuous without special stains, mast cells may be confused with

  • Fibrotic foci.
  • Histiocytes.
  • Lymphoid follicles.

AP reviewer (17 decks)

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