Lymph Nodes, Lymphomas and Related Tumors-Parks Flashcards
What are the three types of things you should be thinking about if you see an enlarged lymph node?
- benign, reactive lymph nodes
- non-hodgkins lymphomas (NHLs)
- Hodkins lymphoma
If you have enlarged preauricular nodes (drain scalp and skin) what is your differential diagnosis?
scalp infections, mycobacterial infection
What are the malignancies associated with preauricular nodes?
skin neoplasm, lymphomas, head and neck squamos cell carcinoma
If you have enlarged posterior cervical nodes (drain scalp, neck and upper thoracic skin) what is your differential diagnosis?
scalp infections, mycobacterial infections
If you have enlarged supraclavicular nodes (drains GI tract, GU tract pulmonary) what is your differntial diagnosis?
abdominal/thoracic neoplasms, thyroid/laryngeal disease, mycobacterial/fungal infections
If you have enlarged submandibular nodes (drain oral cavity) what is your differential diagnosis?
mononucleosis, upper respiratory, viral/bacterial infections, myocbacterial infections, toxoplasm, cytomegalovirus, dental disease, rubela
What are the malignancies associated with enlarged submandibular nodes?
squamos cell carcinoma of the head and neck, lymphomas and leukemia
If you have enlarged anterior cervical nodes (drain larynx, tongue, oropharynx, anterior neck) what is your differential diagnosis?
mononucleosis, upper respiratory, viral/bacterial infections, myocbacterial infections, toxoplasm, cytomegalovirus, dental disease, rubela
The (blank) areas are very common locations to find lymphadenopathy because there are so many structures to undergo inflammation, infection and neoplasia.
head & neck
Which would you rather have, a reactive or a neoplastic lymph node?
reactive!
When will you get reactive lymphadenitis?
draining sore throats, either strep or viral
draining skin wounds.
Reactive lymphadenitis is a type of (blank) nonspecific lymphadenitis
acute
In benign reactive hyperplasia (chronic nonspecific lymphadenitis) what are the three things that happen?
follicular hyperplasia
oaracortical hyperplasia
sinus histiocytosis
In benign reactive hyperplasia, what will you see in germinal centers?
expansion so B cells are being activated/stimulated
What causes B cell hyperplasia? What causes T cell hyperplasia?
bacteria
viruses
What is this:
16 y/o female has major tiredness, sore throat and fever. She is found to have a bilateral cervical adenopathy and mild splenomegaly
mono
In mono even though it affects your B cells you will get (blank) hyperplasia
T cell
With cancers, 2 processes can occur in regional draining lymph nodes, what are they?
1) metastasis
2) no metastasis but Reactive Changes- Sinus histiocytosis
If you have sinus histiocytosis, do you have breast cancer?
no
What is commonly found in lymph nodes draining breast cancer and other cancers? This finding does not mean that there is metastatic carcinoma. It is a reaction.
sinus histiocytosis
(blank) can cause cervical lymphadenopathy
Bartonelli hensley
(blank) are primary cancer while metastatic carcinoma is secondary
lymphoma
T or F
All lymphomas are malignant
T
Lymphomas and leukemias come from the same (blank)
stem cell in the bone marrow
What differs between lymphomas and leukemias?
- lymphomas are in masses
- while leukemias involved the bone marrow and peripheral blood (leukemias)
What color are lymphomas?
white :)
With (blank) you can get lymphomas in the brain
AIDS/HIV
** people with AIDS/HIV have an increased incidence of lymphomas***
What are the 2 types of lymphomas?
non-hodgkins lymphoma
Hodgkins Lymphoma
Non-hodgkins lymphoma primarily affects (blank) cells
B cells (80%) T cells (20%)
T or F
Most lymphomas are B cell
T
What is another name for lymphoplasmacytic lymphoma?
waldenstroms macroglobulinemia
most lymphomas are coming out of the (blank) because this is where B cell maturation occurs
germinal center
If you have a lymphoma and run it through flow cytometry you will get (blank)
light chain restriction (i.e one type of light chain cuz you have monoclonal population)….either all kappa or all lambda
(blank) population is reactive.
(blank) population is malignant
polyclonal
monoclonal
What is the most common lymphoma?
diffuse large B cell lymphoma
What is the second most common lymphoma?
Follicular pattern
The t(blank; blank) chromosomal translocation is a model for several translocations in lymphomas that result in juxtaposition of a cellular proto-oncogene with immunglobulins or T cell receptor genes.
14;18
The t(14;18) chromosomal translocation is a model for several translocations in lymphomas that result in juxtaposition of a cellular proto-oncogene with immunglobulins or T cell receptor genes. THe (blank) gene on chromosome 18 is translocated to chromosome 14 directly adjacent to immunoglobulin heavy chain gene.
Bcl-2
With follicular hyperplasia you see a lot of (blank)
apoptosis
In follicular hyperplasia what is the chromosomal abnormality?
you translocate BCL2 in front of the IGH (heavy chain) which is an intense promotor thus creating a shit ton of BLC2 (therefore inhibition of apoptosis and increased proliferation)
How come BCL2 inhibits apoptosis?
because it stabilizes the mitochondrial membrane inhibiting cytochrome C release and thus you cannot get apoptosis
In DLBCL you have dysregulation of (Blank) which results in overexpression of it.
BCL-6
What will dysresgulation (overexpression) of BCL-6 get you in DLBCL?
No germinal cell formation
imparied B cell diff,
no apoptosis
B cells have (Blank) that retuximab (a monoclonal antibody) attacks
CD20
retuximab can attach to CD20 and cause (Blank) and (blank)
complement mediated lysis and ADCC (antibody dependent cell mediated cytotoxicity)
What are the three types of Burkitt’s Lymphomas?
African (endemic) type
Sporadic (nonedemic) type
HIV associated type
Almost all Burkitts lymphomas are caused by (blank)
EBV
What is this:
Almost all latently infected with EBV> Most african cases in “malarial belt”. Extra-nodal. (think head and neck)
African (endemic) type Burkitt’s lymphoma
Why type of burkitts lymphoma will you see in America?
Sporadic (nonedemic) type
What is this:
15-20% latent infection with EBC. Retroperitoneum. (think abdomen)
Sporadic (nonedemic) type Burkitt’s lymphoma
Of the people who have HIV associated Burkitt’s lymphoma, what percent are caused by latent EBV?
25%
What is the chromosomal abnormality associated with Burkitt’s lymphoma?
Myc Oncogene translocated next to Ig heavy chain locus resulting in increased MYC protein (between chromsome 8 and 14)
(blank) participates in many cell processes including proliferation and apoptosis.
C-myc
(blank) is usually an aggressive lymphoma, as opposed to (blank) which may take years to cause problems.
DLBCL
follicular lymphoma
With (blank) we started seeing aggressive B cell lymphomas of the brain and are highly assocated with EBV
HIV
In HIV, EBV turns into a (blank) virus
oncogenic
(blank) is a T lymphoma in which the skin is the primary site. The cutaneous manifestations of mycosis fungoides are protean like those of leukemia cutis. The premycotic stage is characterized by skin.
Mycosis Fungoides
What age group do you see mycosis fungoides?
old people
If you see nests in the epidermis, what disease process is occuring?
mycosis fungoides
THe mycosis fungoides cells have (blank)
epidermotropism
In mycosis fungoides; the nucleus is (blank) chromatin is (blank) nucleolus is (bank) cytoplasm is (blank)
irregular, convoluted
dense
indistinct
scant
What kind of nuclei appearance do sezary cells (mycosis fungoides) have?
cerebriform
What kind of nuclei appearance does HTLV1 have?
clover leaf floret
When mycoides fungoides gets into the blood stream you get (blank) cells
sezary
When mycoides fungoides gets into the blood stream you get (blank) cells
sezary
Is hodgkins lymphoma a B cell or a T cell lymphoma?
B cell lymphoma
Hodgkins lymphoma is assoicated with (blank) cells.
Classic Reed-Sternberg cell
What are the 2 most common hodgkins lymphomas?
Nodular sclerosis (70%) and Mix cellularity (20%)
In nodular sclerosis, is it common to have EBV
no
In mix-cellularity hodkins lymphoma is it common to have EBV?
yes (70%)
(blank) in hodgkins lymphoma turns on genes which promote lymphocyte proliferation and survival
NF-kB
What are the four classifcal forms of hodgkins lymphoma?
nodular sclerosis
mix-cellularity
lymphocyte-rich
lymphocyte depletion
What is the nonclassical form of hodgkins lymphoma?
Lymphocyte-predominate (L and H variants of RS cells)
not associated with EBV
What type of hodgkins lymphoma has the best survival rate?
What has the worst?
lymphocyte predominate
lymphocyte depletion
Reed sternberg cells secrete a lot of (Blank) which turn on fibroblasts and cause scarring, bring in plasma and eosinophils
cytokines
What do reed sternberg cels suppress to cause cutaneous anergy and make you more suceptible to TB and listeria?
TH1 and cytotoxic T cell response
Night sweats are a clinical sign of (blank)
hodgkins lymphoma
Is it “usual or unusual” for nodular sclerosis to involve the mediastinum and hilar lymph nodes?
usual
Normal lymph nodes are (round/flat)?
flat, if you see a round one, you should be worried
where do you see popcorn cells?
in ymphocyte predominant, L and H varient hodgkins lymphoma
90% of the time, hodgkins lymphoma that has a primary tumor in the cervical lymph nodes will first go to the hilar/mediastinum and then to ….?
spleen!!!!
In hodgkins lymphoma you have (blank) spread
contiguous
How do you stage hodgkins?
1-4…. restricted to one are (1), 2 areas (2), both sides of the diaphragm (3), extranodal (4)
What is this:
more frequent involvement of multiple peripheral nodes
noncontiguous spread
waldeyer ring and mesenteric nodes commonly involved
extranodal involvement common
non-hodgkin lymphoma
What is this:
more often localized to a single axial group of nodes (cervical, mediastinal, para-aortic)
orderly spread by contiguity, mesenteric nodes and waldeye ring rarely involved, extranodal involvment uncommon.
Hodgkin lymphoma
If you are in an A category what does that mean.
no symptoms
therefore B means you have symptoms
If you have a B catergory lymphoma what does this mean?
you have fever, night sweats, and unexplained weight loss
If a patient has one or more of the above (fevers, night sweats or weight loss exceeding 10% body weight over 6 months) then they are (blank). If these are Absent then they are (blank).
B
A
Where do you find marginal zone lymphomas?
in MALT and chronically inflammed tissue like H pylori gastritis.
How do you treat marginal zone lymphomas?
antibiotics leads to regression (remain localized for long periods)
(blank) is TB involving the lymph nodes of the head and neck
Scrofula
