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USMLE Hematology Leukemmia and Lymphoma > Lymphadenopathy > Flashcards

Lymphadenopathy Flashcards

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USMLE® Step 1 flashcards
1
Q

What part of the lymph node is affected in RA and early HIV?

A

Follicles

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2
Q

What area of the lymph node is affected in a viral infection?

A

Paracortex (e.g mono)

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3
Q

What part of the lymph node is affected in cancer

A

Sinus histiocytes (in medulla) - draining issue

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4
Q

What is a lymphoma?

A

Neoplastic proliferation of lymphoid cell that form a mass

- May arise in LN or in extranodal tissue

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5
Q

What is follicular lymphoma?

A
  • Neoplastic small B cells (CD20+) that make follicle-like nodules
  • Clinically presents in late adulthood with painless, generalised LAD
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6
Q

What translocation is associated with follicular lymphoma?

What does this lead to?

A

t(14;18)

  • BCL2 on chromosome 18 translocates to Ig heavy chain locus on chromosome 14
  • Results in overexpression of Bcl2, which inhibits apoptosis
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7
Q

What process in the follicle of the lymph node requires apoptosis?

A

Somatic hypermutation
- Cells that fail somatic hypermutation must undergo apoptosis - if Bcl2 is overexpressed the B cells of the follicle that fail cant undergo apoptosis

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8
Q

How is follicular lymphoma treated?

A
  • Low dose chemo
  • Rituximab

Asymptomatic patients (many) are not usually treated

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9
Q

What is the major complication associated with follicular lymphoma?

A

Diffuse large B-cell lymph node

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10
Q

What is the difference between follicular lymphoma and hyperplasia?

A
  • Hyperplasia may occur with infection
  • Follicular lymphoma there is a lack of tingible body macrophages in germinal centre (white spaces)
  • Follicular Lymphoma has expression of Bcl2 in follicles
  • FL has monoclonality
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11
Q

Reactive proliferation of lymphocytes

A

Polyclonal - ratio of kappa to lamda light chain 3:1

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12
Q

Neoplastic proliferation of lymphocytes

A

Monoclonal - ratio of kappa to lamda light chain ~ 20;1

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13
Q

What is Mantle cell lymphoma?

A
  • Neoplastic small B cells (CD20+) that expand the matle zone (region immeadiately adjacent to the follicle)
  • Clinically presents in late adulthood w. painless LAD
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14
Q

Mantle cell lymphoma is associated with what translocation?

And what does this result in?

A

11;14

  • Cyclin D1 on chr 11 translocated to Ig heavy chain locus on chromosome 14
  • Overexpression of cyclin D1 promotes G1/S transition in cell cycle
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15
Q

What does cyclin D1 do?

A

Cell cycle regulator which helps the cell go from G1 to S phase - it does this by phosphorylating proteins

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16
Q

What is a marginal zone lymphoma?

A

Neoplastic small B-cells (CD20+) that expand marginal zone

17
Q

What kind of diseases is marginal zone lymphoma associated with?

A
  • Hashimoto’s thyroiditis, Sjorgen syndrome, H pylori gastritis
  • Marginal zone is formed by post-germinal center B-cells
18
Q

What kind of lymphoma is H pylori associated with?

A

Marginal zone lymphoma in mucosal sites (e.g stomach)
(MALToma)
- Gastric maltoma may regress with treatment of H pylori

19
Q

What is Burkitt Lymphoma?

A

Neoplastic intermeadiate-sized B cells (CD20+)

  • Associated with EBV
  • Extranodal mass in child or young adult
20
Q

Where do the different forms of Burkitt lymphoma present?

A
  • African form usually involves jaw

- Sporadic form usually involves abdomen

21
Q

What kind of translocations are involved in Burkitt lymphoma?

A
  • Driven by translocations of c-myc (chr8)
  • t(8;14) is most common
  • Results in translocation of c-myc to Ig heavy chain locus on chr14
  • Overexpression of c-myc oncogene which promotes cell growth
22
Q

Describe the histology in Burkitt Lymphoma

A

Starry sky appearence (due to high mitotic rate)

- Macrophages eat away at cells while they die

23
Q

What is diffuse large B cell lymphoma (DLBCL)?

A
  • Neoplastic large B-cells (CD20+) that grow diffusely in sheets
  • Presents in late adulthood as an enlarging LN or extranodal mass
  • Most common of all NHL
  • Clinically aggressive
24
Q

What can DLBCL arise from?

A

Follicular lymphoma

25
Q

What cells are involved in Hodgkin lymphoma?

A

Reed-Sternberg cells
- Secrete cytokines which draw in other inflammatory cells (lymphocytes, plamsa cells, macrophages and eosinophils) - this is what produces the mass

26
Q

Describe the Reed-Sternberg cell

A

Large B cell with multilobed nuclei and prominent nucleoli

  • CD 15 and 30+
  • Looks like an owl
27
Q

What are the subtypes of Hodgkin lymphoma?

A
  • Nodular sclerosis (70%)
  • Lymphocyte-rich
  • Mixed cellularity
  • Lymphocyte-depleted
28
Q

What are the subtypes of Hodgkin lymphoma?

A
  • Nodular sclerosis (70%)
  • Lymphocyte-rich (best prognosis)
  • Mixed cellularity (abundant eosinophils, IL-5)
  • Lymphocyte-depleted (worst prognosis, elderly and HIV+ often)
29
Q

Describe the classic presentation of Nodular sclerosis Hodgkin lymphoma?

A

Enlarging cervical neck or mediastinal LN in a young adult, usually female

30
Q

What will the biopsy of nodular sclerosis Hodgkin lymphoma reveal?

A

Lymph node divided by bands of fibrosis (pink)

- RS cells are present in late-like spaces (lacunar cells) (they sit in big open spaces on histology)

USMLE Hematology Leukemmia and Lymphoma (14 decks)

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