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SBCP Pathology > Lymphadenopathy > Flashcards

Lymphadenopathy Flashcards

1
Q

What organs are in the haemopoeitic system?

A

Lymph nodes
Spleen
Bone marrow

Lumphoid tissue also found in:
Gut mucosa
Salivary glands
Respiratory tract

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2
Q

How does lymph flow through lymph node?

A

Afferent lymphatic vessels in cortex>flows through intranodal sinuses>efferent vessels in medulla

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3
Q

What are centroblasts?

A

Large immature B cells in follicles of lymph node cortex

Mature into smaller centrocytes and divide and mature within the follicles when an antigen is encountered.

They differentiate into plasma cells OUTSIDE the follicles

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4
Q

Where are T cells found in the lymph nodes?

A

Between follicles and medulla

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5
Q

Where are macrophages found in lymph nodes?

A

Between sinuses and follicles

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6
Q

Antibodies associated with B cells?

A

CD19, CD20 and CD79a

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7
Q

Antibodies associated with T cells?

A

CD3, CD4, CD8

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8
Q

Where are B cells found in the lymph node?

A

In the follicles

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9
Q

Common causes of enlarged lymph nodes?

A

Infectious diseases (viral, bacterial, fungal, parasites etc.)

Immune disorders (RA, SLE, PBC, hypersensitivity)

Cancer (haematological or metastasis)

Others: (sarcoidosis and 100s of others)

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10
Q

Investigations for enlarged lymph nodes?

A

*****FNA OR BIOPSY!!!

General and ENT examination

FBC

Serology for EBV, CMV, HIV, Toxoplasma, ANA, anti ds DNA

CXR, USS, CT, MRI, PET

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11
Q

What are these histological patterns examples of? (Follicular, paracortical, sinus or combination)

A

Lymph node hyperplasia patterns

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12
Q

What causes purulent/pus filled lymph nodes?

A

Bacterial infections due to neutrophil infiltration

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13
Q

What is a granuloma?

A

A collection of macrophages surrounded my lymphocytes

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14
Q

What is the most common infective cause of swollen lymph nodes in children and YAs?

A

Infective mononucleosis (glandular fever)

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15
Q

Clinical features of glandular fever?

A

Fever
Sore throat
Swollen lymph nodes
*Splenomegaly

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16
Q

What is the monospot test?

A

For anti EBV antibodies in glandular fever

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17
Q

True/false: Biopsies are always taken for diagnosis of mono

A

False, only when malignancy suspected or atypical features

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18
Q

Histology of which disease: Non caseating granulomas with epitheloid cells, Langhan’s giant cells, asteroid bodies (Schaumann bodies)

A

Sarcoidosis

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19
Q

Test for sarcoidosis?

A

Serum ACE levels

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20
Q

Organs affected in sarcoidosis

A

Lungs, skin, lymph nodes, kidneys, eyes (and others)

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21
Q

What is mycosis fungiodes?

A

A T-cell lymphoma of the skin

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22
Q

Which type of tumour rarely spreads to lymph nodes?

A

Sarcomas

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23
Q

What cell is present in Hodgkin lymphoma?

A

Reed-Sternberg cell

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24
Q

Two types of Hodgkin lymphoma?

A

Nodular lymphocyte predominant

Classical (nodular sclerosing, lymphocyte rich, lymphocyte depleted, mixed cellularity)

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25
Q

How are lymphomas classified in general?

A

Based on clinical features, immunophenotype, molecular features

NO SINGLE FEATURE IS THE GOLD STANDARD

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26
Q

Indolent forms of Non-Hodgkin’s lymphoma?

A 
Lymphocytic lymphoma (B)
Follicular lymphoma (B)
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27
Q

Aggressive forms of Non-Hodgkin’s lymphoma?

A

LymphoBLASTIC lymphoma (B/T)

Burkitt’s lymphoma (B)

Diffuse large B cell lymphoma (B)

Mantle cell lymphoma (B)

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28
Q

Difference between indolent and aggressive lymphomas?

A

Indolent: progressive, hard to cure

Aggressive: grow rapidly, may be easier to treat

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29
Q

How is clonality of a lymphoma investigated?

A

PCR. All cells in lymphoma are of same type

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30
Q

True/False: 85% of lymphomas are B-cell non Hodgkins

A

True.

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31
Q

How can morphology be used to subtyping lymphomas?

A

CELL SIZE

Small lymphoid cells: Small lymphocytic, Follicular, Mantel cell lymphomas

Intermediate: Burkitt’s

Large: Diffuse large B cell

32
Q

Most common leukaemia?

A

CLL/small lymphocytic lymphoma

33
Q

Age at diagnosis for CLL?

A

Mean 60

34
Q

Autoimmune abnormalities of CLL

A

Hypegammaglobulinameia, thrombocytopaenia, haemolytic anaema

35
Q

Histology of which leukaemia: Small lymphocytes, larger pro-lymphocytes, express CD5 and pan B markers

A

CLL

36
Q

Molecular abnormalities of which leukaemia: trisomy 12, del 13q

A

CLL

37
Q

Median survival of CLL? What is Richter’s transformation?

A

4-6 years

CLL can change into small lymphocytic lymphoma (aggressive form of large cell lymphoma)

38
Q

Which lymphoma accounts for 45% of adult lymphomas?

A

Follicular lymphoma

39
Q

Histology of which lymphoma: centroblasts and centrocytes. Expresses CD10, bcl2 and pan B markers

A

Follicular lymphoma

40
Q

Molecular abnormalities of which lymphoma? t(14:18), bcl2 over expression

A

Follicular lymphoma (B)

41
Q

Prognosis of follicular lymphoma?

A

Indolent, incurable

Median survival 10 yrs

Transforms to diffuse large B cell in 30-50% :(

42
Q

Lymphoma associated iwht GI involvement in the form of polyps (lymphamatoid polyposis)?

A

Mantle cell

43
Q

Histology of which lymphoma: Monotonous proliferation of small lymphoid cells, expressing pan B, CD5 and CyclinD1

A

Mantle cell lymphoma (aggressive)

44
Q

Molecular pattern of which lymphoma? t(11:14) resulting in over expression of CYCLIN D1

A

Mantle cell lymphoma

45
Q

Which lymphoma? Endemic, sporadic or HI associated, may present as leukaemia

A

Burkitt’s lymphoma (aggressive but curable)

46
Q

Histology of which lymphoma: intermediate cells, diffuse growth, STARRY SKY APPEARANCE, highest turnover rate. Expresses pan B, CD10, surface IgM

A

Burkitt’s

47
Q

Molecular pattern of which lymphoma? T(8:14) involving c-myc on chr 8

A

Burkitt’s

48
Q

Histology of which lymphoma: large B cells, diffuse growth pattern and expresses pan B antigens

A

Diffuse B cell lymphoma

49
Q

Molecular pattern of which lymphoma: t(14:18) in 30%, Bcl6 gene mutations

A

Diffuse Large B Cell Lymphoma

50
Q

Special types of diffuse large B cell lymphoma

A

AIDS related

Body cavity based

51
Q

Prognosis of diffuse large B cell lymphoma

A

Aggressive
50-60% complete remission
Around 50% cure rate

52
Q

General prognosis of T-Cell NH lymphomas?

A

Worse than B cell NHLs

53
Q

Common T cell lymphomas?

A

Mycosis fungiodes
Peripheral T cell lymphoma

All these tumours express CD3 and show a T cell receptor gene rearrangement at the genetic level

54
Q

What can predispose to MALT lymphoma?

A

Chronic H pylori infection
Sjogrens syndrome
Hashimoto thyroiditis

55
Q

Uncommon lymph node sites to be affected by Hodgkin’s?

A

Gut
Skin
Mesenteric
Waldeyer’s ring

56
Q

True/false: All Hodgkins lymphomas are derived from B cells but not all of them will express B cell markers

A

True

57
Q

Histology subtypes of which cell: Classic binucleate, lymphohistiocytic, lacunar, mononuclear, mummified

A

Reed sternberg cell

58
Q

What antibodies stain for Classical Hodgkins? Nodular lymphocyte predominent Hodgkins?

A
  1. CD15 and CD30

2. CD20

59
Q

Classical Hodgkin’s subtype affecting young adults and women?

A

Nodular sclerosing

60
Q

Classical Hodgkin’s subtype associated with LACUNAR RS CELLS and SCLEROTIC BANDS?

A

Nodular sclerosis

61
Q

Classical Hodgkin’s subtypes with good prognoses?

A 
Nodular sclerosing (excellent)
Mixed cellularity
Lymphocyte rich (excellent)
62
Q

Classical Hodgkin’s subtype with CLASSIC RS CELLS?

A

Mixed cellularity

63
Q

Classical Hodgkin’s subtype with HISTIOCYTE RS cells?

A

Lymphocyte rich

64
Q

Classical Hodgkin’s subtype with isolated cervical or axillary lymphadenopathy?

A

Lymphocyte rich

65
Q

Classical Hodgkin’s subtype appearing as high stage disease in older men?

A

Lymphocyte depleted

66
Q

Ann Arbor stages?

A

Stage 1: Single node/ regio affected

Stage 2: >1 regions affected on same side of diapharm

Stage 3: Both sides of diaphragm affected

Stage 4: Widespread disease and bone marrow involvement

67
Q

Leukaemia most common in kids?

A

ALL

68
Q

Prognosis of ALL?

A

90% complete remission

66% cured

69
Q

Urine proteins present in myeloma?

A

Bence-Jones portein

70
Q

Morphology of myeloma?

A

Sheets of mature and immature plasma cells in bone marrow

71
Q

Median survival of myeloma?

A

3 years, infections and renal failure are common causes of death

72
Q

Excess immunoglobulins in myeloma?

A

IgG and IgA

73
Q

Causes of splenomegaly (CHICAGO)

A

Cancer
Haematological malignancy
Infection
Congestion (portal HTN)

Autoimmune (SLE, RA, haemolytic anaemia)

Glycogen storage disease
Other (amyloidosis, lipid storage)

74
Q

True/false: Patients treated for HL are at higher risk of developing a second haematological malignancy

A

True, occurs in 15% of patients

75
Q

True/false: B symptoms are found in 90% of Hodgkin patients

A

False, 40%

Drinking alcohol increases pain

SBCP Pathology (24 decks)

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