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Heme/Lymph > Lymphadenopathy CC + slides > Flashcards

Lymphadenopathy CC + slides Flashcards

1
Q

Would we call this a reactive or neoplastic lymph node? Why?

Would we expect to see patient with night sweats or a fever?

A

This is reactive

the tissue structure is still intact and you can see clear morphologic features

a fever, night sweats are assoicated with neoplastic conditions

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2
Q

Is this lymph node reactive or neoplastic?

What would we see clincally; low grade fever or night sweats?

A

Neoplastic

we can tell because the morphology is not maintained

You would see night sweats = hematolymphoid symptom (also fatigue)

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3
Q

55 yo Man comes in with several lumps on neck that have been there for past 6 months.

Afebrile, no night sweats or weight loss nor any recent illness

the nodes are 1 to 2 cm and paplable on both sides, can’t palpate spleen

All labs are normal but CT shows mild splenomegaly and lots of 1 to 3 cm nodes in neck, axilla, mediastium, paraaortic and ingunal.

What is our most likey dx?

A

Follicular lymphoma

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4
Q
A
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5
Q

What are key considerations when deciding beween a benign and neoplastic lymphadenopathy?

A

– Duration? Growth interval?; fast = neoplastic, slow = indolent
– Size? was growth rapid adn is it over 1 cm
– Location? Extent? axilla, inguinal adn cervical and IG promiment , if you can feel them elsewhere this is concerning
– Tender vs. Nontender? tender is more reactive, nontender more neoplastic
– Fixed vs. mobile? fixed is bad sign

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6
Q

What do we look at in the histological exam when discerning between neoplastic and benign lymphadenopathy?

A

– LN architecture? intact = normal and reactive vs effaced for neoplastic
– Dominant cell type? neoplastic tends to be more homogenous while reactive still has all cell types
– Atypia? deviation from normal cytology sign of neoplasm
– Flow cytometry?

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7
Q

Common causes of reactive lymphadenopathy

A

– Infectious
– Autoimmune
– Drugs
– Foreign body

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8
Q

3 causes of neoplastic lymphadenopathy

A

– Lymphoma
– Leukemic involvement
• Lymphoblastic lymphoma
• Myeloid sarcoma
– Metastatic tumor

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9
Q

In reactive lymphadenopathy, what do we see on HE in the following conditions?

• Autoimmune, early HIV, toxoplasmosis

A

– Follicular hyperplasia

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10
Q

What do we see on HE in EBV, CMV, herpes, drugs

A

– Paracortical hyperplasia

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11
Q

What do we see on HE in sinus histiocytosis?

A

draining tumors

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12
Q

Follicular Lymphoma

______of all lymphomas; ____ of B-cell lymphomas
• ____median age; slight male predominance
• Nodal ____extranodal involvement

A

20%

1/3

60 y/o

nodal>

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13
Q
A
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14
Q

Most cases of Follicular lymphoma are caused by?

Are indolent or aggresive?

A

t(14;18)

Indolent

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15
Q

Follicular lymphoma is

• Generally indolent; however, 40% “transform” to
aggressive lymphomas which are:

A

– Diffuse large B-cell lymphoma
– Burkitt lymphoma

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16
Q

What do you see here on HE?

A

Follicular hyperplasia

lymph nodes are nodular, but they are excessive

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17
Q

You perform flow cytometry on patient that has follicular hyperplasia

it reveals clonal B cell population w/ low forward scatter and :

CD5-, CD10+ , CD19+, CD20+, CD23-

Doc decides to watchfully wait: 18 months later patient has increased fatigue and see more invovlement on scans. Whats the most appropriate managment now?

A

Chemotherapy and anti-CD20 monoclonal antiB therapy

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18
Q

The following are all examples of:

  • Follicular lymphoma
  • Diffuse large B-cell lymphoma
  • Mantle cell lymphoma
  • Marginal zone lymphoma
  • Lymphoplasmacytic lymphoma
  • Burkitt lymphoma
A

Non hodkgins lymphoma (NHL)

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19
Q

When Dx B-Cell NHL, what things do we need to consider?

A

Morphology: Archichecture and tumor cells

Immunophenotype:
– Establish B-lineage
– Small-sized lymphomas: CD5, CD10, CD23
• Cytogenetics
– t(14;18), t(11;14); t(8;14)

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20
Q

What NHL have SMALL tumor size and are NODULAR or FOLLICULAR?

A

• Follicular lymphoma

  • Marginal zone lymphoma
  • CLL/SLL

Exceptions:

*Mantle Cell is nodular but can be any size

• Lymphoplasmacytic lymphoma is small but not nodular

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21
Q
A
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22
Q
A
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23
Q

What do Diffusse large B cell lymphoma and Burkitt lymphoma have in common?

A

Both have diffuse architecture and are meduim to large sized

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24
Q

What small cell NHL are CD5-

A

Follicular lymphoma

Marginal Zone lymphoma

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25
Q

What small B celled leukemia/lymphomas are CD5+?

A

Mantle cell lymphoma

CLL/SLL

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26
Q

What small B cell lymphoma has the following markers?

CD5+

CD23+

A

CLL/SLL

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27
Q

What small B cell lymphoma is

CD5+

CD23-

A

Mantle cell lymphoma

28
Q

What small B cell lymphoma is

CD5-

CD10-

A

Marginal zone lymphoma

29
Q

What small B cell lymphoma is

CD5-

CD10+

A

Follicular lymphoma

30
Q

What is the translocation for Follicular lymphoma?

A

t(14;18)

31
Q

What is the translocation for Mantle cel lymphoma

A

t(11;14)

32
Q

What is the translocation in Burkitt Lymphoma

~ there are 3

A

t(8;14)
t(2;8)
t(8;22)

33
Q

What is the translocation in Marginal zone
lymphoma

A

t(11;18)

34
Q

t(14;18) seen in Follicular lymphoma is results in what mutatation?

A

BCL-2

Prevents cells from apoptosis
– Overexpressed in many lymphomas

35
Q

– t(14;18)
• ________fusion of follicular lymphoma
• Overexpression
• Tumor progression due to ________ rather than
uncontrolled cell proliferation

A

IgH-bcl-2

inhibition of normal apoptosis,

36
Q

What is the difference in BCL 2 expression in Follicular lymphoma vs follicular hyperplasia?

A

Follicular hyperplasia = BCL-2 -

Follicular lymphoma = BCL 2 +

37
Q

Mantle cell lyphoma has t(11;14) which disregulates what key part of cell cycle?

A

• Cyclin D1

38
Q

Mantle cell lymphoma: t(11;14)
• _______ fusion
• Overexpression of cyclin D1
• Detection by cytogenetics and/or immunohistochemistry
• Diagnostic for mantle cell lymphoma in neoplastic B-cell processes

A

Cyclin D1-IgH

(image is CD1 staining)

39
Q

Burkitt lymphoma has increased _____gene expression

what gene translocation?

A

C-Myc

t(8;14)

40
Q

Describe Burkitt lymphoma on HE

A

starry sky apperance

–> white cells are tumor cells

41
Q

When would I see a tumor that has c-MYC over expression and BCL2 expression?

A

IF patient had follicular lymphoma (BLC2 expression) that developled into Burkitts lymphoma (c-MYC) which can happen!

42
Q

-Chronic lymphocytic leukemia/Small lymphocytic lymphoma
– Follicular lymphoma
– Marginal zonelymphoma
– Lymphoplasmacytic lymphoma

these are all high grade or low grade?

A

all LOW grade

43
Q

What are my high grade NHL?

A

• High grade
– Diffuse large B-cell lymphoma
– Burkitt lymphoma

44
Q

• Extranodal marginal zone lymphoma
– Indolent or aggressive?
– Small-sized cells or Large sized cells?
– Extranodal sites include what?

A

indolent

small

: mainly MALT sites such as gastric, thyroid, lung

45
Q

IG what are our tx options for low grade NHLs?

A

– Treatment may consist
of antibiotics, resection,
radiation, chemotherapy

46
Q

• Diffuse large B-cell lymphoma is a high grade NHL:
– Indolent or Aggressive?
– small or large-sized cells?

A

aggressive

large

with both nodal adn extranodal invovlement

TX = aggresive chemo

47
Q

Brief summary of T/NK cell lymphomas:
• Relatively common or uncommon in the US
• Aggressive or indolent tumors (generally)?
• Types:
– Peripheral T-cell lymphoma
– Anaplastic T-cell lymphoma, ALK(+)
– Extranodal NK/T-cell lymphoma

A

uncommon in US

AGGRESSIVE

48
Q

Anaplastic large-cell lymphoma
– Aggressiv Pediatric tumor
– ______T-cell neoplasm
– Characterized by_____ rearrangements (tyrosine kinase receptor)

Most commonly what translocation?

A

CD8(+)

ALK

t(2;5)

49
Q

CD8(+)

ALK rearrangements

t(2;5)

characteristic of what neoplasm?

A

• Anaplastic large-cell lymphoma

50
Q

– Mostly NK-cell neoplasm but may be T cell
– Formerly mid-line lethal granuloma
– Nasal mass with necrosis, extensive destruction, and angioinvasion

SEen in adults

A

Extranodal NK/T-cell lymphoma, nasal type

51
Q

What clinical variants are there of Burkitt lymphoma

A

-Sporatic (ileocecal mass)
– Endemic (EBV, breast, jaw, ovary masses)
– Immunosuppression-related (EBV)
– Transformation from follicular lymphoma

52
Q

Extranodal NK/T-cell lymphoma, nasal type is associated with ______

is common in what location?

aggressive or indolent?

A

– EBV-associated
– More common in Asia, South America
– Aggressive (all T/NK cell lymphomas are aggresive)

53
Q
A
54
Q

The follow are all:
• Lymphomas (mostly B)
– Endemic Burkitt lymphoma
– Post-transplant lymphoproliferative disorder
– Extranodal NK/T-cell lymphoma, nasal type
– Subsets of Hodgkin lymphoma, diffuse large B-cell
lymphoma, T-cell lymphomas

• Nasopharyngeal carcinoma

A

EBV-associated neoplasms

55
Q

35 yo recent African immigrant has rapidly enlarging breast mass. It’s biopsied and has a ‘stary skied’ apperance, what is the mostly likely Pathology explaining this ?

A

EBV (will cause breast, ovary and jaw masses)

56
Q

Hodkin lypmphoma:

frequently involvems multiple nodes or is localized to single node?

Has orderly spread or noncontiguous spread?

A

Hodkin is more localized to single node often axial groups

wil have orderly, contiguous spread

57
Q

Does the below describe Hodking lymphoma or non-hodking lymphoma:

mesenteric nodes and waldyere ring often involved

extranodal involvment common

BM involvement

A

Non-Hodkin lymphoma

58
Q

You do a biopsy and see these cells, the pathologist calls them “Reed Sternberg cells”

A

Classic Hodkin Lymphoma and MUST be observed to dx HL!

59
Q

Describe the morphology of Reed-Sternberg cells

A

Must be observed to diagnose HL and B-lineage neoplastic cells

-Large size
– Frequent binucleation
– Large, eosinophilic nucleoli (“owleye”)

60
Q

Hodgkin lymphoma is a disease seen in:

____% of all lymphomas

A

adults

30%

61
Q

Reed Sternberg cells
– Contiguous spread
– Lymph node involvement

A

charcteristics of HL

62
Q

Lacunar cells or are a varient of Sternberg cells seen in:

A

Nodular sclerosis HL

63
Q

L&H (popcorn) variation of Sternberg cells are seen in:

A

Nodular lymphocyte predominant

64
Q

Nodular sclerosis is most common HL.

Seen in what age and sex?

location in body?

Common morphology:

A

Nodular sclerosis is 15-35 yo, M=F

located at mediastinum

Lacunar cells with dense sclerosis

65
Q

CD markers in Nodular sclerosis HL

A

CD15(+), CD30 (+);
CD20(-), CD45 (-)

the CD20- is surprising bc it’s a B cell neoplasm!

66
Q

Have a 20 yo woman w/ lump in the right side of neck thats grown larger over the past 4 months. Afebrile, no night sweats or weight loss with no meds or smoking.

PE: 3.5 cm right anterior cervical node and 1 cm right supraclavicular node

Biopsy the node and we se the architecture is effaced. He notes a few obvious cell amidst all the eosinophils in the slide. What is this?

A

them are Reed Sternberg cells and this chick has HL

(B cell neoplastic cells)

Heme/Lymph (10 decks)

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