Lymphadenopathy Study Guide

Question 1

Lymph nodes may become enlarged, termed lymphadenopathy, in two kinds of processes. What are they?

Answer 1

reactive and neoplastic

Question 2

What causes reactive lymphadenopathy and what does does the histology look like?

Answer 2

Causes:

1. Infectious: Infectious mononucleosis, Cat scratch, Others
2. Autoimmune

Histology:

1. Follicular hyperplasia: B cell expansions
2. Paracortical hyperplasia: T cell expansions
3. Sinus histiocytosis

Question 3

What are the two major sub-classes of lymphoma?

Answer 3

Non-Hodgkin lymphomas and Hodgkin lymphomas

Question 4

What are the two sub-classes of Non-Hodgkin lymphomas?

Answer 4

Mature B cell vs mature T cell

Question 5

What are the mature B cell lymphomas?

Answer 5

a. Follicular lymphoma
b. Mantle cell lymphoma
c. Diffuse large B cell lymphoma (DLBCL)
d. Burkitt lymphoma
e. Extranodal marginal zone lymphoma

Question 6

What are the mature T cll lymphomas?

Answer 6

a. Peripheral T-cell lymphoma
b. Extranodal NK/T-cell lymphoma
c. Anaplastic large cell lymphoma

Question 7

What causes Burkitt lymphoma?

Answer 7

Translocations involving c-MYC and immunoglobulin loci, usually t(8; 14) but may be t(2;8) or t(8;22)

Question 8

Who gets Burkitt lymphoma?

Answer 8

Adolescents or young adults withrapidly growing extranodal masses (ileocecum)

Question 9

What course does Burkitt’s take?

Answer 9

Aggressive.

uncommonly presents as “leukemia”; 3 variants: endemic (EBV associated),
sporatic, and
immunosuppression-related (EBVassociated

Question 10

What are the CD markers for Burkitts?

Answer 10

CD10(+)
CD19(+)
CD20(+)

Question 11

What causes Diffuse large B-cell lymphoma?

Answer 11

Diverse chromosomal rearrangements

Question 12

Who gets Diffuse large B-cell lymphoma?

Answer 12

All ages, but most common in adults

Question 13

What is the course of Diffuse large B-cell lymphoma?

Answer 13

Aggressive.

often appears as a rapidly growing mass/lymphadenopathy

Question 14

What are the CD markers for Diffuse large B-cell lymphoma?

Answer 14

CD19(+)

CD20(+)

Question 15

What causes Extranodal

marginal zone lymphoma (MALToma)?

Answer 15

t(11;18) is the most common abnormality observed in gastric MALTomas, creating MALT1-IAP2 fusion genes

Question 16

Who gets MALToma?

Answer 16

Arises in the lymphoid tissue of mucosal/epithelial-based sites in adults

Question 17

What the clinical course of MALToma?

Answer 17

Indolent.

tend to be localized; most frequent sites of involvement include:
gastric, orbital, thyroid, lung; may be observed in association with chronic infections or inflammatory diseases

Question 18

What are the CD markers for MALToma?

Answer 18

CD5(-)
CD10(-)
CD19(+)
CD20(+)

Question 19

What causes follicular lymphoma?

Answer 19

t(14;18) creating BCL2-IgH fusion gene or less commonly BCL6 rearrangements

Question 20

Who gets follicular lymphoma?

Answer 20

Adults with generalized lymphadenopathy, frequent retroperitoneal involvement

Question 21

What is the clinical course of follicular lymphoma?

Answer 21

usually slow growth however 40% transform to a more aggressive lymphoma

Question 22

What are the CD markers for follicular lymphoma?

Answer 22

CD5(-)
CD10(+)
CD19(+)
CD20(+)

Question 23

What causes mantel cell lymphoma?

Answer 23

t(11;14) creating cyclinD1-IgH fusion gene

Question 24

Who gets mantle cell lymphoma?

Answer 24

Older males with disseminated disease;

frequent GI involvement

Question 25

What is the course of mantle cell lymphoma?

Answer 25

moderately aggressive

Question 26

What are the CD markers for mantle cell lymphoma?

Answer 26

CD5(+) CD10(-) CD19(+) CD20(+)

Question 27

What are the Mature T/NK cell lymphomas?

Answer 27

a. Peripheral T-cell lymphoma b. Extranodal NK/T-cell lymphoma c. Anaplastic large cell lymphoma

Question 28

What is the cell of origin in Peripheral T-cell | lymphoma?

Answer 28

helper T cell

Question 29

What mutation causes Peripheral T-cell | lymphoma?

Answer 29

No specific chromosomal abnormality

Question 30

What are the clinical features of peripheral t cell lymphoma?

Answer 30

Aggressive. Mainly older adults; usually presents with lymphadenopathy

Question 31

What is the cell of origin for Anaplastic large-cell lymphoma?

Answer 31

cytotoxic t cell

Question 32

What is the mutation that causes Anaplastic large-cell lymphoma?

Answer 32

Rearrangements of ALK gene

Question 33

What are the clinical features of Anaplastic large-cell lymphoma?

Answer 33

Aggressive. Children and young adults, usually with lymph node and soft-tissue disease

Question 34

What is the cell of origin in Extranodal NK/T-cell lymphoma?

Answer 34

NK-cell (common) or cytotoxic T cell (rare)

Question 35

What is the mutation that leads to Extranodal NK/T-cell lymphoma?

Answer 35

EBV-associated; no specific chromosomal abnormality

Question 36

What is the clinical course of Extranodal NK/T-cell lymphoma?

Answer 36

Aggressive. Adults with destructive extranodal masses, most commonly sinonasa

Question 37

What are the two types of hodgkin lymphoma?

Answer 37

Classical Hodgkin lymphoma and Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)

Question 38

Who gets classical hodgkins?

Answer 38

Adolescents/younger adults

Question 39

What sites are involved in classical hodgkins?

Answer 39

Mediastinum, cervical

Question 40

What do the cells look like in classical hodgkins?

Answer 40

Reed Sternberg cells in the background of reactive inflammatory cells (eosinophils, neutrophils), “lacunar” cells, nodules and sclerosis in a subset

Question 41

What are the CD markers of classical hodgkins?

Answer 41

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

Question 42

What is the cell of origin for classical hodgkins?

Answer 42

B cell

Question 43

What is the clinical course of classical hodgkins?

Answer 43

moderately aggressive. Contiguous, predictable spread

Question 44

Who gets Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 44

Middle-age adults

Question 45

What sites are involved in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 45

Cervical, axillary

Question 46

What do the cells look like in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 46

Nodular collections of “popcorn” cells admixed with lymphocytes

Question 47

What are the CD markers in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 47

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

Question 48

What is the cell of origin in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 48

B cell

Question 49

What are the clinical course of Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?

Answer 49

Indolent. Frequent relapses