Lymphadenopathy Study Guide Flashcards
Lymph nodes may become enlarged, termed lymphadenopathy, in two kinds of processes. What are they?
reactive and neoplastic
What causes reactive lymphadenopathy and what does does the histology look like?
Causes:
- Infectious: Infectious mononucleosis, Cat scratch, Others
- Autoimmune
Histology:
- Follicular hyperplasia: B cell expansions
- Paracortical hyperplasia: T cell expansions
- Sinus histiocytosis
What are the two major sub-classes of lymphoma?
Non-Hodgkin lymphomas and Hodgkin lymphomas
What are the two sub-classes of Non-Hodgkin lymphomas?
Mature B cell vs mature T cell
What are the mature B cell lymphomas?
a. Follicular lymphoma
b. Mantle cell lymphoma
c. Diffuse large B cell lymphoma (DLBCL)
d. Burkitt lymphoma
e. Extranodal marginal zone lymphoma
What are the mature T cll lymphomas?
a. Peripheral T-cell lymphoma
b. Extranodal NK/T-cell lymphoma
c. Anaplastic large cell lymphoma
What causes Burkitt lymphoma?
Translocations involving c-MYC and immunoglobulin loci, usually t(8; 14) but may be t(2;8) or t(8;22)
Who gets Burkitt lymphoma?
Adolescents or young adults withrapidly growing extranodal masses (ileocecum)
What course does Burkitt’s take?
Aggressive.
uncommonly presents as “leukemia”; 3 variants: endemic (EBV associated),
sporatic, and
immunosuppression-related (EBVassociated
What are the CD markers for Burkitts?
CD10(+)
CD19(+)
CD20(+)
What causes Diffuse large B-cell lymphoma?
Diverse chromosomal rearrangements
Who gets Diffuse large B-cell lymphoma?
All ages, but most common in adults
What is the course of Diffuse large B-cell lymphoma?
Aggressive.
often appears as a rapidly growing mass/lymphadenopathy
What are the CD markers for Diffuse large B-cell lymphoma?
CD19(+)
CD20(+)
What causes Extranodal
marginal zone lymphoma (MALToma)?
t(11;18) is the most common abnormality observed in gastric MALTomas, creating MALT1-IAP2 fusion genes
Who gets MALToma?
Arises in the lymphoid tissue of mucosal/epithelial-based sites in adults
What the clinical course of MALToma?
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
What are the CD markers for MALToma?
CD5(-)
CD10(-)
CD19(+)
CD20(+)
What causes follicular lymphoma?
t(14;18) creating BCL2-IgH fusion gene or less commonly BCL6 rearrangements
Who gets follicular lymphoma?
Adults with generalized lymphadenopathy, frequent retroperitoneal involvement
What is the clinical course of follicular lymphoma?
usually slow growth however 40% transform to a more aggressive lymphoma
What are the CD markers for follicular lymphoma?
CD5(-)
CD10(+)
CD19(+)
CD20(+)
What causes mantel cell lymphoma?
t(11;14) creating cyclinD1-IgH fusion gene
Who gets mantle cell lymphoma?
Older males with disseminated disease;
frequent GI involvement
What is the course of mantle cell lymphoma?
moderately aggressive
What are the CD markers for mantle cell lymphoma?
CD5(+)
CD10(-)
CD19(+)
CD20(+)
What are the Mature T/NK cell lymphomas?
a. Peripheral T-cell lymphoma
b. Extranodal NK/T-cell lymphoma
c. Anaplastic large cell lymphoma
What is the cell of origin in Peripheral T-cell
lymphoma?
helper T cell
What mutation causes Peripheral T-cell
lymphoma?
No specific chromosomal abnormality
What are the clinical features of peripheral t cell lymphoma?
Aggressive.
Mainly older adults; usually presents with lymphadenopathy
What is the cell of origin for Anaplastic large-cell lymphoma?
cytotoxic t cell
What is the mutation that causes Anaplastic large-cell lymphoma?
Rearrangements of ALK gene
What are the clinical features of Anaplastic large-cell lymphoma?
Aggressive.
Children and young adults, usually with lymph node and soft-tissue disease
What is the cell of origin in Extranodal NK/T-cell lymphoma?
NK-cell (common) or cytotoxic T cell (rare)
What is the mutation that leads to Extranodal NK/T-cell lymphoma?
EBV-associated; no specific chromosomal abnormality
What is the clinical course of Extranodal NK/T-cell lymphoma?
Aggressive.
Adults with destructive extranodal masses, most commonly sinonasa
What are the two types of hodgkin lymphoma?
Classical Hodgkin lymphoma and Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)
Who gets classical hodgkins?
Adolescents/younger adults
What sites are involved in classical hodgkins?
Mediastinum, cervical
What do the cells look like in classical hodgkins?
Reed Sternberg cells in the background of reactive inflammatory cells (eosinophils, neutrophils), “lacunar” cells, nodules and sclerosis in a subset
What are the CD markers of classical hodgkins?
CD15(+)
CD30(+)
CD20(-)
CD45(-)
What is the cell of origin for classical hodgkins?
B cell
What is the clinical course of classical hodgkins?
moderately aggressive.
Contiguous, predictable spread
Who gets Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
Middle-age adults
What sites are involved in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
Cervical, axillary
What do the cells look like in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
Nodular collections of “popcorn” cells admixed with lymphocytes
What are the CD markers in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
CD15(-)
CD30(-)
CD20(+)
CD45(+)
What is the cell of origin in Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
B cell
What are the clinical course of Nodular lymphocyte predominate Hodgkin lymphoma (NLPHL)?
Indolent.
Frequent relapses
