lympho Flashcards
Non hodgkin
Haphazard mode of spread
Leukemia phase
Involves extranodal sites
Secondary site of production of lymphocytes
Lymph node
spleen
peyer’s patches
Tertiary lymphoid organs
Acquired lymphoid tissues in stomach, skin, respiratory and reproductive tracts
major cells in cortex of lymph node
B cells
major cells in paracortex
T cells
implication of expansion of paracortex
CMI response
majority of T cells are CD4+
True or false
true
which cells do medullary cordds contain
Transformed lymphoid cells and plasma cells
lypmphocytes from circulation enter node via
high endothelial venules in paracortex
do follicles in newborn have germinal centres
no
where does lymph eventually drain to
thoracic duct and SVC
LAP anatomical site and disease
Post auricular node
occipital nodes
post cervical nodes
axillary node
Rubella
Scalp infections
toxoplasmosis
infection of arm
type of lymphadenopathy in TB
Granulomatous lympadenitis
Suppurative granulomatous LAP seen in
LGV
Cat scratch disease
types of reactive hyperplasia
Follicular hyperplasia
Paracortical expansion
sinus histiocytosis
dermatopathic lymphadenopathy(xterised by lipomelanic reticulosis)
Sinus histiocytosis with massive lymphadenopathy(Rosai-Dorfman syndrome)
febrile disease in children and young adults. bilateral cervical LAP. some patients have immune deficiency
kikuchi disease
necrotizing histiocytic
SLE like disease
cervical LN
AIDS related LAP
Severe follicular hyperplasia
- Regressive follicular hyperplasia
- Follicular involution, progressing to
lymphocyte depletion. Helper T-cells are reduced and suppressor T-cells are increased in the germinal centres
which malignant lesions may seen in AIDS
Kaposi sarcoma
HL
NHL
On what basis do we classify lymphomas as HL Or NHL
presence or absence of Reed-Stenberg cells
lymphomas may be only nodal
false
can be extranodal
Apart from R-S cells, which other cells can be found in HL
Lacunar cells
Lymphocytic cells
Histiocytic(popcorn)
Hodgkin cell
Hodgkin lymphoma
tumor of germinal centre B - cell with non-productive Ig gene arrangements
Characteristic giant cell in HL
H-RS cell
Characteristic giant cell in NLPHL(nodular lymphocyte predominant hodgkin lymphoma)
L and H cell
it is a type of Hodgkin lymphoma but not a classical one.
mature b cell lymphoma
term given to how or why HRS cell escape apoptosis
fail to undergo negative selection
role of NFKB in HL pathogenesis
upregulates pro-proliferative and anti-apoptotic gene expression programme in lymphocytes in inflammation
which gene is highly mutated in HL and what’s its function
A20
regulates activity of NFKB
Is A20 mutatiion only found in HL
No
also in DLBCL
Extranodal MZL
Mechanisms by which HRS cells are resistant to apoptosis
expression of CFLIP (antiapoptic protein) inhibition of caspase 8 cleavage a20 mutation lack b cell receptor lineage promiscuity more in monozygotic twins
role of EBV
Via LMPS- latent membrane proteins
2 - shuts down BCR expression
1 - leads to NFKB activation. 2 can do same.
this upregulation inhibits fas signalling
key difference between NLPHL and HRS
HRS cells of CHL lack Bcl-6 proteins
what HRS cells secrete
TH 2 cells cytokines and chemokines
Classification of HL
Nodular sclerosis
mixed cellularity
lymphocyte depleted
lymphocyte rich
nodular sclerosis
predilection for mediastinal lymph nodes
dominated by lacunar cells
graded 1 and 2 with 2 being worse
mixed cellularity
younger age
EBV+
Lymphocyte depletion
previously diagnosed as anaplastic carcinomas or high grade NHLs
HIV+
Aggressive but curable
lymphocyte rich
no eosinophils
rare
ebv negative
Staging of Hodgkin lymphoma
I – A single lymph node or a single extralymphatic organ
II- 2 or more groups of lymph nodes on the same side of diaphragm or localized involvement of an extralymphatics organ or site(IIE)
III- Lymph nodes on different side of diaphragm without or with involvement of an extralymphatic organ or site (IIIE)
IV- Diffuse involvement of 1 or more extralymphatic organs or sites with or without lymphatic involvement
Etiology of NHL
Congenital and acquired immune state Ebv T cell leukemia GMZL H pylori Sunlight EM field Herbs, pesticides Hep C virus Hair dressing Petrochemicals
2 types of lymphoid leukemia
B cell acute or lymphoblastic leukemia or lymphoma
T cell acute or lymphoblastic leukemia or lymphoma
Follicular lymphoma in gastric biopsy
CD 10
Bcl 2
Which sites does Burkitt Lymphoma usually affect
Jaw
Abdominal organs
What two factors govern the geographical distribution of BL
Temperature… Over 60F 15.5C
Humidity…. High
BL Belt
10 15 N S equator
Where is BL rare
High land
Dry arid area
Cold area
Etiology of Burkitt Lymphoma
EBV infects B cells and nasopharyngeal epithelium.
T cell immunity required for control of EBV infection.
Deficiency in t cell immunity
Malaria… T cell immunodeficiency
Translocation of cmyc oncogene
Translocation of cmyc oncogene
8 14
8 22
2 8
Clinical presentation of BL
Jaw more in maxilla than mandible
Abdominal mass
CNS
Other organs repro thyroid kidneys
Clinical presentation of BL
Jaw more in maxilla than mandible
Abdominal mass
CNS
Other organs repro thyroid kidneys
Appearance in histology
Starry sky appearance
Markers in BL
CD 20
CD 10
Ki67
Negative for bcl2
Indolent disease Ema Positive with pop corn cells and respond to local chemotherapy
NLPHL
Staging of BL
A - single extra abdominal mass
B - Multiple extra abdominal mass
C - Abdominal mass with or without facial tumor
D - Abdominal mass with sites of tumor other than facial or bone marrow
AR - Abdominal mass with >90 of tumor resected
