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Heme > Lymphocytes and lymphoma > Flashcards

Lymphocytes and lymphoma Flashcards

1
Q

List causes of lymphopenia

A 
aplastic anemia
AIDS
immunodeficiency
lymphomas- ex advanced stage Hodgkins
steroid/ immune suppressive treatment
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2
Q

List causes of lymphocytosis

A

EBV infection
Bordatella pertussis
CLL

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3
Q

Small mature appearing lymphocytes are seen in :

A

CLL

pertussis in childhood

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4
Q

______ are poorly differentiated cells seen in ALL

A

lymphoblasts

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5
Q

_______ lymphocytes have a large polygonal nucleus, abundant blue cytoplasm, and a few distinct red granules. They skirt the edges of nearby RBCs

A

reactive/ atypical

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6
Q

______ lymphocytes are seen in viral illness, drug reactions, and have a kidney bean shaped nucleus and a few large red granules

A

Large rangular

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7
Q

______ lymphocytes synthesize IgM and are characteristic of Waldenstrom’s macroglobulinemia

A

Plasmacytoid

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8
Q

Describe the arrangement of B and T cells in lymph nodes

A

B cells aggregate in primary follicles, arrayed around the cortex of the lymph node, while T cells take up residence between these follicles (perifollicular region) and extend down into the
medulla

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9
Q

Describe the epidemiology of Hodgkins in terms of age

A

Bimodal distribution, common in ages 20-40 and 60-80

More common in men

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10
Q

What presenting symptom is common to all lymphomas?

A

painless swelling of lymph nodes

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11
Q

Hodgkin’s lymphoma is ____ in 70-80% of cases

A

curable

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12
Q

____ immune function is poor in Hodgkin lymphoma, whereas ___ immunity is more likely to be deficient in the B cell and T cell lymphomas

A

T cell in Hodgkin

Humoral immunity in B/T cell lymphomas

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13
Q

Due to abnormalities in cellular immunity in Hodgkin lymphoma, what sort of infections are patients at risk for?

A

Fungal, viral infections
skin test anergy
Immunoglobulin production is preserved

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14
Q

Reed-Sternberg cells are derived from _____ cells but usually lack CD20, CD19, CD45. They express CD____

A

B cells, express CD30

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15
Q

List some lab abnormalities seen in Hodgkins lymphoma

A

normocytic anemia
lymphopenia
elevated ESR
elevated LDH

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16
Q

What is the most important prognostic marker in Hodgkin’s lymphoma?

A

Stage of disease

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17
Q

Describe the characteristics of indolent lymphomas

A

generally slower-growing, composed of more mature cells, and, although they are often treatment-responsive, incurable.
They affect mainly older individuals.
May chose not to treat if asymptomatic

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18
Q

Describe the characteristics of aggressive lymphomas

A

faster-growing and composed of less mature cells. They generally exhibit relentless (and in some cases very rapid)
progression and are fatal if untreated. However, in contrast to low grade lymphomas, many patients can be cured with treatment.

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19
Q

What is the most common indolent lymphoma?

A

Follicular lymphoma

20
Q

What is the most common aggressive lymphoma?

A

DLBC lymphoma

21
Q

List the genetic abnormality associated with follicular lymphoma and its pathological effects

A

t(14;18)- IgH + Bcl-2

causes decreased apoptosis (slow growing accumulation of cells)

22
Q

List the genetic abnormality associated with large cell lymphoma and its pathological effects

A

t(3;14)- IgH + Bcl-6

causes decreased transcription

23
Q

List the genetic abnormality associated with plasmacystoid lymphoma and its pathological effects

A

t(9;14)- IgH + PAX5

unknown effect

24
Q

List the genetic abnormality associated with mantle cell lymphoma and its pathological effects

A

t(11;14) IgH + cyclin D

causes increased proliferation

25
Q

List the genetic abnormality associated with Burkitt’s lymphoma and its pathological effects

A

t(8;14)- IgH + c-myc

causes increased proliferation

26
Q

In ________ lymphoma, bcl2 is placed under control of the IgH promoter, leading to an increased _______ threshold

A

follicular

apoptotic

27
Q

In ______ lymphoma, c-myc is placed under control of the IgH promoter causing _________

A

Burkitt’s

increased proliferation

28
Q

More than 2/3 of patients with B cell lymphomas have ____ disease at diagnosis; many have extranodal disease.

A

disseminated

29
Q

What is the most important prognostic marker in non-Hodgkins lymphoma?

A

Histologic subtype

30
Q

What drug is used against some aggressive lymphomas, and what is its mechanism of action

A

rituximab, anti-CD20

31
Q

Contrast the goals of treatment in aggressive vs indolent NHL

A

the goal of treatment in patients with indolent NHL is control of symptoms and improvement in quality of life, while the goal of treatment in a newly-diagnosed
patient with aggressive lymphoma is cure of the disease

32
Q

List some prognostic markers for NHL

A 
age
pathologic classificaiton
immunologic function
growth rate
site (ex brain is very poor)
LDH levels
performance status
33
Q

Describe features of infectious mononucleosis caused by EBV

A

fever, sore throat, fatigue, lymphadenopathy

lymphocytosis with preponderance of atypical lymphocytes

34
Q

Despite the fact that EBV
preferentially infects _____, the circulating atypical lymphocytes are mainly _____ cells that
react specifically to EBV-produced antigens.

A

infects B cells

circulating lymphocytes are CD8+ T cells

35
Q

What are SPECIFIC tests for infectious mononucleosis

A

assay for antibodies against components of EBV-
early rise in IgM against viral capsid antibody
IgG against VCA persists for life
Antibody against EBNA develops after several weeks

Quantitative PCR for EBV virion number

36
Q

What immunophenotype is associated with CML?

A

Expresses CD5 and CD19, CD20, CD23

37
Q

What cell types are seen in CLL?

A

Smudge cells, as well as normal appearing small lymphocytes

38
Q

CLL will have a skewed _____ ratio

A

kappa: lambda

39
Q

Presence of CD____ distinguishes mantle cell lymphoma from CLL

A

CD23- positive in CLL/ negative in mantle cell

40
Q

In CLL, it is common to see a combination of immunodeficiency and a propensity towards autoantibody-mediated immune
phenomena, particularly:

A

autoimmune hemolytic anemia and immune thrombocytopenia (ITP)

41
Q

What factors contribute to the immunodeficiency in CLL?

A
  • decreased levels of normal immunoglobulins

- T cell deficiency (anergy on skin tests, poor response to vaccination, susceptible to bacterial and viral infections)

42
Q

Malignant B cells in CLL secrete ______ to inhibit T cell function

A

immunosuppressive cytokines, ex TGF-B; cell surface receptors such as CD27

43
Q

What explains the autoimmunities seen in CLL?

A

manifestation of dysregulation of the immune system, with resultant loss of tolerance to self-antigens.

In some cases the autoantibodies
are produced by the leukemic cells themselves, but more often they are produced by
“normal” (non-neoplastic) B-cells.

44
Q

CLL can transform into _______ lymphoma

A

large cell lymphoma

“richter’s transformation”

45
Q

What treatment is needed for patients with CLL?

A

None if asymptomatic

rituximab if rapidly progressing

Heme (9 decks)

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