Lymphoma

Question 1

Markers

Answer 1

B cell: CD19, CD20, CD22
T cell: CD3, CD4, CD5, CD8
Germinal center: BCL6, CD10

Question 2

CLL/SLL

Answer 2

30% of leukemias: ~65 year old, males 2X
Small cells with scant, agranular cytoplasm
Smudge cells, basket cells, prolymphocytes
Positives: CD5, CD19, CD23

Question 3

Follicular lymphoma

Answer 3

40% of lymphomas: ~60 years old, equal sex
Neoplastic follicles are homogenous
No dark/light zone or tingible body macrophages
t(14;18)(q32;q21) BCL2
BCL2: suppress apoptosis of clonal abortion
Positives: CD19, CD20, CD10, BCL6, BCL2

Question 4

Mantle Cell lymphoma

Answer 4

6% of NHL: ~60 years, males 2X
Effacement of node and diffuse infiltrate
Small-medium size tumor cells
t(11;14)(q13;q32) - BCL1 overexpression
BCL1 binds CDK4/6 - Rb phosphorylation
Positives: CD19, CD20, CD5, BCL1

Question 5

Burkitt’s Lymphoma

Answer 5

Medium sized cells with basophilic nucleoli
“Starry sky” infiltration into node
Endemic - African kids, jaw/abdomen, 95% EBV
Sporadic - youngish, ileocecal, 30% EBV
Immunodeficiency - in HIV, 35% EBV
t(8;14)(q24;q32) - MYC
Positive: CD19, CD20, CD10, BCL6, MYC
Aggressive but good cure if treated aggressively

Question 6

Plasma cell neoplasms

Answer 6

Proliferation of plasma cell secreting single Ig
Detect M protein in urine/serum
Most originate as bone marrow tumors

Question 7

Multiple Myeloma (Plasma Cell Myeloma)

Answer 7

~68 with back bone from bone lesions and fatigue
M protein, CRAB, bone marrow plasma cell clones
Lytic bone lesions in large bones

Question 8

MGUS

Answer 8

Ig monoclonal evidence in urine/serum
M component less than myeloma level
Marrow plasmacytosis less than 10%
No lytic bone lesions or myeloma symptoms
Transforms in PCM 1.5%

Question 9

Solitary plasmacytoma of bone

Answer 9

Localized tumor of bone made of monoclonal plasma cells
Only bone, no other of the CRAB
Absent or low level M protein

Question 10

Extraosseous plasmacytoma

Answer 10

Localized plasma tumor outside of bone
~55 males 2X
75% present in upper respiratory tract

Question 11

CHL

Answer 11

Malignant cells less than 2% of tissue
Reed-Sternberg cells - large, multiple nuclei, large eosinophilic nucleus, ample cytoplasm
Positives: CD15, CD30
Negative: CD45

Question 12

Nodular sclerosis

Answer 12

70% of CHL mostly in young females
Thickened node with collagen bands
Lacunar cells - clearing around nucleus
EBV in 20%

Question 13

Mixed cellularity

Answer 13

25% of CHL in children and older patients
Lack broad collagen bands
May see Reed-Sternberg cells
EBV in 75%

Question 14

Lymphocyte rich

Answer 14

5% of CHL
Lack broad bands of collagen
Reed-Sternberg cells are rare

Question 15

Lymphocyte depleted

Answer 15

Less than 1% of CHL
Few lymphocytes, many weird RS cells
Majority with EBV