Lymphoma Flashcards
How do lymphomas differ in general from leukemias?
they start in the lymph nodes (not the bone marrow) and can only be lymphoid
What are the two general classifications for the lymphomas?
Hodgkin’s and Non-Hodgkin’s
Just to stay grounded…what’s the most common cause of lymphadenopathy? What’s the most common malignant cause of lymphadenopathy?
benign reaction to infection
metastatic carcinoma
What forms in the lymph nodes with antigen stimulation?
secondary follicles - germinal centers
What do we call the dark ring around one half of the germinal center?
mantle zone
What type of macrophages are located near the mantle zones of germinal centers and get stuffed with debris?
tingible body macropahges
WHat do you call it when there’s a collection of large irregular follicles that have a mixture of cells and tingible body macrophages in a B-cell response to an immune stimulus?
benign follicular hyperplasia
What do you call it when you have proliferation BETWEEN follicles?
benign interfollicular hyperplasia
What does “partial effacement” mean in the context of interfollicular hyperplasia?
it means the lymph nodes is not completely replaced in the proliferation process (if it was, that wouldn’t be benign)
How does an interfollicular hyperplasia differ from a benign follicular hyperplasia (bsides where the proliferation occurs)?
follicular = B cell interfollicular = T cell
Does NHL follow a predictable progression, or does it jump around?
it jumps around - this makes it hard to treat
Is NHL mostly B cell or T cell?
B cell
What are the symptoms of NHL?
painless but firm lymphadeopathy
extranodal manifestations
“b symptoms” - weight loss, night sweats, fever
If you don’t have B symptoms, what’s your classification? Better or worse prognosis?
A -better prognosis
How do low-grade and high-grade NHLs differ?
low: older patients, indolent (indurable), small, mature cells, non-destructive
high: can be younger patietns, aggressive (but sometimes curable), big, ugly cells, destructive
What are the four types of low grade NHL?
small lymphocytic lymphoma
malt lymphoma
follicular lymphoma
mycosis funngoides
What are the 3 high grade NHL?
large cell lymphoma
lymphoblastic lymphoma
burkitt lymphoma
What is small lymphocytic lymphoma the same as?
CLL!
it’s small mature lymphocytes, B-cells with CD5+ markers, long course, death from infection
What transformation can low grad elymphomas undergo to become a high grade lymphoma?
the Richter transformation - not a good thing
Describe marginal zone lymphoma.
It’s actually a bunch of lymphomas, but you see a marginal zone pattern of staining (an area of light-staining around a germinal center) in the lymph nodes (when normally it’s just in the spleen).
What’s the most common type of marginal zone lymphoma?
Malt lymphoma
What’s the odd treatment if you catch malt lymphoma early?
Give antibiotics against H. pylori and many of them are completely cured - biazarre
Describe mantle cel llymphoma.
you have small angulated lymphocytes in mantle zone patterns
What’s the genetic abnormality in mantle cell lymphoma?
t(11:14) - you get cyclin D paired with an IgH, which is constitutively expressed, so you get constant expression of cyclin D, which helps the cell continue thoruhg the cell cycle
Describe follicular lymphoma.
it’s a lymphoma that develops in a follicular pattern - but they’re not folicles. they start in the germinal center. Can be small cells (grade 1), mixed cells (grade 2) or big cells (grade 3)
What’s the genetic abnormality in follicular lymphoma?
t(14:18) - Bcl2 gets paired with IgH, so you get lots of Bcl2 to protect the cells from apoptosis
What sort of odd cell will you see in follicular lymphomas?
butt cells
How do you stage a follicular lymphoma?
1 - single node
2 - two or more nodes on the same side of the diaphragm
3 - lymph nodes on both sides of the diaphragm
4 - diffuse extranodal involvement
(and then A or B depending on symptoms)
How does mycosis fungoides/sezary syndrome present?
You get skin lesions that are often mistaken for psoriasis or eczema. They eventually become raised and almost look like mushrooms - can develop into leonine facies
What do we call the lymphocytes seen in mycosis fungoides?
cerebriform lymphocytes (they look like brains)
Is mycosis fungoides T cell or B cells?
T cell
For diffuse large-cell lymphoma…B or T cells? Extranodal involvement common or uncommon? Growth slow or rapid? Prognosis good or bad?
B cells (usually)
extranodal involvement common
grows rapidly
bad prognosis
What are the two types of lymphoblastic lymphoma? What is it the same as?
B and T
It’s the same as acute lymphoid leukemia!
What group of patients is often affected by T cell lymphoblastic lymphoma?
Teenage boys with mediastinal mass
What’s the most common presentation of Burkitt Lymphoma?
A child with fast-growing, extranodal mass (often in the abdomen or mandible)
What’s the classic histology appearance of a Burkitt Lymphoma?
starry sky pattern
What’s the “sky” and what’s the “stars”
The sky is the proliferatin lymphoblasts
the stars are tingible body macrophages
What’s the genetic abnormality seen in Burkitt Lymphoma?
t(8:14) - you get c-myc paired with IgH
What do the cells look like in Burkitt Lymphoma?
large - dark purple centers and beautiful dark blue rims with punched-out vacuoles
Where in the world is adult T-cell leukemia/lymphoma found?
most commonly in Japan and the caribbean basin
What virus is associated with adult T-cell lymphoma?
HTLV-1
How does adult T-cell lymphoma present?
- skin lesions
2. hypercalcemia
What cell is absolutely characteristic for Hodgkin’s Lymphoma?
Reed-sternberg cells - they are ENORMOUS with owl’s eyes (two big nuclei with darker nucleoli)
Who usually gets HL?
younger males in their 20-30s
HL better or worse prognosis than NHL?
better - because it progresses as contiguous spread, so it’s predictable and easier to treat
For Nodular lymphocyte-predominance Hodgkin lymphoma: who gets it? with what symptom? good or bad prognosis? b or t cells?
young male - asymptomatic except for cervical lymphadenopathy
good prognosis
B cells
What’s the classic variation on reed-sternberg cells you see in nodular LP hodgkins?
popcorn cells
What’s the most common subtype of HL?
nodular sclerosis HL
nodular sclerosis HL: good or bad prognosis?
good prognosis
What’s the typical Reed-sternberg cell variant you see in nodular sclerosis HL?
lacunar cells
What type of Hodgkin’s has the worse prognosis?
mixed cellularity HL
Why does lymphocyte-rich hodgkin lymphome have a relatively good prognosis?
it’s usually localized at presentation
What reed-sternberg variant do you see in lymphocyte-rich HL?
popcord cells again
Is lymphocyte depletion HL also localized at presentation, or disseminated?
disseminated
WHat’s the background made up in lymphocyte depletion HL?
collagen or reticulin
For prognosis of HL, what’s more important: stage or subtype?
stage
HL is often relativley easy to treat with surgery, chemo and radiation. So what’s the main concern?
Since these patients are relativley young, they live for a long time after chemo and radiation, so run the risk of secondary malignancy which is harder to treat
