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Heme > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

Describe the age distribution of cases of Hodgkin and non-Hodgkin lymphomas.

A

Hodgkin: bimodal with peaks at early twenties and again in the 80’s
Non-hodgkin’s steadily increases with age after middle-age

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2
Q

Name and describe the characteristic cell of Hodgkin lymphoma

A

Reed–Sternberg cells are large and are either multinucleated or have a bilobed nucleus (thus resembling an “owl’s eye” appearance) with prominent eosinophilic inclusion-like nucleoli
note that this cell is not the predominate cell

“crippled germinal center B -cell” it does not have normal B cell surface antigens and rearranged but not non-functional immunoglobulin genes

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3
Q

What are key clinical features of Hodgkin’s lymphoma.

A 
seen in young adults
B symptoms: fevers, night sweats, wt. loss
pruritis
cough/SOB due mediastinal mass (typical)
pain 
painless adenopathy
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4
Q

What are the goals of staging Hodgkin’s disease?

A

plan treatment
evaluate tx. results
formulate prognosis
research communication

I: one node lymphoma site
II: node lymphoma only one side of the diaphragm
III: node lymphoma on both sides to the diaphragm
IV. infiltration of organs

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5
Q

Contrast the spread of Hodgkins and non-Hodgkin’s disease and way in which we approach patients with either disease.

A

HL: tends to spread to contiguous nodal groups although common to have a localized presentation (esp. mediastinal); approach determined where the disease is located; treatment to cure

NHL: is often widespread by time of diagnosis; approach dictated by histologic subtype; treatment depends on subgroup (acute or indolent)

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6
Q

Contrast the differentiation of B-cells in the bone marrow v. in the follicular center

A

Differentiation from stem cell to the mature B cell in the bone marrow is antigen-independent.
Differentiation from follicle-center B cell to plasma cell occurs in the germinal centers of the secondary lymphoid organs and is antigen-dependent

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7
Q

There are three processes of rearrangement in B-cells that can play a role in malignant transformation due to the high genomic pressure, they include _____, _____, and ______

A

receptor editing
class switching
somatic hypermutation**

these can all be normal parts of affinity maturation

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8
Q

How is inflammation and infection related to development of lymphoma?

A

greater antigen stimulus increases receptor editing and somatic hypermutation (more chance for error/mutation), this can also occur in increased cell proliferation of inflammation

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9
Q

Translocation that causes a change in transcriptional deregulation is most likely to cause ________ while translation causing a fusion protein is more like in ________.

A

transcriptional deregulation: lymphoma (except ALCL and MALT)
fusion protein: leukemia

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10
Q

Name the corresponding cancer with the following oncogenes: bcl-1, bcd-2, my and bcd-6.

A

bcl-1: Cylcin D1, t(11:14) leads to mantle cell lymphoma
bcl-2: anti apoptotic t(14:18) leads to follicular lymphoma
myc: proliferation signal t(8;14) Burkitt’s
bcl-6: transcription factor t(3;14) DLBCL

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11
Q

Contrast the initial presentation of indolent and aggressive NHL.

A

indolent: painless adenopathy
aggressive: present with symptoms: night sweats, fever, pain

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12
Q

Why is reliable hematopathology crucial in NHL?

A

approach, treatment and prognosis is dictated mainly by histology

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13
Q

When would you want to treat a patient with indolent NHL?

A

when :
patient begins to experience constitutional symptoms
compromise of vital organ by infiltrate
bulky adenopathy
rapid progression or other evidence of transformation

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14
Q

When would you want to treat aggressive NHL?

A

admin. most effective therapy at diagnosis, if not cured, patients are likely to die within months to a year of diagnosis

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15
Q

What is the risk stratification system used for aggressive NHL?

A

international prognostic index (IPI)

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16
Q

Name three different diseases which can present as either leukemia or lymphoma.

A

lymphoblastic
Burkitts
CLL/SLL

17
Q

Name the most common adult leukemia in the western world and describe how it is usually diagnosed.

A

chronic lymphocytic leukemia

patients are often asymptomatic and are often diagnosed on routine blood work with isolated lymphocytosis

18
Q

What are the clinical manifestations of CLL/SLL?

A

marrow failure (anemia, thrombocytopenia, neutropenia)
lymphadenopathy and splenomegaly
recurrent infections
automimmune cytopenias

*note prognosis can be stratified by identifying cytogenetic causes using FISH [del (17) is bad news]

19
Q

Name 3 possible mechanisms that anti-20 monoclonal antibody rituximab uses to kill malignant cells.

A
  1. induces complement binding and complement-dependent cytotoxicity
  2. signals effector cells in antibody-dependent cell-mediated cytotoxicity
  3. inducing apoptosis
20
Q

Name disease associated with Epstein-Barr virus.

A 
infectious mononucleosis
chronic active EBC infection
nasopharyngeal carcinoma
Burkitt's Lymphoma
Hodgkin's disease
Post transplant lymphoproliferative disorder
21
Q

Why is Epstein Barr virus included in the chapter about lymphomas?

A

Epstein-Barr Virus can cause a lymphocytosis due to virus infection of B-cells

the vigorous cellular response keeps transformed immunoblast under control, the virus usually persists in a small fraction of the resting B-cell population and can reactivate on immunosuppression

22
Q

Precursors to T or B lymphocytes can produce ____ ____. B cells, T cells and rare NK cells are more likely to cause ______.

A

precursors: lymphoblastic leukemia or lymphoma

differentiated cells: non-hodgkins and hodgkin (only B- cells) lymphoma

23
Q

Numerous smudge cells are characteristic of what?

A

CLL (due to fragility of the cells)

24
Q

Name distinguishing features of a reactive or “atypical” lymphocyte

A

1:1 N:C ratio, often nucleolus is present

25
Q

Young patient with lymphocytosis, the most likely diagnosis is_______?

A

reactive/benign process such as mononucleosis or other viral illness

lymphocytosis is mostly due to CD8+ reactive T-cells

26
Q

What is a hairy cell lymphocyte characteristic of?

A

B-cell lymphoma where most of the disease is present in the spleen and in the marrow causing pancytopenia

27
Q

If the lymphoma hugs right up against the bone marrow in section, what does that tell you about the infiltrate of bone marrow?

A

there is a lot of lymphoma in the bone marrow

28
Q

What can kappa or lambda light chains of B cell Ig molecule tell you about B cell proliferation?

A

monoclonal expansion will cause there to be skewing of the normal 3:1 ratio of kappa to gamma light chains

29
Q

If you suspect CML, which is the most convent confirmatory test?

A

confirm with flow cytometry, can show the distribution of cell marker,

also helpful in dx. of CLL

30
Q

Clonality of cells can by analyzed by PCR, analysis would show what in the case of clonal expansion?

A

if a clonal population dominates, that PCR band will stand out on analysis

31
Q

Which layer of cells is adjacent to the germinal center?

A

mantle which is surrounded by the marginal zone

32
Q

What are tingle body macrophages?

A

macrophages that are located in the germinal center that destroy failed B-cells, they are seen in normal tissue sample and may contain other cells (or parts) which have been digested

33
Q

How is follicular lymphoma distinguished from follicular hyperplasia.

A

there are numerous proliferative follicles with poorly defined mantles which cause the nodes to run together

34
Q

A rather homogenous appearance of lymph nodes, with little regularity to germinal centers (pseudofollicules) with proliferating B-cells is apparent in which lymphoma?

A

CLL/SLL

35
Q

Very diffuse appearance of lymphoma composed of large cells is called what?

A

diffuse large B cell lymphoma

36
Q

Classic marker stained for Hodgkin’s is ____.

A

CD30, also CD3

37
Q

Expression of bcl-2 or bcl-6 are characteristic of which diseases?

A

bcl-2: follicular lymphoma

bcl-6: diffuse large B-cell lymphoma

38
Q

What would peripheral cells that are CD20, CD5 positive be diagnosed?

A

CLL

Heme (14 decks)

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