Lymphoma Flashcards
What are the sub types of non-Hodgkin’s lymphoma?
Small B cells - follicular, mantle cell, marginal zone, small lymphocytic lymphoma (CLL)
Intermediate-sized B cells - Burkitt lymphoma
Large B cells - diffuse large B cell lymphoma (DLBCL)
What is a lymphoma? Where does it usually arise? What are its two main classifications?
Neoplastic proliferation of lymphoid cells that forms a mass. May arise in a lymph node or in extra nodal tissue. Divided into Hodgkins (40%) or non Hodgkin lymphoma (60%).
Which lymphoma (NHL) or (HL) is contiguous and rarely extranodal, no leukemic phase, arises in young adults, predominantly reactive cells?
HL
Which lymphoma (NHL) or (HL) is diffuse (often extranodal), leukemic phase, arises in late adults, composed of lymphoid cells?
NHL
What is follicular lymphoma? When does it present? What is the chromosomal translocation and what does it cause? Tx?
Neoplastic proliferation of small B cells (CD20+) that form follicle-like nodules. Presents in late adulthood with painless lymphadenopathy. T(14;18) translocation. BCL2 on chromosome 18 translocates to IgG heavy chain locus on chromosome 14. Over expression of Bcl2 inhibits apoptosis. Tx is for symptomatic pts and involves low dose chemotherapy or rituximab (anti-CD20 antibody)
What can follicular lymphoma progress to? How does it present?
Can progress into diffuse large B cell lymphoma. Presents as an enlarging lymph node.
Which disease has disrupted lymph node architecture, no tingible body macrophages, Bcl2 expression in follicles, monoclonality?
Follicular lymphoma
Which disease has normal lymph node architecture, tingible body macrophages, no Bcl2 expression in follicles, polyclonality?
Reactive follicular hyperplasia
What is mantle cell lymphoma? When and how does it present? What mutation drives it?
Neoplastic proliferation of small B cells (CD20+) that expands the mantle zone. Presents in late adulthood with painless lymphadenopathy. Driven by t(11;14) which is a cyclinD1 gene to IgH heavy chain locus on chromosome 14. This promotes G1/S transition in the cell cycle facilitating neoplastic proliferation.
What is marginal zone lymphoma? What is a MALToma and how would you treat it? What cells are in the marginal zone? What is it associated with?
Neoplastic proliferation of small B cells (CD20+) that expands the marginal zone. Marginal zone is formed by post germinal center B cells. Associated with chronic inflammatory states such as Hashimoto thyroiditis, Sjögren syndrome, H. Pylori gastritis
MALToma is marginal zone lymphoma in mucosal sites. It may regress with H. Pylori treatment
A 4 yo Senegalese child presents with a large mass on his jaw. Prior history shows that he was infected with the Epstein-Barr virus. What does he have and what are the two variants? What translocation are causing it and how does it cause disease. What would you see on histology?
He has Burkitt lymphoma which Neoplastic proliferation of small B cells (CD20+) that is associated with EBV. African variant involves the jaw, sporadic form involves abdomen. T(8;14) translocation of c-myc to the IgG heavy chain locus on chromosome 14. Over expression of c-myc oncogene promotes cell growth. See high mitotic index and ‘starry-sky’ appearance on microscopy.
What is diffuse large B cell lymphoma? How does it arise? What grade is it clinically? When and how does it present?
Neoplastic proliferation of large B cells (CD20+) that grow diffusely in sheets. Most common form of NHL. Clinically aggressive (high grade). Arises sporadically or from transformation of a low grade lymphoma such as follicular lymphoma. Presents in late adulthood as an enlarging lymph node or an extranodal mass.
