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PATH3309 > Lymphoma Diagnosis > Flashcards

Lymphoma Diagnosis Flashcards

1
Q

Riddle me this…

81 yo femaile

Feels well

Lump in left and right groin

  • Present for long time - severl months
  • Fimr confluent mass up to 3cm
  • No rashes, no signs of infect

Full blood picture unremarkable
- WCC 8.7

Prolonged nature and size
- Sent for biopsy

Small lymphocytes
- Unremarkable - maybe low grade

Shitt tonne of germinal centers
- Abnormal shapes

Few T cells

Negative cyclingD1

Flow cytometry (normal)

  • Clonal (lambda light chain restricted
  • B cell (CD19, CD20)
  • CD10

Histology

  • Follicular pattern
  • B cell (CD20), germinal center (BCL6, CD10)
  • Abberant BCL2 expression
A

Could be:

Small lymphocytic lymphoma/leukaemia (SLL/CLL)
- Similar to chronic lymph

Follicular Lymphoma
- Germinal center expansion

Mantle cell lymphoma
- Overexpression of cyclin D1

FOLLICULAR LYMPHOMA
- But what is grade?

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2
Q

What can you do with a fresh lymph node?

A

Triage in lab for

  • Micobio
  • Flow cutometry
  • Histo (PRIORITY if limited tissue)
  • Possibly, frozen, FISH cytogenetics
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3
Q

Whats one of the first things you do?

A

Scrape onto slide and rapid H+E stain

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4
Q

What is the processfor a fresh node triage?

A

Cut surface smear + rapid H+E

Granulomas/necro = micro next

Anaplastic cells = electron micro

mixed small lymph - flow

high grade lymph - fish

limited tissue - histo only

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5
Q

What does CD20 stain?

A

B cells

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6
Q

What does CD3 stain?

A

T cells

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7
Q

What does CD10 stain?

A

Germinal center (membrane)

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8
Q

What does BCL6 stain?

A

Germinal center (nucleus)

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9
Q

How can you tell if normal germinal centers?

A

Send off to test for clonality via flow cytometry or gene rearrangement studies

Can test for aberrant immunophenotype
- Flow or immunohistochemical stains

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10
Q

What is BCL2?

A

Anti-apoptotic marker

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11
Q

What expresses BCL2?

A

Normal T cells, resting B cells

B cells down regulate

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12
Q

How can you tell if its actually B cells expressing BCL2, not just T cells chilling in germinal center?

A

Compare BCL2 stain with CD3 stain of same node

If not may T cells, then it is abberant expression of BCL2

Rekt

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13
Q

How do you test for the more aggressive mantle cell lymphoma?

A

cyclinD1 via immunohistochemistry

If +, mantle cell lymphoma

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14
Q

What are kappa and lambda light chains?

A

Compose immunoglobulin of antibody (light chains)

Each B cell expressing only one class of light chain

Typically kappa lambda ratio is 3:1 in serum

If significantly higher chain than other, probably malignant condition e.g. lymphoma

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15
Q

What does CD21 stain for?

A

Stains to see if Follicles have retained networks

Stains follicular dendritic cells

That there is no bleedthrough in, forming DLBCL
- Diffuse large B cell lymphoma

Used in grading of follicular lymphoma

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16
Q

How are lymphoma graded to do with centroblasts?

A

Depending on ratio of centroblasts to centrocytes

Neoplastic cells are mostly centroblasts

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17
Q

What is a centroblast?

A

An activated B cell that is enlarged and proliferating

Large number means malignancy

Larger looking cell

18
Q

What is MIB1?

A

Proliferation marker

19
Q

What happens after you tell docs its a follicular lymphoma?

A

PET Scan

Picks up metabolically active areas

20
Q

What does staging involve for hodgkin and non hodgkin lymphoma?

A

The spread of the lymhpoma

Renal liver function
HIV, Hep
Bone marrow trephine
CT scan - mass lesions
PET scan - metabolic activity
Performance status
21
Q

What does indolent mean?

A

Causing little or no pain

22
Q

Is follicular lymphoma curable?

A

No

Generally indolent though

23
Q

When would you treat follicular lymphoma?

A

Generally left untreated unless

  • Progressive disease or bulky
  • Organ dysfunction
  • Systemic B symptoms
  • Cytopenias (marrow infiltration)
24
Q

What is a cytopenia?

A

Low blood cell count (any blood cell)

25
Q

What is the common genetic fusion in follicular lymphoma?

A

t(14;18)(q32;q21)

BCL2-IgH fusion
= 90% of FL

BCL2 - antiapoptopic proten

Upregulated by IgH

26
Q

What happens genetically if follicular lymphoma progresses to double hit lymphoma?

A

Additional MYC or BCL6-breakapart associated with transformation and poor prognosis

MYC = pro proliferation

BCL and MYC = rekt

27
Q

How is DLBCL treated?

A

R-CHOP

  • Retuximab (anti-CD20)
  • Cyclophosphamide
  • Doxorubicin
  • Vincristine
  • Prednisone

Palliative radiation therapy

28
Q

Whow is double hit follicular lymphoma treated?

A

More intese

HyperCVAD

29
Q

Riddle me this one fewl….

29yo male

Neck swelling slowly progressing

Night sweats

Weight loss (10kg), fevers

No travel

CT showed extensive lymphadenopathy

Lymph node biopsy followed by PET
- Lots of node involvment

Macro:
- Nodular appearence to naked eye with fibrosis

Micro:
Many histiocytes - send to micro
- Granulomas
Large atypical lymphs

Histo:
Fibrotic node

Red large cell with large nuc

  • Red steenberg
  • Large irregular membrane
  • Typically binucleated

Keep checking

Flow Cytometry:
- No monoclona B cell or aberrant T cell population

Immunohisto:

  • CD20 - (on large cells)
  • CD3 -ve (on large cell)
  • CD30+ve
  • CD15 weak/neg (usually hodgkin is positive)
  • CD45 -ve on large cells
  • PAX5 weak+ve
  • EBER+ve (EBV related to hodg)
A

Classical hodgkin lymphoma

Nodular sclerosis subtype

30
Q

What does CD45 stain?

A

All cells except steenberg cells

pan lymphocytic marker

31
Q

What is PAX5?

A

Usually B cell marker
Hodgkins thought of as crippled B cell
RSB typically bind PAX5

32
Q

What does EBER test for?

A

Presence of EBV - linked to hodgkins

33
Q

What would the clinical symptoms be of hodgkins lymphoma?

A

B symptoms

34
Q

What would the morphology be of hodgkins?

A

R-S cell variants

Fibrosis, heterogenous background

35
Q

What would the immunophenotype be of hodgkins?

A 
CD30+ (binds randshit on RS)
CD15-
CD45-
CD20-
CD3-
PAX5 weak+ EBER+
36
Q

What other types of hodgkins lymphoma are there?

A

Nodular sclerosis
Lymphocyte rich
Mixed cellularity
Lymphocyte deplete

37
Q

What % of lymphomas are hodgkin?

A

10%

38
Q

When does hodgkins typically strike?

A

bimodal - 20 years and 65 years

39
Q

How is hodgkin lymphoma staged?

A

PET +/- consider bone marrow traphine

40
Q

How is hodgkin lymphoma treated?

A

ABVD

41
Q

What is the cure rate for hodgkin lymphoma?

A

Below 75%

PATH3309 (14 decks)

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