Lymphoma Dr. Krafts 5/15/14 Flashcards
(25 cards)
Causes of lymphadenopathy***
- Most common cause overall: benign reaction to infection
- Most common malignant cause: metastatic carcinoma
Benign follicular hyperplasia things you must know
large, irregular follicles
mixture of cells in germinal centers
tangible body macrophages (macrophages stuffed full w/ debris)
B-cell response to some immune stimulus
Benign interfollicular hyperplasia things you must know
expanded area between follicles
mixture of cells
partial effacement (lymph node not completely replaced by this process)(if completely wipes it out it is more likely to be a malignancy)
T-cell response to some immune stimulus
Non-hodgkin lymphoma things you must know
malignant proliferation of lymphoid cells (blasts or mature cells) in lymph nodes
skips around (can’t predict what it is going to do)
many subtypes
most are B cell
Sx of NHL
painless, firm lymphadenopathy
extranodal manifestations (e.g. cns invovlement, large spleen, etc)
“B” sx: weight loss, night sweats, fever (prognosis worse)
Low v. high grade NHL
Low grade
- older patients
- Indolent***(incurable)
- small, mature cells
- non-destructive
High grade
- children, sometimes
- aggressive***(curable?)
- big, ugly cells
- destructive
Types of NHL
Low grade (more pushing)
- small lymphocytic lymphoma
- malt lymphoma
- follicular lymphoma
- mycosis fungoides
High grade (more invading)
- large cell lymphoma
- lymphoblastic lymphoma
- burkitt lymphoma
Small lymphocytic lymphoma things you must know
small mature lymphocytes
same things as CLL
B-cell lesion, but CD5+ (weird)
Long course; death from infection
Richter transformation–>can transform into large lymphoma?? (bad prognosis)
Marginal zone lymphoma things you must know
actually a bunch of lymphomas
marginal zone pattern
malt lymphoma*** is a common type (happens in lymphoid tissue next to mucosa–salivary gland, in the gut, if catch it early and give antibiotics against helicobacter it will go away)
helicobacter pylori
Mantle cell lymphoma things you must know
mantle zone pattern
small angulated lymphocytes
t(11;14) - cyclin D1 (helps cell progress through cell cycle) and IgH*** (IgH expressed a lot so when put cyclin D1 nearby it also gets expressed a lot)
more aggressive
Follicular lymphoma things you must know
Follicular pattern (later diffuse)
small cleaved cell, mixed or large cell
grade 1 (small cleaved/butt cells), 2, or 3 (look at nodules, small cleaved better prognosis)(grade 3 more likely to become diffuse)
t(14;18) - IgH and bcl-2 (anti-apoptotic so when combined w/ IgH which is expressed a lot cell become almost immortal)***
Likes to hang out near bony trabeculae
Staging and prognosis of follicular lymphoma
Stage I single node
stage 2 two or more nodes on same side of diaphragm
stage 3 lymph nodes on both sides of the diaphragm
stage 4 diffuse extra nodal involvement
A= no additional symptoms B= weight loss, night sweats, fever
Mycosis fungoides/sezary syndrome things you must know (can look like a lot of different things e.g. eczema)
skin lesions
blood involvement
cerebriform lymphocytes***
T-cell*** immunophenotype
pautrier microabscess
Diffuse large-cell lymphoma things you must know
large B cells
extranodal involvement
grows rapidly
bad prognosis
Lymphobastic lymphoma things you must know
two types: B and T
lymphoblasts in diffuse pattern
same as ALL
T-lymphoblastic lymphoma often in teenage male w/ mediastinal mass
Burkitt lymphoma things you must know
child w/ fast growing, extra nodal mass
starry-sky pattern***
t(8;14) = c-myc and IgH***
occasionally involves blood (called burkitt leukemia)
Punched out holes in cell is characteristic***
Adult T-cell leukemia/lymphoma things you must know
Japan/caribbean basin
HTLV-1
Skin lesions, hypercalcemia
Very aggressive
T-cell***
flowery look to the cells
Hodgkin lymphoma things you must know
younger patients, good prognosis
contiguous spread
five subtypes
reed-sternberg cell (owl eyes)(big cell)***
Hodgkin lymphoma subtypes
Nodular lymphocyte-predominance hodgkin lymphoma
Classical hodgkin lymphoma
- nodular sclerosis
- lymphocyte rich
- mixed cellularity
- lymphocyte depletion
Nodular L-P Hodgkin lymphoma
asymptomatic young male w/ cervical lymphadenopathy***
good prognosis (early stage)
B-cell origin
Popcorn cells***
Nodular sclerosis hodgkin lymphoma
Most common subtype
Good prognosis (early stage)
Lacunar cells***
Mixed cellularity hodgkin lymphoma
worse prognosis
usually disseminated at presentation***
classic reed-sternberg cells***
mixture of background cells
patient usually presents in late stage
Lymphocyte-rich hodgkin lymphoma
uncommon
usually localized at presentation***
popcorn cells***
Lymphocyte depletion hodgkin lymphoma
rare
often disseminated at presentation
classic reed-sternberg cells
collagen or reticulin background***
