Lymphoma/LAD Flashcards
causes of neoplastic LAD?
lymphoma, leukemic involvement (lymphoblastic lymphoma, myeloid sarcoma), metastatic tumor
causes of reactive LAD?
infectious, autoimmune, drugs, foreign bodies, castleman’s dz, sarcoidoisis
histologic patterns of reactive LAD?
follicular hyperplasia (autoimmune, early HIV, toxo) paracortical hyperplasia (EBV, CMV, herpes, drugs-- T cell expansion) sinus histiocytosis (draining tumors-- filled with macrophages)
follicular lymphoma?
common, 20% of all lymphoma. M, 60. nodal > extranodal. extensive general LAD.
t (14, 18)
40% transform to Burkitt, DLBCL
follicular lymphoma tx?
rituximab: binds to CD 20. induces CDC, ADCC, apoptosis. much higher survival than chemo alone
diffuse large B cell?
all ages, adults > kids. aggressive. nodal and extranodal. larger cells. CD 19, CD 20, but CD 10 negative. need aggressive chemo
burkitt lymphoma?
young adults. rapidly growing extranodal mass. in US- ileocecum. africa- jaw.
increased c-MYC- mitotically active. starry sky. usually t (8, 14). maybe t (2, 8) or t(8, 22). endemic, immunosuppression, and sporatic variants.
CD 19+, CD 20+, CD 10+
B-NHL with nodular/follicular architecture?
FL, mantle cell, marginal zone, CLL/SLL
B-NHL with diffuse architecture?
DLBCL, Burkitt
B-NHL with small tumor size?
FL, marginal zone, lymphoplasmacytic lymphoma, CLL/SLL
B-NHL with med/large tumor size?
DLBCL, burkitt
B-NHL with variable tumor size?
mantle cell
what doe t (14, 18) cause?
BCL 2 + IgH. prevents apoptosis, cells can’t die. in FL. inhibition of normal apoptosis- indolent.
what does t(11, 14) cause?
cyclin D1 fuses with IgH- over express D1 (G1 to S unregulated). mantle cell lymphoma.
what does t(8, 14) cause?
c-MYC. continual proliferation because transcription factor always on. Burkitt lymphoma - aggressive.
extranodal marginal zone lymphoma
t (11, 18). indolent, local. small sized cells. CD 5-, CD 10-, CD 19+, CD 20+. extranodal sites: MALT sites including thyroid, orbit. tx varies.
T/NK cell lymphomas in general?
uncommon, aggressive
Peripheral T cell lymphoma?
CD 4+, older, most common. aggressive. LAD.
anaplastic t-cell lymphoma, ALK +
pediatric. CD 8+. t(2,5). aggressive. nasal mass w necrosis, extensive destruction, angioinvasion.
EBV-associated neoplasms?
burkitt forms, post-transplant lymphoproliferative disorder, extranodal NK/T cell lymphoma nasal type, subsets of hodgkin, DLBCL, t cell lymphomas.
nasopharyngeal carcinoma
EBV virus structure?
DS DNA genome, linear. encapsidated, enveloped.
EBV early antigen? viral capsid, membrane antigen?
Beta protein.
gamma proteins.
mono?
CD 8+. downey cells. increased activated B cells, not EBV+ causes heterophile antibodies. long incubation (weeks to 2 mo). anti-EBNA is latest marker.
mechanisms of viral oncogenesis in EBV?
direct transformation. hit and run. bystander effect. chronic inflammation.
hodgkin vs non-hodgkin lymphoma?
single axial group of nodes vs multiple peripheral.
orderly contiguous vs non contiguous
not mesenteric notes or waldeyer ring vs commonly mesenteric notes and waldeyer ring
not extranodal or BM involved vs common extranodal and BM involvement
hodgkin lymphoma?
30% of all lymphomas. YA. contiguous spread, LN involvement. reed sternberg cells in background of inflammatory cells. B lineage, owl eye (binucleate).
classical HL types?
nodular sclerosis (lacunar cells, dense sclerosis). mixed cellularity (lots of inflammation).
CD 15+ CD 30+
CD 20- CD 45- BREAKS B CELL RULE
non-classical HL types?
nodular lymphocyte predominant HL. rare. L&H cells. popcorn nuclei. indolent, frequent relapses.
CD 15- CD 30-
CD 20+ CD 45+
