Lymphomas 1 (White) Flashcards
T or F: The spleen can be involved in primary and secondary lymphomas.
T
Order the follow cell from least to most mature:
Memory cell
Hematopoeitc stem cell
Immunoblast
Lymphoid progenitor cell
Hematopoeitc stem cell
Lymphoid progenitor cell
Immunoblast
Memory cell
What type of cell(s) are in the medulla?
mixed (B and T)
What type of cells mature in the follicular center?
B cells
What cells reside in the cortex?
B cells
T or F: Most lymphomas are of T cell origin.
F: they are B cell
What are the 4 basic patters of lymph nodes?
- follicular hyperplasia
- sinus hyperplasia
- active paracortical response
- passive paracortical reaction
T or F: Lymphoid follicles are not polarized.
F they are polarized
Describe how a follicle can be polarized?
- one side has bigger cells than the other
- it is wider/not a circle
What cells are in the center of a normal follicle?
B cells, T cells, and macrophages
What type/stage of maturation of a B cell is normally found in the interfollicualr zone?
immunobastic and small B lymphocyte
What type/stage of maturation of a B cell is normally found in the follicular center?
Small and large cleaved and uncleaved
T or F: A sezary cell is more immaure than a convoluted lymphocyte.
F: convoluted lymphocute is more immature than sezary cell
Convoluted lymphocyte –> small T lymphocyte –> sezary cell
What were the conflicting lymphoma classification schemes in the 60s/70s?
rappaport vs lukes/collins
What classification scheme reffered to lymphomas as centroblastic or centrocytic?
Kiel classification
Why is lymphoma classification needed?
classification determined course of treatment
T or F: T cell lymphomas are typically more homogenous than B cell lymphomas
T
What are the 9 modalities used in modern lymphoma Dx?
- clinical features (presentation, H&P)
- Imprint cytomorphology (look @ indiv cells)
- Immunophenotyping (flow cyt, immunohisto)
- H & E
- routine karyotyping
- moluecular genetics
- DNA (FISH, PCR)
- RNA (CISH, RTPCR)
- Integrated report
What modalities for Dx require fresh tissue?
imprinr cytomorphology
flow cytometry
cytogenetics
How long does a biopsy sample ideally need to spend in the fixative agent to be properly “fixed”?
at least 24 hrs
Describe the process of preparing a touch imprint.
- light touch of cut section to surface of slide
- air dry once for wright stain
- immediately the rest of the tissue to be examined in Carnoy’s fixative
What is the make-up of carney’ fixture and how is it stored?
60% EtOH, 30% acetone, 10% glacial acetic acid
store at room temp
What is imprinting useful for?
morphologic view of…
- cell size
- chromatin pattern (blastic vs mature)
- fine morphological details = vacules, granules, rods
Ideal for FISH testing!!
Flow cytometry is based on (fresh or frozen) section of lymph node tissue
frozen
T or F: If frozen section is done too small, a sample should not be sent for flow cytometry.
F: a sample should always be sent, limited FC is better than none
What is RPMI 1640?
medium that tissue culture is put in for flow cytometry
What can be determined form karyotyping a lymphoma?
- can tell you if there is a neoplastic process actually going on
- provides basis for sub-typing/classification/Dx
- prognostic info
- provides info for follow up on occult clonal abnormalities
White said we didn’t need to know the genotypes assc with the subtypes for his part of the test…
strom said he’d give us a list…
What is the volume of the tissue sample needed for karyotyping?
5 mm3
What tests are of priority for the path lab to run on a tissue sample?
imprint and formin fixed tissue > flow sample > cytogenetics
Describe the ideal “lymphoma work up”
- pt sees PCP w/ sings/sympoms suspicious of lymphoma
- referral to surgeon for excisional biopsy of peripheral lymph node
- ->fresh sample to path for FFPET, cytogenetics, flow
- -> micro cultures some
- -> frozen to path for adequacy of assessment and specimen triage
What are the immunophenotying panels used to differentiate?
B cell, T cell, NK, Blast lymphomas, AML
What is the classification system that is now widely in use?
W.H.O.’s sys
What are the 2 most common lymphomas
Diffuse large B cell and follicular lymphoma
For follicular Center lymphoma, describe the cell morphology.
mixture of germinal center blasts and cleaved cells
What are the surface markers assc with follicualr center lymphoma?
+ surface Ig, BCL-2, CD10, 19, 20, 22, 79a
- CD5
What are the genetics assc with follicular B cell lymphoma?
t(14; 18) and BCL-2 rearrangement
Are adults or children more likely to have follicular lymphoma?
adults
Describe the cell morpholgy assc with diffuse large B cell lymphoma
monomorphous cells with prominent nucloli and basophillic cytoplasm
What are the cell surface markers assc with dIffuse large B cell lymphoma?
+/- surface Ig, cytoplasmic Ig, CD5, CD10
+ CD19, 20, 22, 79a
What are the genetics assc with diffuse large B cell lymphoma?
40% have BCL-6 rearrangement/mutation
30% have t(14; 18)
Do children or adults get diffue large B cell lymphoma?
both
Is diffuse large B cell lymphoma agressive or indolent?
aggressive
Describe the morphology of Burkitt’s lymphoma.
medium sized cells, basophillic cytoplasm, starry sky appearence, high mitotic rate
What are the cell surface markers assc with burkitt’s lymphoma?
+ surface IgM, CD10, 19, 20, 22, 79a
- CD5, 23
+ KI 67 in > 87% of cells
`What are the genetcs assc with burkitt lymphoma?
t(2; 8), t(8; 14), or t(8, 22)
*rearrangement of c-MYC
Do children or adults get burkitt lymphoma?
Children»_space; adults
What lymphoma is defined by the expression of the Hodgkin’s disease assc Ag KI-1 in reactive and neoplastic lymphoid tissue?
anaplastic large cell lymphoma
What is the genetics assc with anaplastic large cell lymphoma
t(2; 5)
What is the molecular abnormality assc with anaplastic large cell lymphoma?
ALK-NPM
*kinase gene fused to nucleolar protein gene
What are the good prognosis lymphomas?
Anaplastic large cell > MALT > follicular
What are the intermediate/good prognosis lymphomas?
nodal marginal zone > lymphoplasmacytoid > small lymphocytic
What are the intermediate/poor prognosis lymphomas?
mediastinal > large B cell > burkitt’s
T or F: there is accuracy and consensus with the Dx of many lymphoma?
F
What is the defining cahracteristics of hodgkin’s classical type?
nodular sclerosis and mixed cellularity
