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Heme > Lymphomas 1 (White) > Flashcards

Lymphomas 1 (White) Flashcards

1
Q

T or F: The spleen can be involved in primary and secondary lymphomas.

A

T

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2
Q

Order the follow cell from least to most mature:

Memory cell
Hematopoeitc stem cell
Immunoblast
Lymphoid progenitor cell

A

Hematopoeitc stem cell
Lymphoid progenitor cell
Immunoblast
Memory cell

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3
Q

What type of cell(s) are in the medulla?

A

mixed (B and T)

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4
Q

What type of cells mature in the follicular center?

A

B cells

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5
Q

What cells reside in the cortex?

A

B cells

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6
Q

T or F: Most lymphomas are of T cell origin.

A

F: they are B cell

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7
Q

What are the 4 basic patters of lymph nodes?

A
  1. follicular hyperplasia
  2. sinus hyperplasia
  3. active paracortical response
  4. passive paracortical reaction
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8
Q

T or F: Lymphoid follicles are not polarized.

A

F they are polarized

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9
Q

Describe how a follicle can be polarized?

A
  • one side has bigger cells than the other

- it is wider/not a circle

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10
Q

What cells are in the center of a normal follicle?

A

B cells, T cells, and macrophages

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11
Q

What type/stage of maturation of a B cell is normally found in the interfollicualr zone?

A

immunobastic and small B lymphocyte

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12
Q

What type/stage of maturation of a B cell is normally found in the follicular center?

A

Small and large cleaved and uncleaved

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13
Q

T or F: A sezary cell is more immaure than a convoluted lymphocyte.

A

F: convoluted lymphocute is more immature than sezary cell

Convoluted lymphocyte –> small T lymphocyte –> sezary cell

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14
Q

What were the conflicting lymphoma classification schemes in the 60s/70s?

A

rappaport vs lukes/collins

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15
Q

What classification scheme reffered to lymphomas as centroblastic or centrocytic?

A

Kiel classification

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16
Q

Why is lymphoma classification needed?

A

classification determined course of treatment

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17
Q

T or F: T cell lymphomas are typically more homogenous than B cell lymphomas

A

T

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18
Q

What are the 9 modalities used in modern lymphoma Dx?

A
  1. clinical features (presentation, H&P)
  2. Imprint cytomorphology (look @ indiv cells)
  3. Immunophenotyping (flow cyt, immunohisto)
  4. H & E
  5. routine karyotyping
  6. moluecular genetics
  7. DNA (FISH, PCR)
  8. RNA (CISH, RTPCR)
  9. Integrated report
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19
Q

What modalities for Dx require fresh tissue?

A

imprinr cytomorphology
flow cytometry
cytogenetics

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20
Q

How long does a biopsy sample ideally need to spend in the fixative agent to be properly “fixed”?

A

at least 24 hrs

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21
Q

Describe the process of preparing a touch imprint.

A
  1. light touch of cut section to surface of slide
  2. air dry once for wright stain
  3. immediately the rest of the tissue to be examined in Carnoy’s fixative
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22
Q

What is the make-up of carney’ fixture and how is it stored?

A

60% EtOH, 30% acetone, 10% glacial acetic acid

store at room temp

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23
Q

What is imprinting useful for?

A

morphologic view of…

  1. cell size
  2. chromatin pattern (blastic vs mature)
  3. fine morphological details = vacules, granules, rods

Ideal for FISH testing!!

24
Q

Flow cytometry is based on (fresh or frozen) section of lymph node tissue

A

frozen

25
Q

T or F: If frozen section is done too small, a sample should not be sent for flow cytometry.

A

F: a sample should always be sent, limited FC is better than none

26
Q

What is RPMI 1640?

A

medium that tissue culture is put in for flow cytometry

27
Q

What can be determined form karyotyping a lymphoma?

A
  1. can tell you if there is a neoplastic process actually going on
  2. provides basis for sub-typing/classification/Dx
  3. prognostic info
  4. provides info for follow up on occult clonal abnormalities
28
Q

White said we didn’t need to know the genotypes assc with the subtypes for his part of the test…

A

strom said he’d give us a list…

29
Q

What is the volume of the tissue sample needed for karyotyping?

A

5 mm3

30
Q

What tests are of priority for the path lab to run on a tissue sample?

A

imprint and formin fixed tissue > flow sample > cytogenetics

31
Q

Describe the ideal “lymphoma work up”

A
  • 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
32
Q

What are the immunophenotying panels used to differentiate?

A

B cell, T cell, NK, Blast lymphomas, AML

33
Q

What is the classification system that is now widely in use?

A

W.H.O.’s sys

34
Q

What are the 2 most common lymphomas

A

Diffuse large B cell and follicular lymphoma

35
Q

For follicular Center lymphoma, describe the cell morphology.

A

mixture of germinal center blasts and cleaved cells

36
Q

What are the surface markers assc with follicualr center lymphoma?

A

+ surface Ig, BCL-2, CD10, 19, 20, 22, 79a

  • CD5
37
Q

What are the genetics assc with follicular B cell lymphoma?

A

t(14; 18) and BCL-2 rearrangement

38
Q

Are adults or children more likely to have follicular lymphoma?

A

adults

39
Q

Describe the cell morpholgy assc with diffuse large B cell lymphoma

A

monomorphous cells with prominent nucloli and basophillic cytoplasm

40
Q

What are the cell surface markers assc with dIffuse large B cell lymphoma?

A

+/- surface Ig, cytoplasmic Ig, CD5, CD10

+ CD19, 20, 22, 79a

41
Q

What are the genetics assc with diffuse large B cell lymphoma?

A

40% have BCL-6 rearrangement/mutation

30% have t(14; 18)

42
Q

Do children or adults get diffue large B cell lymphoma?

A

both

43
Q

Is diffuse large B cell lymphoma agressive or indolent?

A

aggressive

44
Q

Describe the morphology of Burkitt’s lymphoma.

A

medium sized cells, basophillic cytoplasm, starry sky appearence, high mitotic rate

45
Q

What are the cell surface markers assc with burkitt’s lymphoma?

A

+ surface IgM, CD10, 19, 20, 22, 79a

  • CD5, 23

+ KI 67 in > 87% of cells

46
Q

`What are the genetcs assc with burkitt lymphoma?

A

t(2; 8), t(8; 14), or t(8, 22)

*rearrangement of c-MYC

47
Q

Do children or adults get burkitt lymphoma?

A

Children&raquo_space; adults

48
Q

What lymphoma is defined by the expression of the Hodgkin’s disease assc Ag KI-1 in reactive and neoplastic lymphoid tissue?

A

anaplastic large cell lymphoma

49
Q

What is the genetics assc with anaplastic large cell lymphoma

A

t(2; 5)

50
Q

What is the molecular abnormality assc with anaplastic large cell lymphoma?

A

ALK-NPM

*kinase gene fused to nucleolar protein gene

51
Q

What are the good prognosis lymphomas?

A

Anaplastic large cell > MALT > follicular

52
Q

What are the intermediate/good prognosis lymphomas?

A

nodal marginal zone > lymphoplasmacytoid > small lymphocytic

53
Q

What are the intermediate/poor prognosis lymphomas?

A

mediastinal > large B cell > burkitt’s

54
Q

T or F: there is accuracy and consensus with the Dx of many lymphoma?

A

F

55
Q

What is the defining cahracteristics of hodgkin’s classical type?

A

nodular sclerosis and mixed cellularity

Heme (38 decks)

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