Lymphomas Flashcards
What are Reed Sternberg cells? What receptors are they positive for?
Large tumor B cell seen in Hodgkin’s lymphoma with binucleated or bilobed nuclei with prominent nucleoli: 2 halves are like mirror image “owl eyes”, have CD15+ and CD30+.
What do Reed Sternberg cells do?
- Secrete cytokines, which can result in “B symptoms” - fevers, chills, weight loss, and eosinophils.
- Attract reactive lymphos/plasmas/macs/eos.
- May lead to fibrosis.
What is the composition of the mass in Hodgkin’s?
Primarily reactive cells - inflammatory and fibrosis
What kind of spread does Hodgkin’s have?
Contiguous spread, extranodal involvement is rare.
What is the most important predictor of prognosis with Hodgkins?
Staging
What is the age of presentation with Hogdkin’s?
Bimodal. Peak in young adulthood and at 55+ yrs.
What virus is Hodgkin’s strongly associated with?
EBV
What are the four types of Hodgkin’s?
- Nodular sclerosing
- Lymphocyte rich
- Mixed cellularity
- Lymphocyte depleted
What is the most common subtype of Hodgkin’s, and what characterizes the typical patient?
Nodular sclerosing (70%), young adult, usually female w/ enlarging cervical or mediastinal lymph node.
What do nodular sclerosing Hodgkin’s tumors look like?
Lymph node is divided by bands of sclerosis, RS cells are present in lake-like spaces - lacunar cells.
Which subtype of hodgkin’s has the best prognosis?
Lymphocyte rich
Which subtype of hodgkin’s is associated with abundant eos, and what recruits them?
Mixed cellularity - recruited by IL-5 from RS cells.
Which is the most aggressive type of Hodgkins, what patient population it is typically seen in?
Lymphocyte depleted. Elderly and HIV+ people.
What is the presentation (physically) of non-Hodg lymphomas?
Multiple, peripheral nodes, extranodal involvement is common. Non-contiguous spread.
What is the typical age presentation of non-Hodg lymphomas?
20-40yrs.
What virus/disease may be associated with Non-Hodgkin’s lymphoma?
HIV and autoimmune diseases.
What are the small B cell lymphomas?
follicular, mantle, marginal zone
What are the intermediate sized B cell lymphomas?
Burkitt lymphoma
What are the large B cell lymphomas?
diffuse large B cells lymphoma
What translocation is follicular lymphoma associated with?
t(14, 18):
IgH (heavy chain) is on 14 and is heavily expressed
BCL-2 (inhibits apoptosis) is on 18.
BCL-2 gets overexpressed, not enough apoptosis happens.
What does follicular lymphoma look like? What markers are present?
Follicle-like nodules of small B cells with CD20+, with cleaved nuclei.
What is the clinical presentation of follicular lymphoma?
Painless waxing and waning lymphadenopathy, indolent course.
How can follicular lymphoma be distinguished from follicular hyperplasia in response to infection?
- Disruption of lymph node architecture
- Lack of tingible body macrophages in germinal centers (macs clean up shits, should see them at work in normal hyperplasia).
- Bcl-2 expression in follicles - it is expressed in most cells of the body, but shouldnt be expressed in follices
- Monoclonality
How can one determine if the cells present in a follicular mass are monoclonal b cells or polyclonal?
Kappa:lambda ratio should be 3:1. In lymphoma, closer to 20:1
