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Hematology - Pathology > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What are Reed Sternberg cells? What receptors are they positive for?

A

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+.

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2
Q

What do Reed Sternberg cells do?

A
  1. Secrete cytokines, which can result in “B symptoms” - fevers, chills, weight loss, and eosinophils.
  2. Attract reactive lymphos/plasmas/macs/eos.
  3. May lead to fibrosis.
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3
Q

What is the composition of the mass in Hodgkin’s?

A

Primarily reactive cells - inflammatory and fibrosis

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4
Q

What kind of spread does Hodgkin’s have?

A

Contiguous spread, extranodal involvement is rare.

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5
Q

What is the most important predictor of prognosis with Hodgkins?

A

Staging

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6
Q

What is the age of presentation with Hogdkin’s?

A

Bimodal. Peak in young adulthood and at 55+ yrs.

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7
Q

What virus is Hodgkin’s strongly associated with?

A

EBV

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8
Q

What are the four types of Hodgkin’s?

A
  1. Nodular sclerosing
  2. Lymphocyte rich
  3. Mixed cellularity
  4. Lymphocyte depleted
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9
Q

What is the most common subtype of Hodgkin’s, and what characterizes the typical patient?

A

Nodular sclerosing (70%), young adult, usually female w/ enlarging cervical or mediastinal lymph node.

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10
Q

What do nodular sclerosing Hodgkin’s tumors look like?

A

Lymph node is divided by bands of sclerosis, RS cells are present in lake-like spaces - lacunar cells.

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11
Q

Which subtype of hodgkin’s has the best prognosis?

A

Lymphocyte rich

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12
Q

Which subtype of hodgkin’s is associated with abundant eos, and what recruits them?

A

Mixed cellularity - recruited by IL-5 from RS cells.

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13
Q

Which is the most aggressive type of Hodgkins, what patient population it is typically seen in?

A

Lymphocyte depleted. Elderly and HIV+ people.

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14
Q

What is the presentation (physically) of non-Hodg lymphomas?

A

Multiple, peripheral nodes, extranodal involvement is common. Non-contiguous spread.

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15
Q

What is the typical age presentation of non-Hodg lymphomas?

A

20-40yrs.

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16
Q

What virus/disease may be associated with Non-Hodgkin’s lymphoma?

A

HIV and autoimmune diseases.

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17
Q

What are the small B cell lymphomas?

A

follicular, mantle, marginal zone

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18
Q

What are the intermediate sized B cell lymphomas?

A

Burkitt lymphoma

19
Q

What are the large B cell lymphomas?

A

diffuse large B cells lymphoma

20
Q

What translocation is follicular lymphoma associated with?

A

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.

21
Q

What does follicular lymphoma look like? What markers are present?

A

Follicle-like nodules of small B cells with CD20+, with cleaved nuclei.

22
Q

What is the clinical presentation of follicular lymphoma?

A

Painless waxing and waning lymphadenopathy, indolent course.

23
Q

How can follicular lymphoma be distinguished from follicular hyperplasia in response to infection?

A
  1. Disruption of lymph node architecture
  2. Lack of tingible body macrophages in germinal centers (macs clean up shits, should see them at work in normal hyperplasia).
  3. Bcl-2 expression in follicles - it is expressed in most cells of the body, but shouldnt be expressed in follices
  4. Monoclonality
24
Q

How can one determine if the cells present in a follicular mass are monoclonal b cells or polyclonal?

A

Kappa:lambda ratio should be 3:1. In lymphoma, closer to 20:1

25
Q

What is the treatment for follicular lymphoma?

A

Only sx patients, lose dose chemo or rituximab (anti CD20 antibody).

26
Q

What is the feared progression of follicular lymphoma?

A

To diffuse large B cell lymphoma - would present as an enlarging lymph node

27
Q

What is the translocation associated with mantle cell lymphoma?

A

t(11,14).

14: IgH, heavy chain locus.
11: Cyclin D1 - overexpression promotes G1/S transition in the cell cycle.

28
Q

What cell markers are associated with mantle cell lymphoma?

A

CD20, CD5.

29
Q

What patients does mantle zone lymphoma typically occur in?

A

Older males

30
Q

What does mantle zone lymphoma present as? What does it look like?

A

Painless LAD.

Expands the mantle zone.

31
Q

What triggers Marginal zone lymphoma?

A

Not a translocation! Marginal zone formed by activation of germinal center by post-germinal center B cells; associated with chronic inflammatory states such as hashimoto, sjogrens (*unilateral parotid enlargement), and h pylori.

32
Q

What is a MALToma?

A

Marginal zone lymphoma in mucosal sites

33
Q

What is first line treatment for gastric MALToma?

A

Eradicate H pylori

34
Q

What translocation is Burkitt’s lymphoma associated with?

A

t(8,14)

14: IgH heavy chain locus
8: c-myc - overexpression of oncogene means poor regulation of cell growth

35
Q

What virus is Burkitt’s lymphoma associated with?

A

EBV

36
Q

How does Burkitt’s classically present?

A

Extranodal mass in child or young adult. African form: jaw, sporadic form: abdomen

37
Q

What is the classic appearance on microscopy?

A

Starry sky - sheets of lymphocytes (blue) with interspersed macrophages (white)

38
Q

What is the most common form of NHL?

A

Diffuse large B cell lymphoma. Very aggressive.

39
Q

What does diffuse large B cell lymphoma look like?

A

Grows in sheets.

40
Q

What causes adult T cell lymphoma?

A

human t-lymphotrophic virus (associated with IV drug abuse)

41
Q

How does adult T cell lymphoma present?

A

Cutaneous lesions, lytic bone lesions, hypercalcemia.

42
Q

Where does T cell lymphoma present in the world?

A

Japan, west africa, caribbean

43
Q

How does mycosis fungoides present? How does it look histologically?

A

Skin patches/plaques

Characterized by atypical CD4+ cells w/ cerebrieform nuclei.

44
Q

What is it called when mycosis fungoides progresses?

A

Sezary syndrome/T cell leukemia.

Hematology - Pathology (5 decks)

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