Lymphomas Flashcards by Tom O

What are the B cell Non-Hodgkin Lymphomas?

Follicular lymphoma
Mantle cell lymphoma
Burkitt lymphoma
Diffuse large B cell lymphoma

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How would you diagnose a lymphoma?

You need an excisional tissue or lymph node biopsy

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List some common B Cell markers

CD19

CD20

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List some common T cell markers

CD3

CD2, 4, 5, 7, 8

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Follicular Lymphoma

Symptoms

Painless lymphadenopathy

They may be totally asymptomatic

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Follicular Lymphoma

What is the morphology of the cells?

Centrocytes
Small cells with cleaved or irregular nuclei

Centroblasts
Large cells with open nuclear chromatin and many nucleoli

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Follicular Lymphoma

What chromosomal translocation is common? Why does this cause lymphoma?

t(14;18)
BCL2 / IGH fusion

BCL2 (anti-apoptotic) gets overexpressed along with the IGH gene

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Follicular Lymphoma

What is seen on lymph node histology?

Tons of follicles all bunched up, not just underneath the capsule

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Follicular Lymphoma

What is seen on gross imaging of the spleen?

Lots of white dots all over, which are many follicles proliferating

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Follicular Lymphoma

How can you look at this disease with immunohistochemical stain?

Stain for BCL2 expression in the follicles

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Mantle Cell Lymphoma

What is the appearance of the cells present?

Small cells with irregular nuclei

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Mantle Cell Lymphoma

What chromosomal translocation is common? Why does this cause lymphoma?

t(11;14)
Fusion of the Cyclin D1 and IGH genes

Leads to overexpression of Cyclin D1, which causes increased cell proliferation

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Burkitt Lymphoma

Who most commonly presents with this disease?

Kids and young adults

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Burkitt Lymphoma

Symptoms

Tumors at extranodal sites (mandible tumors, abdominal tumors)

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Burkitt Lymphoma

What is the appearance on histology?

Starry Sky Pattern

See lots of dark cells with some clear areas (benign macrophages clearing up apoptotic debris)

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Burkitt Lymphoma

What chromosomal translocation is common? Why does this cause lymphoma?

t(8;14)
Fusion of the MYC and IGH genes

Causes overexpression of MYC

What are some other causes of Burkitt Lymphoma (not due to chromosome translocation)?

B cell neoplasm
EBV infection
HIV infection

What is the most common form of lymphoma in adults?

Diffuse large B cell lymphoma

Diffuse Large B Cell Lymphoma

What are the two distinct subtypes? Which has better survival?

Germinal center B Cell (GBC)
Activated B Cell (ABC)

GBC has better survival

Diffuse Large B Cell Lymphoma

What is the clinical presentation?

Rapidly enlarging symptomatic mass at single or extranodal site

Diffuse Large B Cell Lymphoma

What genetic abnormalities may be present?

30% have t(14;18) - BCL2 overexpression (anti-apoptosis)

30% have BCL6 rearrangement

Some have MYC rearranged to increase cell proliferation

Diffuse Large B Cell Lymphoma

What is the appearance on histology?

Large cells (4x normal size)
Vesicular chromatin ("bubbly" appearance of chromatin)

Peripheral T Cell Lymphoma NOS

Clinical Presentation

Lymphadenopathy
Eosinophilia
Pruritis (itchy skin)
Fever
Weight loss

Peripheral T Cell Lymphoma NOS

How would you make the diagnosis of this disease?

Demonstrate it is a T cell (CD3+) with immunophenotypic and genotypic analysis

Normal T cells would also express CD5, but the neoplastic T cells in PTCL NOS do not express CD5

Hodgkin Lymphoma | Who tends to get this?

Young people (20s) and very elderly

Hodgkin Lymphoma | Where does it arise?

Generally arises in one lymph node and spreads contiguously to the nearby lymphoid tissues

Hodgkin Lymphoma | What are the characteristic cells?

Reed-Sternberg cells (Owl eyes)

List the 4 classic Hodgkin Lymphomas

Lymphocyte rich Mixed cellularity Lymphocyte depleted Nodular sclerosis

What is the non-classic Hodgkin Lymphoma?

Nodular lymphocyte predominant

Hodgkin Lymphoma | What are the neoplastic cells? What activates the reactive cells?

B cells are neoplastic. Reactive cells most likely due to cytokines made by RS cells

Hodgkin Lymphoma | What two antigens are expressed on the cell surface of classic Hodgkin Lymphoma?

CD15 and CD30

Hodgkin Lymphoma | What two antigens are expressed on the cell surface of NON-classic Hodgkin Lymphoma?

CD20 and CD45

Hodgkin Lymphoma | How would you make a diagnosis of nodular sclerosis?

If there is fibrosis present, you know it is nodular sclerosis

Hodgkin Lymphoma | How would you make a diagnosis of Lymphocyte Rich?

Lots of reactive small lymphocytes Not too many RS cells

Hodgkin Lymphoma | How would you make a diagnosis of Mixed Cellularity?

Lots of RS cells with eosinophils, plasma cells, T lymphocytes, histiocytes

Hodgkin Lymphoma | How would you make a diagnosis of Lymphocyte Depleted?

Lots of RS cells with few reactive lymphocytes

What is the general appearance of Reed Sternberg cells?

"Owl eyes" Binucleate Big eosinophilic cells May be mononuclear Lacunar variant - more white space in cell(?)

What is the classic cell seen in Nodular lymphocyte Predominant Hodgkin Lymphoma?

Popcorn cells | Express CD20 and CD45