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Blood and Cancer > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What is a lymphoma?

A

A malignancy of lymphoid cells based in lymphoid tissues such as the lymph nodes, spleen, thymus, or MALT. It may involve the marrow and blood secondarily.

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2
Q

B-ALL clinical presentation

A

Acute Several weeks of fatigue due to anemia Easy bruising due to thrombocytopenia Fever, signs of infection due to neutropenia May have pain in a single long bone, skin involvement

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3
Q

B-ALL workup

A

Peripheral blood smear: lymphoblasts CBC: anemia, thrombocytopenia, granulocytopenia Bone marrow: lymphoblasts are >20% of marrow cellularity

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4
Q

B-ALL flow cytometry

A

TdT+ CD19+ CD34+

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5
Q

B-ALL age of peak incidence

A

3 (FYI this is the time of peak B cell production in the bone marrow)

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6
Q

Does the presence of t(9;22) produce a good or bad prognosis?

A

Bad

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7
Q

T-ALL peak incidence

A

15

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8
Q

T-ALL clinical presentation

A

cough, shortness of breath, superior vena cava

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9
Q

T-ALL clinical presentation

A

usually presents as a large thymus mass with cough, shortness of breath, superior vena cava syndrome (swelling and redness of face and upper extremities)

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10
Q

T-ALL flow cytometry markers

A

TdT+ CD 2-8

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11
Q

Are ALLs agressive tumors?

A

Yup! Treat early, treat fast!

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12
Q

What are B symptoms?

A

fever night sweats weight loss

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13
Q

Relative to T or NK cells, why are germinal center B cells most likely to give rise to neoplasms?

A

B cells rely on somatic hypermutation and class switching to function properly. Since their genomes are designed to be able to change, they are also most likely to mutate in a malignant way.

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14
Q

What infections are associated with lymphoid neoplasms?

A

EBV HHV8 (kaposi sarcoma herpesvirus) HTLV-1 HIV H. pylori

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15
Q

CLL/SLL pathogenesis

A

Not entirely understood but thought to involve deletions

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16
Q

CLL workup (blood smear, bone marrow, etc)

A

Blood smear: increased numbers of small round lymphocytes, smudge cells

Bone marrow: aggregates of similar appearing tumor cells

Lymph nodes: diffusely infiltrated by small lymphocytes and patchy collections of larger, mitotically active cells known as proliferation centers.

CBC: lymphocytosis (lymphs > 5000)

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17
Q

CLL clinical presentation

A

Often asymptomatic

May present with weight loss, fatigue, anorexia, diffuse LAD, or hepatosplenomegaly

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18
Q

CLL flow cytometry

A

CD 5+

CD 10-

CD 20 +, CD 19+, CD23+

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19
Q

What does this CBC suggest?

A

CLL

lymphocytosis with everything else fairly normal

20
Q
A

CLL

smudge cells

21
Q

Does CLL always require treatment?

A

No, approx. 60% of patients with CLL never require treatment.

High lymphocyte count alone is not an indication to start treatment

22
Q

What’s the significance of chromosome 17 in CLL?

A

Chromosome 17 is home to the p53 tumor suppressor gene. This is a common target for chemotherapy so CLL with deletions of this gene cannot be treated effectively with conventional chemo. They have a very poor prognosis.

23
Q
A

Hairy cell

24
Q

Hairy cell leukemia

A
  • A tumor of mature B cells expressing CD20 but not CD5 of CD10
  • Associated with BRAF mutations
  • Often presents with splenomegaly and cytopenia, especially monocytopenia, and infections (especially with mycoplasma)
  • Peripheral blood shows “hairy cells”
25
Q

What’s this?

A

A healthy lymph node germinal center

26
Q

What’s this? (Note: this is a low power view)

A

Lymph node germinal center in diffuse large B cell lymphoma

27
Q

What’s this? (Note: this is high power)

A

Lymph node germinal center in diffuse large B cell lymphoma

  • large cells with prominent nucleoli
28
Q

DLBCL pathogenesis

A

Mutations involving BCL6 which codes for a transcription factor required for the maturation of germinal center B cells.

  • lead to survival and continued proliferation of B cells.
  • thought to be due to errors in class switching or somatic hypermutation
29
Q

DLBCL presentation

A

Can present with B symptoms and LAD or a rapidly enlarging mass

30
Q

Does DLBCL have an elevated LDH?

A

Yup.

31
Q

DLBCL flow cytometry

A

CD20+

may also express CD10 and surface Ig

32
Q

Burkitt Lymphoma

A
  • Endemic (Africa): EBV+, jaw mass
  • Sporadic (US): may be EBV+, abdominal mass, spreads to the CNS
  • Associated with HIV
  • Associated with c- MYC gene mutations - t(8;14)
  • Express CD20, CD10, BCL6, but not usually BCL2 (distinguishes from DLBCL)
  • tissue histology shows “starry sky”
33
Q
A

Starry sky

  • Pale macrophages in the Burkitt’s lymphoma
34
Q

Follicular lymphoma pathogenesis

A
  • t(14;18) (plus other mutations)
  • causes overexpression of BCL2 which inhibits apoptosis.
  • FYI: Normal B cells downregulate BCL2, resulting in the death of cells that don’t produce high affinity Abs. With the overexpression of BCL2, these cells do not die.
35
Q
A

Follicular lymphoma lymph node

Nodular growth pattern

36
Q
A

Follicular lymphoma peripheral blood

small to intermediate sized cells with cleaved nuclear contours and clumped chromatin

37
Q

What is a Non-Hodgkin’s Lymphoma anyway?

A

Any lymphoma that isn’t a Hodgkin’s lymphoma.

38
Q

What’s going on in Hodgkin’s lymphoma?

A

Neoplastic cells are in the minority. They secrete cytokines and chemokines that attract inflammatory cells, which make up most of the tumor mass.

39
Q

Hodgkin Lymphoma subtypes

A

Classical vs nodular lymphocyte predominant

Classical subtypes:

  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte rich
  • Lymphocyte depleted
40
Q

Reed-Sternberg cells

A

The neoplastic cells of Hodgkin’s lymphoma. They are derived from germinal center B cells and have clonal rearranged immunoglobulin heavy chains that have undergone somatic hypermutation. They express PDL-1 (programmed death ligand 1), inhibiting immune response.

  • express CD 15 and CD 30
  • Do not express CD20
  • “owl eyes”
41
Q
A

Nodular sclerosis HL

42
Q
A

Reed-Sternberg cell

Characteristic of Hodgkin’s lymphoma

Large highly atypical cells with abundant cytoplasm, one or 2 nuclear lobes, vesicular chromatin, prominent eosinophilic nucleoli

43
Q

HL clinical presentation

A

Painless LAD

  • In nodular sclerosis subtype, may be in the mediastinum resulting in chest discomfort, cough, dypsnea, and/or SVC syndrome

May have B symptoms

May have itching

44
Q

HL workup

A

CBC: leukocytosis, eosinophilia

  • may show anemia in chronic state

Lymph node biopsy: Reed Sternberg cell (owl eyes)

45
Q

Classical HL flow cytometry

A

CD 20-

CD 15+

CD 30+

46
Q
A

Blood and Cancer (11 decks)

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