Lymphomas

Question 1

What does the lymphoreticular system involve

Answer 1

Primary Lymphoid Organs (Maturation)
- Bone Marrow, Thymus, NKC mature in secondary organs

Secondary Lymphoid Organs
- Spleen, Lymph Nodes, MALTs, others, Tonsils

Cells, Mononuclear phagocytes
- B cells, T Cells, NKC

Question 2

Non-neoplastic diseases

Answer 2

Lymphadenopathy - involves hyperplasia

Subsets of lymphadenopathies:
- Infective: acute lymphadenitis, non-specific, granulomatous, bacterial, viral; necrotizing - Kikuchi’s

• Autoimmune: literally name any have association: SLE, RA

Question 3

List causes of granulomas [7]

• think infective agents + others

Answer 3

Bacteria: TB, Cat Scratch (Bartonella) Syphilis
Foreign Bodies
Sarcoidosis
Fungal
Helminth: In the helminthic infection (flatworm) schistosomiasis the liver granulomas that form around the parasite eggs shield the liver parenchyma cells against the secreted toxic substances.

Subacute granulomatous thyroiditis
Xanthogranulomatous pyelonephritis

Question 4

Define Lymphomas and symptoms

Answer 4

Malignancies presenting outside of the bone marrow
- anywhere, nodal, extranodal;

B symptoms
- fever, night sweats, weight loss

Question 5

Contrast aggressive and indolent lymphomas [3]

Answer 5

Aggressive

• High proliferation rate > normal apoptosis
• Short natural history, survive shorter, curable (childhood ones are aggressive)
• Localized
• Note all T cells and NKC lymphomas are aggressive

Indolent

• Slow replication, Apoptosis defective
• Long natural history, survive longer, INCURABLE
• Widespread at diagnosis

Note natural history = clinical behavior; without treatment

Question 6

Describe classifications of Lymphomas and clinical features to look out for

Answer 6

Non-Hodgkin’s
- B Cell (super impt)/ T Cell/ NKC

Hodgkin’s (super impt)
- all B Cell

• Clinical presentation
• Morphology/histology, growth pattern, starry skies
• Genetic features
• Immunophenotype (antigens!)

Question 7

DLBCL - top most common

- Characteristics, Pathogenesis, Pathology

Answer 7

Diffused Large B Cell Lymphoma DLBCL

• Aggressive, rapidly enlarging
• no defined pathogenesis
• diffuse infiltration of lymph node, LARGE lymphoid cells; B cell markers of CD20

Question 8

What is starry sky appearance and found in where?

Answer 8

Macrophages for debris of necrosis, ingested nuclear debris on background of Lymphocytes (neoplastic)

• found in aggressive BCL, including Burkitt’s, DLBCL

Question 9

Burkitt’s Lymphoma

- Characteristics, Pathogenesis, Pathology

Answer 9

• Aggressive, associated w EBV (mono)
• t(8;14), MYC oncogene, regulates cell cycle
• diffuse infiltration of LN, high cell turnover, Starry sky;
• surface antigens CD20; CD10 - follicular
• Molecular signature t8;14

Question 10

Follicular Lymphoma

- Characteristics, Pathogenesis, Pathology

Answer 10

2nd top lymphomas, under DLBCL
Top indolent lymphoma

• Indolent, widely disseminated, incurable;
• t(14;18) - UPREGULATES BCL2, anti-apoptotic, blocks Cytochrome C release from mitochondria - CC activates Caspase cascade for apoptosis
• Follicular structure retained, monotonous accumulation w single cell type;
• CD20, CD10, BCL2
• t(14;18) - PCR, FISH

Question 11

Define Hodgkin’s Lymphoma

Answer 11

Lymphoid neoplasm w Reed-Sternberg cells in an inflammatory background - especially eosinophils

Owls eyes; usually derived from B lymphocytes either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli

(eosinophils upregulate ligands for RS cells proliferation)

Question 12

Hodgkin’s spread for lymph nodes

Answer 12

Contiguous, in sequence

Question 13

Carcinoma vs Sarcoma spread

Answer 13

Carcinoma by LN, Sarcoma by blood; general\

Recall Thyroid cancers:

• Follicular CA - Blood, bone
• Parpillary CA - nodes