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Pathology > Lymphomas and Multiple Myeloma > Flashcards

Lymphomas and Multiple Myeloma Flashcards

1
Q

What are the 4 typical locations for lymphomas to infiltrate?

A
  1. Lymph nodes
  2. Spleen
  3. Thymus
  4. Bone marrow
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2
Q

What are the 2 types of lymphomas?

A
  1. Hodgkins Lymphoma

2. Non-Hodgkins Lymphoma

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3
Q

What type of cell will be seen in nodules or follicles?

A

B cells

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4
Q

What type of lymphoid cell will be seen between follicles (paracortical)

A

T cells

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5
Q

Chronic lymphocytic leukemia (CLL) in the bloodstream is the same as _______ in the tissue

A

Small lymphocytic lymphoma (SLL)

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6
Q

What is the most common type of lymphoma in the western world?

A

B-cell Non-Hodgkin’s Lymphoma

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7
Q

B-cell Non-Hodgkin’s Lymphoma are uncommon in children except for which type?

A

Burkitt Lymphoma

  1. very aggressive
  2. In the jawbone
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8
Q

Most common type of B-cell Non-hodgkins Lymphoma?

A

follicular and diffuse*

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9
Q

In what situation does primary non-hodgkins lymphoma occur in the brain?

A

HIV

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10
Q

What is the most common B-cell lymphoma?

A

Diffuse non-hodgkins lymphoma

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11
Q

Follicular (nodular) Lymphoma

A
  • low-grade
  • slow growing
  • 2nd most common (behind diffuse)
  • older people (60s)
  • follicular structure is preserved and the tumor cells resemble mature lymphocytes
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12
Q

Diffuse Large Cell Lymphoma

A
  • most common B-cell lymphoma

- high grade

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13
Q

Histological features of diffuse B-cell Non-Hodgkins lymphoma

A
  • complete effacement of normal lymph node architecture
  • tissue infiltration
  • large lymphoblast with irregular nuclei and prominent nucleoli
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14
Q

Diffuse Non-hodgkins Lymphoma: prognosis

A

Poor.

-high and intermediate-grade lymphomas survive only 1-2 years. Chemo can help 75% get to complete remission byt cure rate is extremely low

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15
Q

Burkitt’s Lympphoma

A

high grade malignant tumor of lymphoid stem cells that divides rapidly

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16
Q

What are the two extranodal site common in Burkitt’s lympphoma?

A
  1. Mandible

2. Facial soft tissue

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17
Q

Where is Burkitt’s Lymphoma commonly seen globaly?

A

sub-Saharan Africa

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18
Q

What virus and translocation are associated with Burkitt’s lymphoma?

A

EBV (DNA enveloped herpes virus)

8:14 translocation

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19
Q

What is a “starry sky” histology is associated with?

A

Burkitt Lymphoma

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20
Q

Non-Hodgkins Lymphoma will give fatigue, malaise, fever, weight loss and sweating + pancytopenia, why?

A

hypermetabolism (rapid turnover of proliferating tumor cells)

[slide 28]

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21
Q

What is the most common of the malignant lymphomas that is pathologically distinct from other lymphoid malignancies?

A

Hodgkin’s Disease

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22
Q

Who does hodgkin’s disease affect

A
  • Bimodal distribution: 20s and 50s
  • Males
  • Whites
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23
Q

Young adults who have experienced ____ infections have a three-fold increased risk of developing Hodgkin’s Disease

A

EBV infection

24
Q

What is the name for the classic cell in Hodgkin’s disease?

A

Reed-Sternberg cell

“owl-eye cell”
“mirror image cell”

25
Q

What are two factors that may play a role in increased incidence of Hodgkin’s disease?

A
  1. Genetic, high risk in siblings
  2. Immune
    - compromised immunity
    - autoimmune diseases (ex. RA)
26
Q

Hodgkin’s Disease is associated with _________immunity and increased risk of infections, especially _______

A

Hodgkins disease is associated with deficient or impaired cell-mediated immunity (T-cell)

Herpes Zoster

27
Q

Describe the lymphadenopathy of Hodgkin’s Disease?

A
  • Firm or rubbery
  • focal areas of necrosis or softening
  • Nodes can be matted together
28
Q

Hodgkin’s Disease: splenic involvement correlates with what?

A

size of spleen

29
Q

Hodgkin’s Disease spleen pathology

A
  • White pulp is enlarged

- Later red pulp is involved

30
Q

What are unusual/rare at initial diagnosis of Hodgkin’s Disease but involvement when disease progresses?

A
  1. Liver

2. Bone

31
Q

Where in the liver is Hodgkin’s disease extend from?

A

Portal area

32
Q

Which type of Hodgkin’s disease is the most common, and more common in women?

A

Nodular sclerosis HD

33
Q

Which Hodgkin’s disease has the worst prognosis?

A

Lymphocyte depletion HD

34
Q

Lymphocyte Predominance Hodgkin’s Disease

A
  • uncommon
  • Young males
  • Cervical or axillary LAD
  • Excellent prognosis
35
Q

Nodular Sclerosis Hodgkin’s disease

A
  • Most common

- Females>males

36
Q

Lymphocyte depletion Hodgkin’s disease

A
  • Worst prognosis
  • Rare
  • Older patients and HIV
37
Q

Which nodes are most commonly involved in Hodgkins Disease?

A

Cervical**

  • Mediastinal
  • Axillary
38
Q

Ann Arbor Staging is associated with which disease

A

Hodgkin’s Disease

39
Q

Ann Arbor Staging: Stage I

A

Involvement of a single lymph node

40
Q

Ann Arbor Staging: Stage II

A

Involvement of 2 or more lymph nodes, on the same side of the diaphragm

41
Q

Ann Arbor Staging: Stage III

A

Involvement of lymph node regions on both sides of the diaphragm

42
Q

Ann Arbor Staging: Stage IV

A

Disseminated extralymphatic

43
Q

Treatment of Hodgkins Diseasee

A
  1. Chemo and radiation are highly effective
    but. ..
  2. Secondary cancers (lung, breast, NHL, AML, gastric cancer, melanocarcinomas)
  3. Pulmonary fibrosis
  4. Acceleration of atherosclerosis
44
Q

Multiple myeloma

A

plasma cell neoplasm

-multiple skeletal sites

45
Q

Multiple myeloma: describe the malignant transformation

A

single plasma cell with clonal expansion = monoclonal proliferation

46
Q

How is Multiple myeloma detected?

A

Plasma cells make antibodies, so a monoclonal spike can be seen on protein electrophoresis

(the other tall spike is albumin)

47
Q

Describe what happens during normal infection in regards to serum protein electrophoresis

A

infection causes polyclonal activation = Broad-shaped hump

48
Q

Describe what population is at higher risk for multiple myeloma

A
  • Older than 55yrs
  • Male
  • Black
49
Q

What would you expect to see high in the blood with multiple myeloma? why?

A

hypercalcemia due to osteoblast activation

50
Q

What would you expect to see on Xray of patient with multiple myeloma?

A

Punched out holes in blood-forming bones: calvarium + vertebrae

51
Q

Where is the most likely place for the calcium to deposit in multiple myeloma?

52
Q

What are Bence-Jones Proteins?

A

immunoglobulin light chain casts secreted in the urine

53
Q

Describe the peripheral blood changes in multiple myeloma

A

normochromic normocytic anemia with rouleax formation due to increased sedimentation rate

54
Q

Which is done first: Serum Electrophoresis or Serum Protein Immunoelectrophoresis

A

Serum Electrophoresis >Serum Protein Immunoelectrophoresis (which concentrates on the gamma region)

55
Q

What else about the urine contributes to the free light chains having a toxic effect on the tubular epithelial cells of the kidney?

A

acidic pH of the urine

56
Q

What can be found in the distal tubules and collecting ducts in Multiple Myeloma?

A

dense, hyaline casts that are brightly eosinophilic (“pink”) and glassy with angulated borders

57
Q

What do people with multiple myeloma typically die of?

A

kidney failure or infection

Pathology (15 decks)

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