Lymphomas and Plasma cell disorders Flashcards
Focus on B-cell proliferation
Lymph node Cortex
B lymphs and plasma cells
Lymph node Medulla
Contains T cells and macrophages
Lymph node paracortex
CD19, CD20, CD5
Naive B lymph CD markers
CD3, CD5, CD2, CD7, CD4, and CD8
T cell CD markers
- Formation of new B lymphocytes
- Processing of specific immunoglobulins
- Filtration of matter, debris, and bacteria
Lymph node functions
In the pathology laboratory (moist)
- sliced into 3 mm-thick sections
-touch imprints
- thin sections
Lymph node processing
Morphology
Immunophenotype
Molecular Characteristics
Clinical Characteristics
Lymphoma subtypes are distinguished by…
Abnormal, destructive lymph node enlargement
Lymphoma characteristic
Progression into a leukemia
Peripheralization
- Mature B cell lymphoma
- Mature T cell lymphoma
Lymphoma categories
Reed sternberg cell
Hodgkin’s lymphoma
More common in kids
Hodgkin’s lymphoma
Happens to ALL ages
Non-Hodgkins Lymphoma
Unifocal origin with predictable spread along lymph node chain
Hodgkins
Presents with painless, englarged cervical lymph nodes
Hodgkins
Prognosis good if still localized (>90% cure)
Hodgkin’s lymphoma (HL)
Multifocal origin with unpredictable spread
Non-Hodgkins Lymphoma (NHL)
Malignant cell is B lymph in 95% of cases
Non-Hodgkins Lymphoma (NHL)
“owl-eyes”
Reed- Sternberg cell
Accurate staging crucial to treatment
Hodgkin’s lymphoma (HL)
Staging not as crucial
Non-Hodgkins Lymphoma (NHL)
Pleomorphic cells, some normal, some malignant
Hodgkin’s lymphoma (HL)
Uniform, malignant cells
Non-Hodgkins Lymphoma (NHL)
Presents with painless, enlarged cervical lymph nodes & at a more advanced stage
Non-Hodgkins Lymphoma (NHL)
Prognosis worse
Non-Hodgkins Lymphoma (NHL)
fever, weight loss, night sweats (poor prognostic indicator)
B-symptoms
Popcorn cells
Nodular lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)
Cells are positive for CD20 and CD45
Nodular lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)
strong association w/ cmyc proto-oncogene rearrangement on chromosome 8
Non-Hodgkin’s Lymphoma (NHL)
NHL typically_____ have a leukemic presentation at the end stage of the disease
does
Essential to accurately stage disease to determine treatment and prognosis!
Diagnosis of HL
Radiation and chemo. Can affect 90% cure rate if disease is localized!
Hodgkins treatment
slow-growing
Low grade NHL
extranodal disease
Intermediate grade NHL
rapidly growing - rapidly fatal
High grade NHL
ranks according to aggressivity: low, intermediate or high grade
NHL (1982)
All produce monoclonal light chain immunoglobulin gene rearrangements, or both
Mature B cell lymphomas
Derived from circulating IgM, IgD B-cells
Small Lymphocytic Lymphoma/CLL
positive for CD19, CD20, and CD23 (+/- CD5)
Small Lymphocytic Lymphoma/CLL
Linked to t(11;14) defect
Mantle Cell Lymphoma
CD5, CD19, CD20; but negative for CD23!
Mantle Cell Lymphoma
Linked to t(14:18) and (q32;q21)
- positive for CD19 and CD20
Follicular Lymphoma
- Diffuse proliferation of large lymphocytes (Twice the size of normal lymphs)
- Most common lymphoma (30-40%)
Diffuse large B cell Lymphoma (DLBCL)
- “Starry sky”
- CD10, CD19, and CD20
- MYC gene
Burkitt Lymphoma
Diagnosis is considered a medical emergency
Burkitt Lymphoma
skin presentation stage of a T cell lymphoma
Mycosis Fungoides
Typically see pruritus, followed by weepy erythroderma
Mycosis Fungoides
Mycosis fungoides is THE most ____ cutaneous lymphoma
common
P.B presentation stage of T cell lymphoma
Sezary syndrome
Sezary syndrome has _____ prognosis
BAD
“butt cells”
Sezary Syndrome (not specific for this)
Topical chemo. & superficial radiation for _____ _______
mycosis fungoides
HAART
Highly Active Antiretroviral Therapy
increases CD4 counts, unfortunately does not ↓ rate of incidence of HIV-related lymphomas
HAART
- HIV infection increases general lymphoma risk (by ~ 60X)
- Many types (NHL, HL, Burkitt’s, etc.) may occur, especially late in AIDS
- Usually very aggressive
HIV-Related Lymphoma
MM occurs when a tumor of ________ overgrows in the bone marrow
malignant plasma cells
plasma cells that contain ____ ______(rounded accumulations of IG in rER), are called Mott cells/grape cells/morula cells
Russell bodies
Plasma cell seen in IgA myeloma is called a ___ ___
flame cells
_______(starch-like protein deposits) are deposited throughout body, causing multiple organ defects
Amyloid
_____ – new drug; strengthens bones
Aredia
Occurs when absolute # of circulating plasma cells exceeds cutoff (>2000/uL)
Plasma Cell Leukemia (PCL)
proteasome inhibition causes more _______ in malignant cells than in normal cells!
apoptosis
Malignant plasmacytoid lymphocytes
Waldenstrom’s Macroglobulinemia (WM)
- Oversecretion of IgM
- Abnormally increased CD20 cell surface markers
Waldenstrom’s macroglobulinemia
moderate rouleaux in p.b.
Multiple Myeloma
Length of survival - WORSE
Multiple myeloma
More common prevalence
Multiple Myeloma
Rare hepatosplenomegaly
Multiple Myeloma
Marked lytic bone lesions
Multiple Myeloma
May occur as end-stage sequela of MM or by itself
Plasma Cell Leukemia