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Hematology 2 Summer 2023 > Lymphomas and Plasma Cells & Disorder > Flashcards

Lymphomas and Plasma Cells & Disorder Flashcards

1
Q

Lymph node regions are…

A

Cortex
Medulla
Paracortex

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2
Q

Cortex of the lymph node

A

Cortical nodules (arranged in circles in outer cortex) and focus of B-cell proliferation (germinal centers

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3
Q

Medulla of lymph node

A

Medullary cords (B lymphs and plasma cells)

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4
Q

Paracortex of lymph node

A

Contains T-cells and macrophages

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5
Q

What Cd receptors are expressed on naive b lymphs?

A

CD19, CD20 and C5

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6
Q

What cd receptors are expressed on T cells?

A

CD2, CD3, CD4, CD5, CD7, and CD8

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7
Q

What are the functions of the lymph nodes?

A

-Formation of new B lymphocytes from germinal centers
-Processing of specific immunoglobulins
-Filtration of matter, debris, and bacteria

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8
Q

What temperature are extra slides of lymph nodes stored at?

A

-70 C for further studies

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9
Q

What is the thickness of lymph node slides?

A

3 mm- thick sections

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10
Q

What are the strongest risk factors for lymphoma?

A

Altered immune function which is linked to chemical exposure

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11
Q

Bone marrow and peripheral blood involvement varies depending on….

A

Lymphoma subtype

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12
Q

How are lymphoma subtypes distinguished?

A

Morphology, immunophenotype, molecular characteristics, and clinical characteristics

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13
Q

What is the hallmark histology of for general lymphomas?

A

Destructive lymph node enlargement

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14
Q

What is required in lymphoma diagnosis?

A

Lymph node biopsy

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15
Q

When are abnormal cells seen in peripheral blood in lymphomas?

A

Late in the disease with a chance to progress to leukemia

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16
Q

What are the categories of lymphoma?

A

Mature B cell lymphoma & mature T cell lymphomas

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17
Q

What department are extra lymph node histology slides sent to?

A

flow cytometry

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18
Q

What department are lymph node histology slides are sent to for examination?

A

Pathology

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19
Q

Which lymphoma is common in kids?

A

Hodgkin’s lymphoma

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20
Q

What cell indicates hodgkin’s lymphoma in a patient?

A

Reed-Sternberg cell aka owl eye cell

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21
Q

Unifocal origin with predictable spread along lymph node chain. Accurate staging is important to treatment. HL or NHL?

A

HL

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22
Q

Multifocal origin, unpredictable spread, and staging is not crucial. HL or NHL?

A

NHL

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23
Q

Presents with painless enlarged cervical lymph nodes. HL or NHL?

A

HL

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24
Q

Presents with painless, enlarged cervical lymph nodes at a more advanced stage. HL or NHL?

A

NHL

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25
Q

Between HL and NHL, which has the better prognosis?

A

HL has the better prognosis if it is still localized >90% with a chance of being cured.

NHL has the worse prognosis

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26
Q

In NHL, what cell type is commonly malignant?

A

B lymphocytes 95% of the cases. Then T lymph and rarely ever NK cells.

27
Q

What is a poor prognostic indicator in Hodgkin Lymphoma?

A

Fever, weight loss, and night sweats. These symptoms are also called B symptoms

28
Q

What are the clinical findings of HL?

A
  • Painless, enlarged cervical lymph nodes
  • Sometimes mediastinal mass between lungs.
  • Patients are generally young
29
Q

How long would a patient survive HL with no treatment?

A

1-2 years after onset due to recurrent infections and organ failure

30
Q

What cell may indicate nodular lymphocyte-Predominant HL?

A

Popcorn cell

31
Q

What are two categories of HL?

A

-Classical HL
-NLPHL

32
Q

What cell receptors would be expressed in cells from a patient with NLPHL?

A

CD20 and CD45

33
Q

Why is lymph node biopsy required to diagnose a patient for HL?

A

Theres no leukemic phase so a lymph node biopsy is the only definitive test. All other tests are non-specific.

34
Q

Describe Reed-sternberg cell.

A
  • 4-8x size of normal lymphs
    *Expresses CD30+ all cases
    *CD15+ in 80% of cases
    *Abundant cytoplasm
    *Eosinophilic dual nucleus with distinctive surrounding halo (owl eyes)
35
Q

What tests are required to accurately diagnosis HL?

A

-Bone scans
-Thoracic CT scans
-Immunophenotyping
-Routine labs
Lymph node and Liver biopsies

36
Q

What is the treatment for HL?

A

Radiation and chemo

37
Q

What are the 3 combined B&T cell disorders?

A

Wiskott-Aldrich, SCID, and ataxia telangiectasia (AT)

38
Q

Having pre-existing NHL increases risk of developing combined B&T cell disorder by…

A

10,000X

39
Q

What is strongly associated with NHL?

A

cmyc proto-oncogene rearrangement on chromosome 8

40
Q

What chromosome is involved in cmyc proto-oncogene?

A

chromosome 8

41
Q

What is cymc?

A

It is a transcription factor for cell growth found to be over-expressed in many different kinds of malignancies.

42
Q

NHL typically does have a ________ presentation at the end stage of the disease.

A

leukemic presentation

43
Q

NHL mostly has normal peripheral blood cell morphology, but may see ______ _______ in lymphs,

A

Cleaved nuclei or butt cells

44
Q

Describe low grade NHL

A

Slow growing with a survival of 5-7 years with treatment

45
Q

Describe intermediate grade NHL

A

More rapid enlargement and more common extra nodal disease. Frequently diffuse large B cell lymphoma subtype

46
Q

What is NHL treatment?

A

Similar to HL. Radiation and chemotherapy

47
Q

Which lymphoma produces monoclonal light chain immunoglobulins, clonal immunoglobulin gene rearrangement or both?

A

Mature B Cell lymphomas

48
Q

What kind of patient are mostly effected by lymph node based?

A

Elderly individuals

49
Q

What differentiates SLL from CLL?

A

SLL is in lymph nodes and lymphoid organs

CLL is in peripheral blood and bone marrow

50
Q

Both SLL and CLL have…

A

-Diffuse proliferation of small hypermature (soccer-ball) lymphoid cells and smudge cells
-Derived from circulating IgM, IgD B-cells
-Both types are positive for CD19, CD20, CD23, and may have CD5

51
Q

What are the median survival for SLL and CLL patients?

A

10 years

52
Q

Mantle cell lymphoma is linked to what mutation?

A

t(11,13) defect

53
Q

What cell receptors are expressed in mantle cell lymphoma?

A

CD5, CD19, CD20, BUT NEGATIVE for CD23

54
Q

Describe Mantle cell lymphoma

A

-Diffuse proliferation of medium sized cells w/ irregular nuclear outlines.
-Peripheral blood can mimic PPL

55
Q

What is the median survival for patients with mantle cell lymphoma

A

3 to 5 years

56
Q

In follicular lymphoma nodular proliferation replaces…

A

Normal architecture

57
Q

Follicular lymphom originates where and involves…

A

Originates in germinal centers of lymph nodes. It involves neoplastic proliferation of medium-sized cells, mixed w/ large lymphoid cells.

58
Q

How is follicular lymphoma graded?

A

Graded by the average number of large cells observed per hpf

59
Q

What cell receptors are expressed in follicular lymphoma?

A

CD19 and CD20

60
Q

In follicular lymphoma cells proliferate because of

A

decreased sensitivity of apoptosis

61
Q

What mutations are linked to follicular lymphoma?

A

t(14:18) and (q32;q21) in over 95% of cases. They express BCL-2 protein decreases apoptosis sensitivity.

62
Q

Expression of BCL-2 protein has what effect?

A

Decreased apoptosis sensitivity

63
Q

Slide 30

A

Hematology 2 Summer 2023 (13 decks)

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