Lymphomas and Plasma Cells & Disorder

Question 1

Lymph node regions are…

Answer 1

Cortex
Medulla
Paracortex

Question 2

Cortex of the lymph node

Answer 2

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

Question 3

Medulla of lymph node

Answer 3

Medullary cords (B lymphs and plasma cells)

Question 4

Paracortex of lymph node

Answer 4

Contains T-cells and macrophages

Question 5

What Cd receptors are expressed on naive b lymphs?

Answer 5

CD19, CD20 and C5

Question 6

What cd receptors are expressed on T cells?

Answer 6

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

Question 7

What are the functions of the lymph nodes?

Answer 7

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

Question 8

What temperature are extra slides of lymph nodes stored at?

Answer 8

-70 C for further studies

Question 9

What is the thickness of lymph node slides?

Answer 9

3 mm- thick sections

Question 10

What are the strongest risk factors for lymphoma?

Answer 10

Altered immune function which is linked to chemical exposure

Question 11

Bone marrow and peripheral blood involvement varies depending on….

Answer 11

Lymphoma subtype

Question 12

How are lymphoma subtypes distinguished?

Answer 12

Morphology, immunophenotype, molecular characteristics, and clinical characteristics

Question 13

What is the hallmark histology of for general lymphomas?

Answer 13

Destructive lymph node enlargement

Question 14

What is required in lymphoma diagnosis?

Answer 14

Lymph node biopsy

Question 15

When are abnormal cells seen in peripheral blood in lymphomas?

Answer 15

Late in the disease with a chance to progress to leukemia

Question 16

What are the categories of lymphoma?

Answer 16

Mature B cell lymphoma & mature T cell lymphomas

Question 17

What department are extra lymph node histology slides sent to?

Answer 17

flow cytometry

Question 18

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

Answer 18

Pathology

Question 19

Which lymphoma is common in kids?

Answer 19

Hodgkin’s lymphoma

Question 20

What cell indicates hodgkin’s lymphoma in a patient?

Answer 20

Reed-Sternberg cell aka owl eye cell

Question 21

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

Answer 21

HL

Question 22

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

Answer 22

NHL

Question 23

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

Answer 23

HL

Question 24

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

Answer 24

NHL

Question 25

Between HL and NHL, which has the better prognosis?

Answer 25

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

Question 26

In NHL, what cell type is commonly malignant?

Answer 26

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

Question 27

What is a poor prognostic indicator in Hodgkin Lymphoma?

Answer 27

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

Question 28

What are the clinical findings of HL?

Answer 28

* Painless, enlarged cervical lymph nodes * Sometimes mediastinal mass between lungs. * Patients are generally young

Question 29

How long would a patient survive HL with no treatment?

Answer 29

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

Question 30

What cell may indicate nodular lymphocyte-Predominant HL?

Answer 30

Popcorn cell

Question 31

What are two categories of HL?

Answer 31

-Classical HL -NLPHL

Question 32

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

Answer 32

CD20 and CD45

Question 33

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

Answer 33

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

Question 34

Describe Reed-sternberg cell.

Answer 34

* 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)

Question 35

What tests are required to accurately diagnosis HL?

Answer 35

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

Question 36

What is the treatment for HL?

Answer 36

Radiation and chemo

Question 37

What are the 3 combined B&T cell disorders?

Answer 37

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

Question 38

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

Answer 38

10,000X

Question 39

What is strongly associated with NHL?

Answer 39

cmyc proto-oncogene rearrangement on chromosome 8

Question 40

What chromosome is involved in cmyc proto-oncogene?

Answer 40

chromosome 8

Question 41

What is cymc?

Answer 41

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

Question 42

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

Answer 42

leukemic presentation

Question 43

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

Answer 43

Cleaved nuclei or butt cells

Question 44

Describe low grade NHL

Answer 44

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

Question 45

Describe intermediate grade NHL

Answer 45

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

Question 46

What is NHL treatment?

Answer 46

Similar to HL. Radiation and chemotherapy

Question 47

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

Answer 47

Mature B Cell lymphomas

Question 48

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

Answer 48

Elderly individuals

Question 49

What differentiates SLL from CLL?

Answer 49

SLL is in lymph nodes and lymphoid organs CLL is in peripheral blood and bone marrow

Question 50

Both SLL and CLL have...

Answer 50

-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

Question 51

What are the median survival for SLL and CLL patients?

Answer 51

10 years

Question 52

Mantle cell lymphoma is linked to what mutation?

Answer 52

t(11,13) defect

Question 53

What cell receptors are expressed in mantle cell lymphoma?

Answer 53

CD5, CD19, CD20, BUT NEGATIVE for CD23

Question 54

Describe Mantle cell lymphoma

Answer 54

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

Question 55

What is the median survival for patients with mantle cell lymphoma

Answer 55

3 to 5 years

Question 56

In follicular lymphoma nodular proliferation replaces...

Answer 56

Normal architecture

Question 57

Follicular lymphom originates where and involves...

Answer 57

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

Question 58

How is follicular lymphoma graded?

Answer 58

Graded by the average number of large cells observed per hpf

Question 59

What cell receptors are expressed in follicular lymphoma?

Answer 59

CD19 and CD20

Question 60

In follicular lymphoma cells proliferate because of

Answer 60

decreased sensitivity of apoptosis

Question 61

What mutations are linked to follicular lymphoma?

Answer 61

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

Question 62

Expression of BCL-2 protein has what effect?

Answer 62

Decreased apoptosis sensitivity

Question 63

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