Lymphomas and Plasma Cells & Disorder Flashcards
Lymph node regions are…
Cortex
Medulla
Paracortex
Cortex of the lymph node
Cortical nodules (arranged in circles in outer cortex) and focus of B-cell proliferation (germinal centers
Medulla of lymph node
Medullary cords (B lymphs and plasma cells)
Paracortex of lymph node
Contains T-cells and macrophages
What Cd receptors are expressed on naive b lymphs?
CD19, CD20 and C5
What cd receptors are expressed on T cells?
CD2, CD3, CD4, CD5, CD7, and CD8
What are the functions of the lymph nodes?
-Formation of new B lymphocytes from germinal centers
-Processing of specific immunoglobulins
-Filtration of matter, debris, and bacteria
What temperature are extra slides of lymph nodes stored at?
-70 C for further studies
What is the thickness of lymph node slides?
3 mm- thick sections
What are the strongest risk factors for lymphoma?
Altered immune function which is linked to chemical exposure
Bone marrow and peripheral blood involvement varies depending on….
Lymphoma subtype
How are lymphoma subtypes distinguished?
Morphology, immunophenotype, molecular characteristics, and clinical characteristics
What is the hallmark histology of for general lymphomas?
Destructive lymph node enlargement
What is required in lymphoma diagnosis?
Lymph node biopsy
When are abnormal cells seen in peripheral blood in lymphomas?
Late in the disease with a chance to progress to leukemia
What are the categories of lymphoma?
Mature B cell lymphoma & mature T cell lymphomas
What department are extra lymph node histology slides sent to?
flow cytometry
What department are lymph node histology slides are sent to for examination?
Pathology
Which lymphoma is common in kids?
Hodgkin’s lymphoma
What cell indicates hodgkin’s lymphoma in a patient?
Reed-Sternberg cell aka owl eye cell
Unifocal origin with predictable spread along lymph node chain. Accurate staging is important to treatment. HL or NHL?
HL
Multifocal origin, unpredictable spread, and staging is not crucial. HL or NHL?
NHL
Presents with painless enlarged cervical lymph nodes. HL or NHL?
HL
Presents with painless, enlarged cervical lymph nodes at a more advanced stage. HL or NHL?
NHL
Between HL and NHL, which has the better prognosis?
HL has the better prognosis if it is still localized >90% with a chance of being cured.
NHL has the worse prognosis
In NHL, what cell type is commonly malignant?
B lymphocytes 95% of the cases. Then T lymph and rarely ever NK cells.
What is a poor prognostic indicator in Hodgkin Lymphoma?
Fever, weight loss, and night sweats. These symptoms are also called B symptoms
What are the clinical findings of HL?
- Painless, enlarged cervical lymph nodes
- Sometimes mediastinal mass between lungs.
- Patients are generally young
How long would a patient survive HL with no treatment?
1-2 years after onset due to recurrent infections and organ failure
What cell may indicate nodular lymphocyte-Predominant HL?
Popcorn cell
What are two categories of HL?
-Classical HL
-NLPHL
What cell receptors would be expressed in cells from a patient with NLPHL?
CD20 and CD45
Why is lymph node biopsy required to diagnose a patient for HL?
Theres no leukemic phase so a lymph node biopsy is the only definitive test. All other tests are non-specific.
Describe Reed-sternberg cell.
- 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)
What tests are required to accurately diagnosis HL?
-Bone scans
-Thoracic CT scans
-Immunophenotyping
-Routine labs
Lymph node and Liver biopsies
What is the treatment for HL?
Radiation and chemo
What are the 3 combined B&T cell disorders?
Wiskott-Aldrich, SCID, and ataxia telangiectasia (AT)
Having pre-existing NHL increases risk of developing combined B&T cell disorder by…
10,000X
What is strongly associated with NHL?
cmyc proto-oncogene rearrangement on chromosome 8
What chromosome is involved in cmyc proto-oncogene?
chromosome 8
What is cymc?
It is a transcription factor for cell growth found to be over-expressed in many different kinds of malignancies.
NHL typically does have a ________ presentation at the end stage of the disease.
leukemic presentation
NHL mostly has normal peripheral blood cell morphology, but may see ______ _______ in lymphs,
Cleaved nuclei or butt cells
Describe low grade NHL
Slow growing with a survival of 5-7 years with treatment
Describe intermediate grade NHL
More rapid enlargement and more common extra nodal disease. Frequently diffuse large B cell lymphoma subtype
What is NHL treatment?
Similar to HL. Radiation and chemotherapy
Which lymphoma produces monoclonal light chain immunoglobulins, clonal immunoglobulin gene rearrangement or both?
Mature B Cell lymphomas
What kind of patient are mostly effected by lymph node based?
Elderly individuals
What differentiates SLL from CLL?
SLL is in lymph nodes and lymphoid organs
CLL is in peripheral blood and bone marrow
Both SLL and CLL have…
-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
What are the median survival for SLL and CLL patients?
10 years
Mantle cell lymphoma is linked to what mutation?
t(11,13) defect
What cell receptors are expressed in mantle cell lymphoma?
CD5, CD19, CD20, BUT NEGATIVE for CD23
Describe Mantle cell lymphoma
-Diffuse proliferation of medium sized cells w/ irregular nuclear outlines.
-Peripheral blood can mimic PPL
What is the median survival for patients with mantle cell lymphoma
3 to 5 years
In follicular lymphoma nodular proliferation replaces…
Normal architecture
Follicular lymphom originates where and involves…
Originates in germinal centers of lymph nodes. It involves neoplastic proliferation of medium-sized cells, mixed w/ large lymphoid cells.
How is follicular lymphoma graded?
Graded by the average number of large cells observed per hpf
What cell receptors are expressed in follicular lymphoma?
CD19 and CD20
In follicular lymphoma cells proliferate because of
decreased sensitivity of apoptosis
What mutations are linked to follicular lymphoma?
t(14:18) and (q32;q21) in over 95% of cases. They express BCL-2 protein decreases apoptosis sensitivity.
Expression of BCL-2 protein has what effect?
Decreased apoptosis sensitivity
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