Lymphoproliferative diseases

Question 1

Chronic Lymphocytic leukemia (CLL)

Answer 1

older males; familial incidence; memory B-cells
blood>bone marrow, lymph nodes
small lymphocytes, little cytoplasm “smudge cells”
pseudofollicular lymph node;
light chain restrictive, CD5+, CD23+ (CD20 weak)

Question 2

Mantle cell Lymphoma

Answer 2

older males, mantle cells;
lymph nodes> bone marrow, spleen, blood, GI tract
small lymphocytes, little cytoplasm, smudge cells; starry sky LN; no proliferation centers in LN
light chain restrictive CD5+, CD20+
CD23-
IgH; cyclin D1
t(11:14)

Question 3

sporadic Burkitt Lymphoma

Answer 3

abdominal mass in young adults, inc. in HIV pt; memory B-cells
ileo-cecal, ovaries, kidneys
basophilic medium sized cells, vaculoated cytoplasm; tissue=starry sky
CD 10, 19, 20

Question 4

Plasma Cell neoplasms

Answer 4

old people; bone marrow»blood;
increased total protein; Rouleaux on smear; erode blood in bone marrow
lytic bone lesions, hypercalcemia, renal inefficiency, bacterial infections
CD38+, CD138+, CD19-, CD20-; light chain restrictive
translocations of IgH or trisomies
Del 17p, t(4,14), t(14,16)

Question 5

follicular lymphoma

Answer 5

old people;
failure of B-cells to apoptosis-> over-expression of Bcl-2; enlarged LN with many follicles; no polarity, tingible bodies; few mitotic figures
CD19+, CD20+, CD10+, BCL-2+, BCL-6+
t(14:18)

Question 6

diffuse large B-cell lymphoma

Answer 6

old folks; rapidly growing adenopathy

CD19+, CD20+, CD10+; multiple translocations

Question 7

Hodgkin lymphoma

Answer 7

males 30-50; invovlement of cervical, mediastinal, abdominal LN; Reed/sternberg cells
CD30+, CD15+, Pax5+, CD20-
treat with chemo

Question 8

mycosis funoides

Answer 8

T-cell CD4+ malignancy; patchy, flat, red skin lesions. lymphocytes w/indented nuclei, invade epidermis, cerbriform nuclei in blood
CD3, 4, 5

Question 9

plasma cell markers

Answer 9

CD38, CD138, (CD20-)

Question 10

smudge cell

Answer 10

CLL, MCL

Question 11

Endemic Burkitt lymphoma

Answer 11

Jaw/facial bones in kids (4-7) in malaria areas; memory B-cells
ileo-cecal, ovaries, kidneys
basophilic medium sized cells, vaculoated cytoplasm; tissue=starry sky; infected with EBV
CD10, 19, 20

Question 12

Reed Sternberg cells

Answer 12

large lymphoid cells with mono- or bi-nucleate appearance, eosinophilic nucleoli; horse-shoe shaped
No Ig expression (except in HLNLP); constitutive NFkB, EBV or anti-apoptotic pathways;

Question 13

T cell markers

Answer 13

Tdt, CD3, CD4, CD8, CD7

Question 14

Waldenstrom’s macroglobulinemia

Answer 14

Low grade lymphoma with excess IgM.
Older than 40, hyperviscosity syndrome
Treat with Bortezomib