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Endocrine > Lymphoreticular patho Anki > Flashcards

Lymphoreticular patho Anki Flashcards

1
Q

Diagnosis of lymphoma is based on 4 parameters (mn CMSM) (IMPT!!!): 1. […] 2. […] 3. […] 4. […] Lymphomas can be classified based on: 1. […] 2. […] 3. […]

A

Diagnosis of lymphoma is based on 4 parameters (mn CMSM) (IMPT!!!): 1. Clinical features 2. Morphology (through FNA/ biopsy) 3. Surface antigens (flow cytometry and immunohistochemistry) 4. Molecular signatures Lymphomas can be classified based on: 1. Clinical behaviour 2. Natural history 3. Indolent vs Aggressive lymphoma

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2
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% of each kind of lymphoma Non-Hodgkin lymphomas (NHL) - […]: - B-cell lymphomas ([…]) - T-cell and NK cell lymphomas ([…]) Mature cell lymphomas are the majority Hodgkin lymphomas (HL) - 7%: - Classical HL (95%) - Nodular lymphocyte predominant HL (5%)

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% of each kind of lymphoma Non-Hodgkin lymphomas (NHL) - 93%: - B-cell lymphomas (84%) - T-cell and NK cell lymphomas (16%) Mature cell lymphomas are the majority Hodgkin lymphomas (HL) - 7%: - Classical HL (95%) - Nodular lymphocyte predominant HL (5%) TLDR, most common type of lymphoma is B-cell lymphoma which is a type of NHL! HL is rare but if diagnosed, it is most likely a classical HL

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3
Q

% of each kind of lymphoma Non-Hodgkin lymphomas (NHL) - 93%: - B-cell lymphomas (84%) - T-cell and NK cell lymphomas (16%) Mature cell lymphomas are the majority Hodgkin lymphomas (HL) - […]: - Classical HL ([…]) - Nodular lymphocyte predominant HL ([…])

A

% of each kind of lymphoma Non-Hodgkin lymphomas (NHL) - 93%: - B-cell lymphomas (84%) - T-cell and NK cell lymphomas (16%) Mature cell lymphomas are the majority Hodgkin lymphomas (HL) - 7%: - Classical HL (95%) - Nodular lymphocyte predominant HL (5%) TLDR, most common type of lymphoma is B-cell lymphoma which is a type of NHL! HL is rare but if diagnosed, it is most likely a classical HL

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4
Q

Structure of the lymph nodes The […] is where most metastatic cancers will end up. Germinal centres are only found in […].

A

Structure of the lymph nodes The subcapsular sinus is where most metastatic cancers will end up. Germinal centres are only found in secondary follicles (mostly B cells).

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5
Q

Name some non-neoplastic conditions of lymph nodes! 1. […] 2. […] 3. […] 4. […] 5. […] 6. […] 7. […] Autoimmune classifications of LN disease? 1. Myasthenia Gravis 2. Graves 3. RA 4. SLE

A

Name some non-neoplastic conditions of lymph nodes! 1. Acute non-specific lymphadenitis: Staph infections 2. Necrotising lymphadenitis (Kikuchi’s lymphadenitis) 3. Drug-related lymphadenopathy 4. Autoimmune: RA and SLE 5. Sarcoidosis (diagnosis of exclusion cuz unknown etiology) 6. Granulomatous 7. Viral (eg Infectious mononucleosis - EBV) Autoimmune classifications of LN disease? 1. Myasthenia Gr

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6
Q

Name some non-neoplastic conditions of lymph nodes! 1. Acute non-specific lymphadenitis: Staph infections 2. Necrotising lymphadenitis (Kikuchi’s lymphadenitis) 3. Drug-related lymphadenopathy 4. Autoimmune: RA and SLE 5. Sarcoidosis (diagnosis of exclusion cuz unknown etiology) 6. Granulomatous 7. Viral (eg Infectious mononucleosis - EBV) Autoimmune classifications of LN disease? 1. […] 2. […

A

Name some non-neoplastic conditions of lymph nodes! 1. Acute non-specific lymphadenitis: Staph infections 2. Necrotising lymphadenitis (Kikuchi’s lymphadenitis) 3. Drug-related lymphadenopathy 4. Autoimmune: RA and SLE 5. Sarcoidosis (diagnosis of exclusion cuz unknown etiology) 6. Granulomatous 7. Viral (eg Infectious mononucleosis - EBV) Autoimmune classifications of LN disease? 1. Myasthenia Gr

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7
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Whats the definition of Lymphomas? […] (IMPT!!) How does lymphomas present clinically? (deduce) What are B symptoms? 1. […] 2. […] 3. […] 4. […] Staging of lymphomas (Lugano Classification/Ann Arbor Staging system): Stage 1 - Single lymph node region or single extralymphatic sites Stage 2 - 2 or more lymph node regions on same side of diaphragm, can include extralymphatic Stage 3 - Lymph

A

“Whats the definition of Lymphomas? malignancies of the lymphoid system which primarily manifest themselves outside of the bone marrow, at the sites of normal lymphoid homing. (IMPT!!) How does lymphomas present clinically? (deduce) What are B symptoms? 1. Enlarging, painless masses at sites of nodal tissue 2. Compression and infiltration of hollow organs (pain, obstruction, perforation) 3. Interf

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8
Q

Whats the definition of Lymphomas? malignancies of the lymphoid system which primarily manifest themselves outside of the bone marrow, at the sites of normal lymphoid homing. (IMPT!!) How does lymphomas present clinically? (deduce) What are B symptoms? 1. Enlarging, painless masses at sites of nodal tissue 2. Compression and infiltration of hollow organs (pain, obstruction, perforation) 3. Interfe

A

“Whats the definition of Lymphomas? malignancies of the lymphoid system which primarily manifest themselves outside of the bone marrow, at the sites of normal lymphoid homing. (IMPT!!) How does lymphomas present clinically? (deduce) What are B symptoms? 1. Enlarging, painless masses at sites of nodal tissue 2. Compression and infiltration of hollow organs (pain, obstruction, perforation) 3. Interf

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9
Q

Aggressive vs Indolent lymphomas: Characteristics of aggressive lymphomas: - […] - […] - […] - […] - […]

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Aggressive vs Indolent lymphomas: Characteristics of aggressive lymphomas: - Large proliferative margin - Accelerated replication (mitotic activity) - More localised than indolent lymphomas - Shorter natural history, median survival <2 years - Curable ALL childhood lymphomas are AGGRESSIVE LYMPHOMAS!! TLDR, replicates fast but still dies, so anti-cancer agents works (hence curable). Quite paradoxi

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10
Q

Aggressive vs Indolent lymphomas: Characteristics of indolent lymphomas: - […] - […] - […] - […] - […]

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Aggressive vs Indolent lymphomas: Characteristics of indolent lymphomas: - Small proliferative margin, hard to treat with anti-cancer drugs - Grow slowly, don’t die - Often widespread at diagnosis - Prolonged natural history, median survival >5 years - Currently incurable unless localized/marrow abalation + HSCT TLDR, replicates slow but doesn’t die, so anti-cancer agents DOESNT WORK (hence INcura

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11
Q

NHL Specific cancers - DLBCL (vvvvvv IMPT!!) Diffuse Large B-cell lymphomas (DLBCL) are the most common lymphoma (30%). They are […]. Affects both […], median age […]. Presents as a […] Curable (40%) via […] Pathogenesis is […]. Morphology: - Diffuse infiltration of lymph node - Large lymphoid cells Surface antigens: - B-cell markers: CD20+

A

“NHL Specific cancers - DLBCL (vvvvvv IMPT!!) Diffuse Large B-cell lymphomas (DLBCL) are the most common lymphoma (30%). They are aggressive (not indolent). Affects both adults and children, median age 64. Presents as a rapidly enlarging mass (characteristic of aggressive lymphomas) Curable (40%) via aggressive chemotherapy/ HSCT - Hematopoietic stem cell transplantation Pathogenesis is we still d

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12
Q

NHL Specific cancers - DLBCL (vvvvvv IMPT!!) Diffuse Large B-cell lymphomas (DLBCL) are the most common lymphoma (30%). They are aggressive (not indolent). Affects both adults and children, median age 64. Presents as a rapidly enlarging mass (characteristic of aggressive lymphomas) Curable (40%) via aggressive chemotherapy/ HSCT - Hematopoietic stem cell transplantation Pathogenesis is we still dk

A

“NHL Specific cancers - DLBCL (vvvvvv IMPT!!) Diffuse Large B-cell lymphomas (DLBCL) are the most common lymphoma (30%). They are aggressive (not indolent). Affects both adults and children, median age 64. Presents as a rapidly enlarging mass (characteristic of aggressive lymphomas) Curable (40%) via aggressive chemotherapy/ HSCT - Hematopoietic stem cell transplantation Pathogenesis is we still d

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13
Q

NHL Specific cancers - Burkitt’s Lymphoma Burkitt’s lymphoma is not a common NHL (3%). Has a mutation that causes upregulation of […]. Forms up to 1/3 of all childhood lymphomas. Associated with […]. Affects both […], median age […]. Presents as a […]. Is very aggressive and rapidly fatal. Curable (40%) via […] Morphology: - Diffuse infiltration of lymph node - High cell turnover which

A

“NHL Specific cancers - Burkitt’s Lymphoma Burkitt’s lymphoma is not a common NHL (3%). Has a mutation that causes upregulation of c-myc oncogene. Forms up to 1/3 of all childhood lymphomas. Associated with EBV. Affects both adults and children, median age 31. Presents as a rapidly enlarging mass that is localised in the jaw. Is very aggressive and rapidly fatal. Curable (40%) via aggressive chemo

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14
Q

NHL Specific cancers - Burkitt’s Lymphoma Burkitt’s lymphoma is not a common NHL (3%). Has a mutation that causes upregulation of c-myc oncogene. Forms up to 1/3 of all childhood lymphomas. Associated with EBV. Affects both adults and children, median age 31. Presents as a rapidly enlarging mass that is localised in the jaw. Is very aggressive and rapidly fatal. Curable (40%) via aggressive chemot

A

“NHL Specific cancers - Burkitt’s Lymphoma Burkitt’s lymphoma is not a common NHL (3%). Has a mutation that causes upregulation of c-myc oncogene. Forms up to 1/3 of all childhood lymphomas. Associated with EBV. Affects both adults and children, median age 31. Presents as a rapidly enlarging mass that is localised in the jaw. Is very aggressive and rapidly fatal. Curable (40%) via aggressive chemo

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15
Q

NHL Specific cancers - Follicular Lymphomas Follicular lymphomas are the 2nd most common type of lymphoma. They are […]. Affects […] Presents as a […] Can be treated with […] but has chance of […]. But because it is an indolent tumour it’s generally (treatment) […] Pathogenesis: - t(14;18)(q32,q21) mutation, resulting in upregulation of BCL2 (anti-apoptosis), immortalises lymphoma cell

A

“NHL Specific cancers - Follicular Lymphomas Follicular lymphomas are the 2nd most common type of lymphoma. They are indolent. Affects adults older than 40 (normally median 59) Presents as a widely disseminated tumour by the time of diagnosis (characteristic of indolent lymphomas) Can be treated with gentle chemotherapy but has chance of relapse. But because it is an indolent tumour it’s generally

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16
Q

NHL Specific cancers - Follicular Lymphomas Follicular lymphomas are the 2nd most common type of lymphoma. They are indolent. Affects adults older than 40 (normally median 59) Presents as a widely disseminated tumour by the time of diagnosis (characteristic of indolent lymphomas) Can be treated with gentle chemotherapy but has chance of relapse. But because it is an indolent tumour it’s generally

A

“NHL Specific cancers - Follicular Lymphomas Follicular lymphomas are the 2nd most common type of lymphoma. They are indolent. Affects adults older than 40 (normally median 59) Presents as a widely disseminated tumour by the time of diagnosis (characteristic of indolent lymphomas) Can be treated with gentle chemotherapy but has chance of relapse. But because it is an indolent tumour it’s generally

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17
Q

HL is defined to be a […] (IMPT!!) Reed-Sternberg cells have […] Classical HL: Age of incidence: […] Diagnosis is based on (think of definition): - […] - […] Spread is contiguous (NOT DIFFUSE!!!), meaning that they go with the lymphatic flow. Immunohistology has the markers: CD15+ and CD30+ Prognosis: Curable, about 80%. Depends on staging, bulk of disease instead of morphologic subtype.

A

“HL is defined to be a lymphoid neoplasm composed of Reed-Sternberg cells (neoplastic) residing in an inflammatory (non-neoplastic) background; with histiocytes, lymphocytes, eosinophils and plasma cells. (IMPT!!) Reed-Sternberg cells have Owl’s-eye inclusions Classical HL: Age of incidence: Bimodal (not middle age) Diagnosis is based on (think of definition): - Presence of RS cells - Background r

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18
Q

HL is defined to be a lymphoid neoplasm composed of Reed-Sternberg cells (neoplastic) residing in an inflammatory (non-neoplastic) background; with histiocytes, lymphocytes, eosinophils and plasma cells. (IMPT!!) Reed-Sternberg cells have Owl’s-eye inclusions Classical HL: Age of incidence: Bimodal (not middle age) Diagnosis is based on (think of definition): - Presence of RS cells - Background ri

A

“HL is defined to be a lymphoid neoplasm composed of Reed-Sternberg cells (neoplastic) residing in an inflammatory (non-neoplastic) background; with histiocytes, lymphocytes, eosinophils and plasma cells. (IMPT!!) Reed-Sternberg cells have Owl’s-eye inclusions Classical HL: Age of incidence: Bimodal (not middle age) Diagnosis is based on (think of definition): - Presence of RS cells - Background r

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19
Q

Most common types of metastatic cancers in lymph nodes are […].

A

Most common types of metastatic cancers in lymph nodes are carcinomas. Cuz carcinomas normally spread via lymphatics, sarcomas normally spread via hematogenous routes!

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20
Q

What are the 2 ways to classify leukaemia? - […] - […] Leukaemias are defined as […] (IMPT) Normally present as […] + […] General things we need to know about leukaemia: 1. Leading cause of cancer death in children under 15 years 2. Leukaemic cells always originate in the bone marrow 3. Leukaemic cells usually spill from the bone marrow into the blood, where they may be seen in large num

A

What are the 2 ways to classify leukaemia? - Acute or Chronic - Myeloid/ myeloblastic or Lymphoid/ lymphoblastic Leukaemias are defined as malignancies of the haematopoietic system which are primarily disorders of the bone marrow (IMPT) Normally present as widespread involvement of the bone marrow + large numbers of tumour cells in blood circulation (Seen on PBF) General things we need to know abo

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21
Q

What are the 2 ways to classify leukaemia? - Acute or Chronic - Myeloid/ myeloblastic or Lymphoid/ lymphoblastic Leukaemias are defined as malignancies of the haematopoietic system which are primarily disorders of the bone marrow (IMPT) Normally present as widespread involvement of the bone marrow + large numbers of tumour cells in blood circulation (Seen on PBF) General things we need to know abo

A

What are the 2 ways to classify leukaemia? - Acute or Chronic - Myeloid/ myeloblastic or Lymphoid/ lymphoblastic Leukaemias are defined as malignancies of the haematopoietic system which are primarily disorders of the bone marrow (IMPT) Normally present as widespread involvement of the bone marrow + large numbers of tumour cells in blood circulation (Seen on PBF) General things we need to know abo

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22
Q

Lineages of haematopoietic system: Neoplastic Cells from the lymphoid progenitor lineage would be called […] Neoplastic Cells from the myeloid lineage would be called […] When they form cancers, they are: 1. Hypercellular (90-100%) 2. Monotonous clonal populations Blast cells in the blood would have the following histological/cytological characteristics: - High N/C ratio - Prominent nuclei - E

A

Lineages of haematopoietic system: Neoplastic Cells from the lymphoid progenitor lineage would be called lymphoid/ lymphoblastic leukaemias. Neoplastic Cells from the myeloid lineage would be called myeloid/ myeloblastic leukaemias. When they form cancers, they are: 1. Hypercellular (90-100%) 2. Monotonous clonal populations Blast cells in the blood would have the following histological/cytologica

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23
Q

Lineages of haematopoietic system: Neoplastic Cells from the lymphoid progenitor lineage would be called lymphoid/ lymphoblastic leukaemias. Neoplastic Cells from the myeloid lineage would be called myeloid/ myeloblastic leukaemias. When they form cancers, they are: 1. […] 2. […] Blast cells in the blood would have the following histological/cytological characteristics: - […] - […] - […]

A

Lineages of haematopoietic system: Neoplastic Cells from the lymphoid progenitor lineage would be called lymphoid/ lymphoblastic leukaemias. Neoplastic Cells from the myeloid lineage would be called myeloid/ myeloblastic leukaemias. When they form cancers, they are: 1. Hypercellular (90-100%) 2. Monotonous clonal populations Blast cells in the blood would have the following histological/cytologica

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24
Q

Acute vs Chronic leukaemias: Symptoms of acute leukaemias arise due to […] Hence pt normally present with: 1. […]with accompanying fatigue (Reduced RBC) 2. […] (Reduced Leukocytes) 3. […] (Reduced Platelets) Prognosis: […] Characterised by: […]

A

Acute vs Chronic leukaemias: Symptoms of acute leukaemias arise due to suppression of normal marrow function. Hence pt normally present with: 1. Anaemiawith accompanying fatigue (Reduced RBC) 2. Fever with infection (Reduced Leukocytes) 3. Bleeding (Reduced Platelets) Prognosis: Usually fatal within weeks if untreated Characterised by: Increased immature blast cells Think about pancytopenia!!

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25
Q

Acute vs Chronic leukaemias: Symptoms of chronic leukaemias are usually non-specific They normally present with: 1. Anaemia with accompanying fatigue (Reduced RBC) 2. […] 3. […] Prognosis: […] Characterised by: […]

A

Acute vs Chronic leukaemias: Symptoms of chronic leukaemias are usually non-specific They normally present with: 1. Anaemia with accompanying fatigue (Reduced RBC) 2. Weight loss (>10% BW) 3. Abnormal sensation in the abdomen (splenomegaly) Prognosis: Usually survive much longer than acute leukemia Characterised by: More mature and well differentiated cells (cuz chronic?) Acute leukemia presents w

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26
Q

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: […] Targeted patients: Mostly children, peaks at age 3 Special fact: MOST if not all childhood leukaemias are ALL. Not common in adults AML (Acute Myeloblastic Leukemia): Recurrence: […] Targeted patients: More common in adults than children Special/ Prognosis: Rapidly fatal w

A

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: Rare, about 0.01% a year Targeted patients: Mostly children, peaks at age 3 Special fact: MOST if not all childhood leukaemias are ALL. Not common in adults AML (Acute Myeloblastic Leukemia): Recurrence: Rare Targeted patients: More common in adults than children Special/ Prognosi

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27
Q

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: Rare, about 0.01% a year Targeted patients: […] Special fact: MOST if not all childhood leukaemias are ALL. Not common in adults AML (Acute Myeloblastic Leukemia): Recurrence: Rare Targeted patients: […] Special/ Prognosis: Rapidly fatal without treatment CLL (Chronic Lymphoid

A

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: Rare, about 0.01% a year Targeted patients: Mostly children, peaks at age 3 Special fact: MOST if not all childhood leukaemias are ALL. Not common in adults AML (Acute Myeloblastic Leukemia): Recurrence: Rare Targeted patients: More common in adults than children Special/ Prognosi

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28
Q

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: Rare, about 0.01% a year Targeted patients: Mostly children, peaks at age 3 Special fact: […] AML (Acute Myeloblastic Leukemia): Recurrence: Rare Targeted patients: More common in adults than children Special/ Prognosis: […] CLL (Chronic Lymphoid Leukemia): Recurrence: 1/3 of

A

Lymphoid vs Myeloid leukaemia. Describe their general characteristics. ALL (Acute Lymphoblastic Leukemia): Recurrence: Rare, about 0.01% a year Targeted patients: Mostly children, peaks at age 3 Special fact: MOST if not all childhood leukaemias are ALL. Not common in adults AML (Acute Myeloblastic Leukemia): Recurrence: Rare Targeted patients: More common in adults than children Special/ Prognosi

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29
Q

Diagnosis of leukaemias (same categories as lymphomas) - CMSM 1. […] 2. […] 3. […] 4. […]

A

Diagnosis of leukaemias (same categories as lymphomas) - CMSM 1. Clinical 2. Morphological 3. Surface antigens 4. Molecular signature

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30
Q

What are some functions of the spleen? 1. […] 2. […] 3. […] 4. […]

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What are some functions of the spleen? 1. Filtration of unwanted elements in the blood 2. Major secondary organ of the immune system 3. Source of lymphoreticular/ haematopoietic cells 4. Reserve pool and storage space

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31
Q

Name some causes of splenomegaly! (IMPT!!) 1. […] 2. […] 3. […] 4. […] 5. […] Others

A

Name some causes of splenomegaly! (IMPT!!) 1. Blood borne Infections 2. Congestion (HTN) 3. Lymph-haematogenous disorders 4. Immunologic-inflammatory conditions 5. Storage diseases Others

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32
Q

What are some disorders of the thymus? 1. […] 2. […] 3. […] 4. […] Most common thymus malignancy in children: 1. NHL 2. HL 3. Neuroblastomas Most common thymus malignancy in adults: 1. Thymomas 2. Lymphomas 3. Germ cell tumours

A

What are some disorders of the thymus? 1. Developmental disorders 2. Thymic hyperplasia 3. Myasthenia Gravis 4. Thymic neoplasms Most common thymus malignancy in children: 1. NHL 2. HL 3. Neuroblastomas Most common thymus malignancy in adults: 1. Thymomas 2. Lymphomas 3. Germ cell tumours

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33
Q

What are some disorders of the thymus? 1. Developmental disorders 2. Thymic hyperplasia 3. Myasthenia Gravis 4. Thymic neoplasms Most common thymus malignancy in children: 1. […] 2. […] 3. […] Most common thymus malignancy in adults: 1. […] 2. […] 3. […]

A

What are some disorders of the thymus? 1. Developmental disorders 2. Thymic hyperplasia 3. Myasthenia Gravis 4. Thymic neoplasms Most common thymus malignancy in children: 1. NHL 2. HL 3. Neuroblastomas Most common thymus malignancy in adults: 1. Thymomas 2. Lymphomas 3. Germ cell tumours

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34
Q

What’s the first-line treatment used for NHL? […]

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“What’s the first-line treatment used for NHL? Anti CD20: Rituximab If you think about it all the B lymphocyte NHL (which are the most common ones) have CD20 as a marker. ““just 20 DLBCL”” ““c-myc EBV t(8;14), 10 20 starry sky of Burkitt”” ““10 20 BCL2 t(14;18)(q32,q21) follicular lymphoma”” HL is actually B lymphocyte as well but its not CD20 ““Reed Sternberg in Inflammatory background, 15 30 bim

35
Q

While not really taught, what are the microscopic presentations of multiple myelomas? X-ray: […] Histology: […]

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“While not really taught, what are the microscopic presentations of multiple myelomas? X-ray: Skull and spine shows numerous lesions (pot skull) Histology: Atypical, numerous plasma cells are present ““Multiple myeloma is a cancer of plasma cells”””

36
Q

What are some examples of Primary immune organs? - […] - […] Secondary immune organs? - […] - […] - […] - Everywhere else lol

A

What are some examples of Primary immune organs? - Bone Marrow (B cells, NK cells) - Thymus (T cells) Secondary immune organs? - Lymph Nodes - Spleen - MALT - Everywhere else lol

37
Q

What NHLs (B, T, NK) are aggressive? General rule of thumb is that (IMPT!!!!) 1. ALL […] cell neoplasms are aggressive 2. Of the B cell neoplasms, […] are aggressive.

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What NHLs (B, T, NK) are aggressive? General rule of thumb is that (IMPT!!!!) 1. ALL T cell neoplasms are aggressive 2. Of the B cell neoplasms, DLBCL, Mantle cell L, Burkitt L, Mediastinal large B-cell L are aggressive. Follicular lymphoma (2nd most common NHL) is NOT aggressive~

38
Q

Pt presents with mediastinal lympadenopathy of the lung. Think of? […]

A

Pt presents with mediastinal lympadenopathy of the lung. Think of? Hodgekin’s Lymphoma!

39
Q

Practical approach to lymph node enlargement If suspect lymphoma: - […] - […] If suspect infection: - […] - […] - […] - […]

A

Practical approach to lymph node enlargement If suspect lymphoma: - FNAC - fine needle aspiration cytology - Biopsy If suspect infection: - FNAC - Biopsy - Culture - Serology TLDR if lymph node enlarged, FNAC/Biopsy alw works HAHHAHA

40
Q

Whats the diff between lymphomas and leukemias? (V IMPT!!!) - Lymphomas are […] the bone marrow, Leukemias are […] the bone marrow - Lymphomas are malignancies of the […] system, leukemias are malignancies of the […] system - Lymphomas arises as […], Leukemias present as […]

A

Whats the diff between lymphomas and leukemias? (V IMPT!!!) - Lymphomas are OUTSIDE the bone marrow, Leukemias are INSIDE the bone marrow - Lymphomas are malignancies of the lymphoid system, leukemias are malignancies of the whole haematopoietic system - Lymphomas arises as discrete tumour masses, Leukemias present as wide spread involvement of bone marrow + large number of tumour cells in hematog

41
Q

Pt presents with secondary neoplasms in the lymph nodes. How to find source of primary tumour?? - […] - […] - […]

A

Pt presents with secondary neoplasms in the lymph nodes. How to find source of primary tumour?? - Histological characteristics / morphology - Lymph node area, proximity to main organ - Immunohistochemistry, molecular signals

42
Q

MCQ: B lymphocyte is home to which region of the lymph node? 1. Follicles […] 2. Interfollicular region […] 3. Subcortical sinus […] 4. Medullary sinus […] 5. All of the above […]

A

MCQ: B lymphocyte is home to which region of the lymph node? 1. Follicles Correct 2. Interfollicular region Wrong 3. Subcortical sinus Wrong 4. Medullary sinus Wrong 5. All of the above Wrong

43
Q

MCQ: Which is correct about Indolent Lymphomas? 1. Have a long median survival […] 2. Usually have a high mitotic rate […] 3. Display prominent nucleoli […] 4. Are usually curable […]

A

MCQ: Which is correct about Indolent Lymphomas? 1. Have a long median survival Correct 2. Usually have a high mitotic rate Wrong 3. Display prominent nucleoli Wrong 4. Are usually curable Wrong Thought process: Indolent lymphomas proliferate slowly but has defective apoptosis. Proliferate slowly –> low mitotic rate, nucleoli not prominent (not active), widespread by the time it is diagnosed, long

44
Q

MCQ: The following are common causes of lymph node enlargement EXCEPT 1. EBV Infection […] 2. Tuberculosis […] 3. Metastatic sarcoma […] 4. Metastatic carcinoma […] 5. Follicular lymphoma […]

A

MCQ: The following are common causes of lymph node enlargement EXCEPT 1. EBV Infection Wrong. It is. 2. Tuberculosis Wrong. It is. 3. Metastatic sarcoma Correct. It is not cuz sarcomas usually spread by blood 4. Metastatic carcinoma Wrong. It is the most common cancer found in LNs. 5. Follicular lymphoma Wrong. It is.

45
Q

Patho description: - […] Diagnosis: - […]

A

Patho description: - Diffused enlargement affecting entire spleen Diagnosis: - Splenomegaly

46
Q

Name 3 causes of splenomegaly - […] - […] - […] - […] - […] - Others

A

Name 3 causes of splenomegaly - Infections - Congestion (HTN) - Lymph-haematogenous disorders - Immunologic-inflammatory conditions - Storage diseases - Others Can use VITAMIN CDEF! Vascular Infections Trauma Autoimmune Metabolic Iatrogenic/Idiopathic Neoplastic Congenital Degenerative Endocrine Functional

47
Q

Name 3 complications of splenomegaly (think about the functions of the spleen) - […] - […] - […] - […] - […]

A

Name 3 complications of splenomegaly (think about the functions of the spleen) - Anaemia - Leukopenia - Thrombocytopenia - Splenic Infarction - Splenic Rupture Recap on spleen function (focus on point 3 here):

48
Q

Patho description: - […] - […] - […] Diagnosis: - […]

A

Patho description: - Focal lesion - Pale wedge shaped (due to blood supply) - Coagulative necrosis! Diagnosis: - Splenic Infarction

49
Q

What are the possible causes of splenic infarct? - […] - […] - […] - […] - […]

A

What are the possible causes of splenic infarct? - Thrombus - Emboli (valvular heart disease such as infective endocarditis, AMI, arrhythmias) - Atheromatous plague (of splenic artery) - Splenic artery stenosis (rare?) - Compression of splenic artery (by pancreas cancer) UNDERSTANDING: Think of how to obstruct a tube! - From within (thrombus, emboli, atheromatous plaque) - Tube constrict (arterial

50
Q

Pt Hx: Late one night, a homeless 68 year old man is wheeled into the emergency department. - He is breathless and coughing out blood.- Chest Xray shows a lung lesion near the apex of the lung, with many enlarged hilar nodes. - He dies during resuscitation and an autopsy is performed. - His lung lesion is yellowish, soft and caseous. - Multiple liver and spleen nodules are also seen. - This is his

A

Pt Hx: Late one night, a homeless 68 year old man is wheeled into the emergency department. - He is breathless and coughing out blood.- Chest Xray shows a lung lesion near the apex of the lung, with many enlarged hilar nodes. - He dies during resuscitation and an autopsy is performed. - His lung lesion is yellowish, soft and caseous. - Multiple liver and spleen nodules are also seen. - This is his

51
Q

Describe the histological features you expect to see in this spleen (obviously IMPT) - […] - […] - […] - […] - […] Which stain will you use? What will you see? - […]

A

Describe the histological features you expect to see in this spleen (obviously IMPT) - Granulomas - Epithelioid Histiocytes - Multinucleated Giant Cells - Lymphocytes - Central caseous necrosis Which stain will you use? What will you see? - Ziel Neelsen stain, Acid Fast Bacilli Bread and butter TB histology!!! If u get wrong then you should face the wall for 5 mins to reflect on yourself and tell

52
Q

Just by looking at the pot, how do we differentiate miliary TB from metastatic carcinoma to the liver and spleen??? - […] - […] - […]

A

Just by looking at the pot, how do we differentiate miliary TB from metastatic carcinoma to the liver and spleen??? - Caseous necrosis - Size of nodules - Hx!!! Btw mets to spleen are rare ya?

53
Q

What are the triad symptoms of fever, night sweat and weight loss called? […]

A

“What are the triad symptoms of fever, night sweat and weight loss called? Beta Symptoms!! Think about lymphomas (both NHL and HL)!! ““B symptoms refers to systemic symptoms of fever, night sweats and loss of weight, and are termed as ‘B symptoms’ because of the Ann Arbor staging system, in which ‘B’ indicates presence of these symptoms while ‘A’ indicates absence of symptoms.”””

54
Q

Pt Hx: A previously healthy 30 year old female was seen by the GP for complaints of fever, night sweats, weightloss and increasing abdominal distension.- The GP felt an abdominal mass and referred her to the surgeons, who did an abdominal CT and found splenomegaly and multiple enlarged abdominal lymph nodes. - This is her spleen. Patho Description: - […] - […] - […] - […] Diagnosis: - […

A

Pt Hx: A previously healthy 30 year old female was seen by the GP for complaints of fever, night sweats, weightloss and increasing abdominal distension.- The GP felt an abdominal mass and referred her to the surgeons, who did an abdominal CT and found splenomegaly and multiple enlarged abdominal lymph nodes. - This is her spleen. Patho Description: - 2x focal lesion - homogenous nodular mass - Spl

55
Q

Whats the difference between Lymphoma and Leukemia? (IMPT) Lymphomas are - Malignancies of the […] system which primarily manifest themselves […] the bone marrow - at sites of […] Leukemias are - Malignancies of the […] system which are primarily disorders of the […] - Presents with widespread involvement of the […] - No […] is formed - Usually with […]

A

Whats the difference between Lymphoma and Leukemia? (IMPT) Lymphomas are - Malignancies of the lymphoid system which primarily manifest themselves OUTSIDE the bone marrow - at sites of normal lymphoid homing (LN, spleen, thymus, MALT) Leukemias are - Malignancies of the hematopoietic system which are primarily disorders of the bone marrow - Presents with widespread involvement of the bone marrow -

56
Q

How are lymphomas traditionally classified? - […]

A

How are lymphomas traditionally classified? - NHL (B cell, T/NK cell) vs HL (Classical vs Non-Classical)

57
Q

What are the etiology (causes) of lymphomas? - […] - […] - […] - […] - […] - Smoking lol

A

What are the etiology (causes) of lymphomas? - Chromosomal translocations and other mutations - Inherited genes - Viruses - Chronic inflammation (e.g H pylori) - Iatrogenic factors (e.g radiation) - Smoking lol Lymphomas are very closely associated with chromosomal translocations!!

58
Q

Give an example of a virus that is implicated as the causative agents for lymphomas […]

A

Give an example of a virus that is implicated as the causative agents for lymphomas EBV –> BL, classical HL

59
Q

How is the pathological diagnosis diagnosis of lymphoma made? I.e how do we subclassify the various types of lymphomas? (IMPT!!!) - […] - […] - […] - […]

A

How is the pathological diagnosis diagnosis of lymphoma made? I.e how do we subclassify the various types of lymphomas? (IMPT!!!) - Clinical Features - Morphology - Surface Antigens - Molecular Signatures Bread and butter of lymphoma knowledge!

60
Q

List the systemic symptoms of lymphoma (vvvvv IMPT!!!) - […] - […] - […]

A

List the systemic symptoms of lymphoma (vvvvv IMPT!!!) - Fever - Night Sweats - Weightloss DATS RIGHT. B SYMPTOMS!! Many many cards so you should know it by now :)

61
Q

When looking at an enlarged lymph node pot, how do you tell between TB, lymphoma and metastatic carcinoma??? […]

A

When looking at an enlarged lymph node pot, how do you tell between TB, lymphoma and metastatic carcinoma??? Can is can but TLDR tuff. Hx helps alot. Also recall that met to LN is usually carcinoma. Sarcomas prefer hematologenous routes.

62
Q

Is it possible to tell between HL and NHL grossly (just looking at pot)? […]

A

Is it possible to tell between HL and NHL grossly (just looking at pot)? Generally no except Nodular Sclerosing HL

63
Q

Pt Hx: A 5 year old girl is brought to the paediatrician by her parents, for recent onset of easy bruising and repeated infections.- Her blood and bone marrow was examined and a diagnosis was made. - She was started on chemotherapy but rapidly succumbed to her disease. - These are her organs on autopsy. Patho description: - […] - […] - […] - […] Diagnosis: […]

A

Pt Hx: A 5 year old girl is brought to the paediatrician by her parents, for recent onset of easy bruising and repeated infections.- Her blood and bone marrow was examined and a diagnosis was made. - She was started on chemotherapy but rapidly succumbed to her disease. - These are her organs on autopsy. Patho description: - diffused enlargement of liver, kidney and spleen - homogenous cut surface

64
Q

How are leukemias classified? - […] - […]

A

How are leukemias classified? - Acute vs Chronic - Lymphoid vs Myeloid Hence, ALL AML CLL CML

65
Q

List the symptoms of a patient with bone marrow infiltrated by leukaemic cells (just deduce lol) (IMPT!!!) - […] - […] - […]

A

List the symptoms of a patient with bone marrow infiltrated by leukaemic cells (just deduce lol) (IMPT!!!) - Anaemia w fatigue (reduced RBC) - Infections (reduced leukocytes/leukopenia) - Bleeding (reduced platelets/thrombocytopenia) Btw, lymphocytes are a subset of leukocytes, but not from the same lineage.

66
Q

Patho description: - […] - […] - […] - […] - […] Histo features: - […] - […] - […] Diagnosis: […]

A

Patho description: - Focal lesion - hemogenous, pale - Poorly circumscribed - Nipple retraction due to desmoplastic rx - Metastasis to LN Histo features: - invasive glandular/ductal structures - desmoplastic stroma - cytologic features of malignancy (high N/C ratio, pleomorphism, hyperchromasia) Diagnosis: invasive breast carcinoma (ductal) with LN metastasis See this pot so many times until I wan

67
Q

60-year-old man comes to your clinic with a neck lump, you examine it and it feels like an enlarged lymph node. What are some possible reasons for lymphadenopathy? - […] - […] - […] - […] - […] - […]

A

60-year-old man comes to your clinic with a neck lump, you examine it and it feels like an enlarged lymph node. What are some possible reasons for lymphadenopathy? - Infective - Autoimmune - Necrotising lymphadenitis (Kikuchi’s lymphadenitis) - Storage disease - Drugs - Malignancy (lymphoma/metastatic carcinoma)

68
Q

60-year-old man comes to your clinic with a neck lump, you examine it and it feels like an enlarged lymph node. If you are worried about metastatic carcinoma to a lymph node in the neck, what are likely origins/primary sites? - […] - […] - […] - […] - […] - […] - […]

A

60-year-old man comes to your clinic with a neck lump, you examine it and it feels like an enlarged lymph node. If you are worried about metastatic carcinoma to a lymph node in the neck, what are likely origins/primary sites? - Oral Cavity - Nasopharynx - Upper aerodigestive tract - Thyroid - Lungs - Skin (H&N region) - Breast Anatomy!

69
Q

Lymph node in the neck (or some other part of the body) shows metastatic SQUAMOUS carcinoma, what likely organs did it come from? […] What is the most impt feature in the histology that suggests SQUAMOUS origin? […]

A

Lymph node in the neck (or some other part of the body) shows metastatic SQUAMOUS carcinoma, what likely organs did it come from? Skin, Lungs (metaplasia), etc What is the most impt feature in the histology that suggests SQUAMOUS origin? Keratin Pearls!!

70
Q

Lymph node in the neck (or some other part of the body) shows metastatic ADENOcarcinoma, what likely organs did it come from? […] What is the most impt feature in the histology that suggests GLANDULAR origin? […]

A

Lymph node in the neck (or some other part of the body) shows metastatic ADENOcarcinoma, what likely organs did it come from? Breast, etc What is the most impt feature in the histology that suggests GLANDULAR origin? Mucin pools(??)

71
Q

What are some ways you can sample/biopsy a lymph node? - […] - […] - […]

A

What are some ways you can sample/biopsy a lymph node? - FNAC - fine needle aspiration cytology - Core Biopsy - Excision Biopsy FNAC and Core Biopsy have the chance to miss the cancer cells due to the way it is done.

72
Q

[…]

A

“Idiopathic HH: ““Gwyn, whats the pathology of Kikuchi lymphadenitis?”” Gwyn: ““idk bro”” HH: ““that is correct!”” HAHAHHAHA ded will rmb this forever”

73
Q

[…]

A

Abdominal Pain

74
Q

[…]

A

ZN stain PAS is used in renal biopsies. H&E is your 50 shades of pink GMS is for what sia? Fungi???

75
Q

[…]

A

DLBCL The other 3 options all INDOLENT!!

76
Q

[…]

A

MALT Should be a split second answer! H. Pylori is associated with peptic ulcer, chronic gastritis, gastric carcinoma and MALT lymphoma!!

77
Q

[…]

A

“Burkitt Lymphoma Should be split second also. ““c-myc EBV t(8;14), 10 20 starry sky of Burkitt”””

78
Q

[…]

A

“Hodgkin Lymphoma Split second~ ““Reed Sternberg in Inflammatory background, 15 30 bimodal HL”””

79
Q

[…]

A

Infective Endocartidis All can lead to splenic infarcts but keyword is SEPTIC!!!

80
Q

[…]

A

Breast Cancer Key is ADENOcarcinoma

81
Q

[…]

A

Metastatic sarcoma Sarcomas tend to spread by haematogenous spread and tend to spread to other organs. Still possible to spread to lymph nodes but rare.

82
Q

Lymphogranuloma Venereum (LGV) is a […] non-neoplastic disease of the lymph node LGV is commonly seen in […] patients

A

Lymphogranuloma Venereum (LGV) is a granulomatous non-neoplastic disease of the lymph node LGV is commonly seen in immunocompromised patients

83
Q

Kikuchi’s lymphadenitis is a […] lymphadenitis It is more common in […] and more common in […]

A

Kikuchi’s lymphadenitis is a necrotizing lymphadenitis It is more common in Asian population and more common in young women

84
Q

Chronic Myeloid Leukaemia characterized by the translocation of […] which is the […] chromosome

A

Chronic Myeloid Leukaemia characterized by the translocation of t(9;22) which is the Philadelphia chromosome

Endocrine (13 decks)

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