Lymphoreticular system pathology

Question 1

Leukopenia is defined as a __ in WBCs. 2 reasons for leukopenia are __ and __

Answer 1

Leukopenia is defined as a reduction in WBCs. 2 reasons for leukopenia are low production and early death of WBCs

Question 2

Leukopenia can result from ___, immune suppressing drugs, nutritional deficiencies (__ and __ deficits), genetic conditions like __ and leukemia

Answer 2

Leukopenia can result from aplastic anemia, immune suppressing drugs, nutritional deficiencies (B12 and Folate deficits), genetic conditions like SCID and leukemia

Question 3

Examples of conditions in which WBCs are killed off too early include infections like in __, autoimmunity (e.g. ___), drugs and sequestration in the ___

Answer 3

Examples of conditions in which WBCs are killed off too early include infections like in HIV, autoimmunity (e.g. Lupus), drugs and sequestration in the spleen

Question 4

What is the most common complication/consequence of leukopenia (neutropenia)?

Answer 4

Recurrent fungal and bacterial infection (esp Candida and Aspergillus)

Question 5

What are some causes of leukocytosis?

Answer 5

Increased marrow stores (due to infection, hypoxia, endotoxemia)

Decreased Margination: Cells adherent to vessels(e.g. during exercise, epinephrine)

Decreased extravasation into tissues (e.g. w/ Glucocorticoid use)

Increased marrow precursors (due to tumor, infection, myeloproliferative disorders)

Question 6

What are the components of the lymphoreticular system?

Answer 6

Group of cells that ingest and sequester particles and dyes

Question 7

Cells of the lymphoreticular system can be found in the brain, ___, tissue, liver, ___, kidney, and ___

Answer 7

Cells of the lymphoreticular system can be found in the brain (microglia), tissue (macrophages/histiocytes), liver (Kupffer cells), kidney (glomerular mesangial cells), and bone (marrow, osteoclasts)

Question 8

The major lymphoreticular sites are the ___, lymph nodes, ___ (B cells mature here) and ___ (where T cells mature)

Answer 8

The major lymphoreticular sites are the spleen, lymph nodes, bone marrow (B cells mature here) and thymus (where T cells mature)

Question 9

How does the spleen prevent damaged RBCs from going into the circulation?

Answer 9

The sinusoids that traverse the spleen are lined by macrophages that eat up damaged RBCs

Question 10

The white pulp of the spleen contains T and B cells. Where in the white pulp are these cells?

Answer 10

T cells - PALS (periarteriolar lymphoid sheaths)

B cells - follicles

Question 11

What are some disroders of the spleen?

Answer 11

Systemic disorders

Neoplasms

Congenital anomalies (Asplenia, Hypoplasia, Accessory spleen)

Rupture

Question 12

What is an example of a condition ass’d with splenomegaly that can result in splenic rupture?

Answer 12

Epstein-Barr Virus infection (mononucleiosis)

Question 13

Disorders that can lead to splenomegaly include infections, ___ hypertension, ___ (hint: cancer in the lymph nodes), inflammatory conditions (e.g. __ and __), storage diseases (___ and ___), and amyloidosis

Answer 13

Disorders that can lead to splenomegaly include infections, portal hypertension, lymphoma (hint: cancer in the lymph nodes), inflammatory conditions (e.g. RA and SLE), storage diseases (gaucher and niemann pick), and amyloidosis

Question 14

How can a patient present with anemia-like symptoms and not be anemic? (in context of the spleen)

Answer 14

Splenomegaly >> seuqestration of platelets + RBCs >> hematologic abnormalities (so patient presents like they have anemia but they don’t actually)

Question 15

Where in the body would you find the structure below and why does it look this way?

Answer 15

Hassal corpuscle in the Thymus

Hassal corpuscle looks like the keratin pearls (from squamous cell carcinoma) because T cells are being trained to recognize normal squamous cell epithelium

Question 16

Examples of developmental thymic disorders include ___ and ___

Answer 16

hypoplasia/anaplasia (DiGeorge syndrome)

thymic cysts

Question 17

Myasthenia gravis and SLE are both disorders in which what can happen to the thymus?

Answer 17

Thymic hyperplasia

Question 18

Draw and describe the growth sequence of lymphocytes/granulocytes/phagocytic cells/RBCs

Answer 18

Question 19

Name the mature cells in this slide

Answer 19

Band neutrophil

Platelet

Monocyte

Lymphocyte

Segmented neutrophil

Eosinophil

RBC

Basophil

Question 20

The predominant cells in the bone marrow are___

Answer 20

Neutrophils + precursors

Megakaryocytes

RBCs

(there’s also adipose tissue in there)

Question 21

Draw and describe the sequence of RBC maturation (include cell names and characteristics)

Answer 21

(until I’m red, I’m normo)

Pronormoblast (the pro-athlete); huge nucleus and dark cytoplasm

Basophilic normoblast (pro not doing so well so he looks really blue)

Polychromatophilic normoblast (now he has to work poly jobs); smaller than basophilic, nucleus has 2 shades of color

Orthochromic normoblast (he got hurt now he needs an orthopedic surgeon); concentric dark nucleus, smaller cell

Reticulocyte (bluer cytoplasm, no nucleus, chromatin almost gone)

Mature RBC (he gives up and skips town; nucleus is gone and rbc is a lot smaller)

Question 22

Draw and describe the sequence of neutrophil maturation

How can you tell a blast from a lymphocyte?

Answer 22

(see image below)

1 = blast

2 = promyelocyte

3 = myelocyte

4 = metamyelocyte

5 = band

6 = segmented

Question 23

Label the cells in this slide

Answer 23

1 = blast

2 = promyelocyte

3 = myelocyte

4 = metamyelocyte

5 = band

6 = segmented

10= lymphocyte

11= monocyte (young)

Question 24

In the lymph node diagram below, where are T cells, B cells and activated B cells housed?

Answer 24

T cells - paracortical area

B cells - primary follicle

activated B cells - germinal center

Question 25

The lymph node germical center is where which 3 important B cell processes take place?

If there are any errors, the B cell undergoes ___

Answer 25

Clonal expansion

Somatic hypermutation

Class switching

Apoptosis

Question 26

Lymphadenitis refers to ___

An enlarged lymph node is called __

An enlarged lymphnode that’s likely lymphadenitis will likely be ___

A diffuse enlarged lymph node with what other features suggests malignancy?

Answer 26

Inflammation, likely due to infectious process

Lymphadenopathy

painful

No pain, fixed/immobile, no resolution within a few weeks

Question 27

Lymphoma is a __ lesion that usually arises in lymphoid tissue and is __ derived, whereas leukemia can be either lymphoid or myeloid derived and can arise in __ and __

Multiple myeloma is __ derived

Answer 27

Lymphoma is a mass lesion that usually arises in lymphoid tissue and is lymphoid derived, whereas leukemia can be either lymphoid or myeloid derived and can arise in blood and bone marrow

Multiple myeloma is plasma cell derived

Question 28

Etiology of WBC malignancies include chromosomal translocations and oncogenes, inherited genetic factors: (Down’s, NF-type I), viruses (HTLV-1, **EBV, HHV8), environmental agents, and iatrogenic factors

Question 29

The two types of leukemia are ___ and ___. What is the difference between the 2?

Answer 29

Acute and Chronic

Acute - malignancy involving arrest in differentiation/maturation (so there are a lot of precursor/progenitor cells)

Chronic - malignancy involving mature cells

Question 30

Leukemia involving myeloid lineage cells is called __, whereas leukemia involing lymphoid lineage cells is called ___

Answer 30

Leukemia involving myeloid lineage cells is called myelogenous leukemia, whereas leukemia involing lymphoid lineage cells is called lymphocytic leukemia