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Miscellaneous Flashcards

1
Q

Myeloid cells in EMH of spleen

A

Can look immature for some reason

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2
Q

Primary follicles

A

BCL2+ CD10-

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3
Q

Remember that BCL2 is normally a ____ marker

A

T cell

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4
Q

Early “precursor” to progressive transformation of germinal center

A

Follicle lysis

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5
Q

Normal distribution of B cells in lymph node

A

Within germinal center, mantle zone, and marginal zone

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6
Q

Intrasinusoidal pattern of lymphoma within node

A

ALCL ALK+ DLBCL

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7
Q

Difference in AML blasts vs MDS blasts

A

In AML they are often CD34 and CD117 negative In MDS they are often positive

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8
Q

Can see circulating polyclonal plasma cells in…

A

Angioimmunoblastic T cell lymphoma Superbug infection HIV *Also can see few clonal circulating plasma cells in myeloma, not an outright plasma cell leukema*

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9
Q

Lesson to learn about flow…

A

Do NOT make your morphologic impression based on flow! -Case called “T cell lymphoproliferative process” by flow was actually a DLBCL (miscalled a PTCL by outside client based on flow) -Case with flow showing “increased CD4+/CD57+ coexpression, can be seen in nodular LP HL” by flow is actually a T-cell/histiocyte rich large B cell lymphoma (miscalled NLPHL by outside)

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10
Q

Evan’s Syndrome

A

-An autoimmune disease in which an individual’s antibodies attack their own red blood cells and platelets -Both of these events may occur simultaneously or one may follow on from the other -Combination of autoimmune hemolytic anemia (DAT+) and idiopathic thrombocytopenic purpura

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11
Q

TAR Syndrome

A

Thrombocytopenia-Absent Radius Syndrome: -rare genetic disorder that is characterized by the absence of the radius bone in the forearm, and a dramatically reduced platelet count -may occur as a part of the 1q21.1 deletion syndrome -other findings may include heart problems, kidney problems, knee joint problems, lactose intolerance and thumb hypoplasia

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12
Q

Rules for karyotype clonality

A

Loss= 3 cells Gain= 2 cells Structural= 2 cells

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13
Q

Rules for separated 138+ plasma cells FISH

A

≥8 total cells for 1F1G1R ≥5 total cells for all the readers (not a %) for everything else (p.s. these are arbitrary cutoffs)

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14
Q

Commonly rearranged chromosomes in hematolymphoid neoplasms

A

chromosomes 1 and 6 (this is why we have the MYB FISH- not to look at the gene rather to look at chromosome 6)

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15
Q

ATM gene

A

DNA repair gene

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16
Q

Location of BCL-6 gene

A

chromosome 3q27

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17
Q

TdT

A

can be expressed on immature myeloid cells in addition to immature lymphoid cells

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18
Q

Burkitt

A

shows a loss of normal infiltrating lymphocytes, unlike DLBCL

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19
Q

BCL2+

A

unlikely to be Burkitt

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20
Q

MYH9 disorders

A

1. May-Hegglin Anomaly:

  • AD mutation in this gene leading to Dohle leukocyte inclusions (in granulocytes only) with macrothrombocytopenia (usually requires no tx, unless severe)
  • MHA is also a feature of the Alport syndrome (hereditary nephritis with sensorineural hearing loss)

2.Sebastian, Fechtner, Epstein syndromes:

  • related syndromes with macrothrombocytopenia and leukocyte inclusions
  • also feature deafness, nephritis, and/or cataracts
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21
Q

BCL2 IHC interpretation

A

weaker in B cell lymphomas compared to adjacent normal T cell expression

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22
Q

Interstitial lymphoid aggregate

A

If perivascular, interstitital- very good sign it is reactive

23
Q

Monocytic AML with hemophagocytosis

24
Q

Flow findings in APL

A
  • side scatter usually increased (unlike monoblastic AML)
  • CD33 usually very tight cluster (not a smear)
  • CD11b, CD11c, CD15 negative
  • in hypogranular APL: pCD34, pCD15 with negative CD2, CD56
  • Note: variant APL such as t(11;17) may be more monocytic, more hypogranular
25
Monoblastic AML
often associated with MLL less strong side scatter than APL
26
CD123
plasmacytoid dendritic cells hairy cell leukemia basophils
27
increased plasma cells
normal aging MGUS viral (HIV) autoimmune
28
Assessing Fe stores
If 1-2 histiocytes contain iron, then can say decreased (or absent) If a lot, you can also say increased Otherwise, say present
29
ATRA syndrome
potentially life-threatening complication observed in patients with acute promyelocytic leukemia(APML) and first thought to be specifically associated with all-trans retinoic acid (ATRA) (also known as tretinoin) treatment.[1] Subsequently it was recognized that so-called RAS appeared in APML patients who had been treated with another highly efficacious drug, arsenic trioxide, and yet did not appear in patients treated with tretinoin for other disorders. These facts and others support the notion that RAS depends on the presence of the malignant promyelocytes. This has led to the growing deprecation of the term 'retinoic acid syndrome' and to an increasing use of the term differentiation syndrome to signify this APML treatment complication The syndrome is characterized by dyspnea, fever, weight gain, hypotension, and pulmonary infiltrates. This is effectively treated by givingdexamethasone and holding ATRA (or arsenic trioxide) in severe cases.
30
PRES
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a syndrome characterized byheadache, confusion, seizures and visual loss. It may occur due to a number of causes, predominantly malignant hypertension, eclampsia and some medical treatments (immunosuppresion). Onmagnetic resonance imaging (MRI) of the brain, areas of edema (swelling) are seen.
31
Blastic plasmacytoid dendritic cells
CD13, CD33, very bright HLA-DR, TdT (~30%), TCL1 in some
32
TdT in AML
Usually in M0
33
CD43
Burkitt (almost all)
34
Threshold for BCL6 staining and BCL2 staining
~30%
35
Threshold for BCL2 staining and MYC staining
??? (not 30%)
36
Starry Sky Appearance
T-lymphoblastic lymphoma! NOT just Burkitt (any highly proliferative lymphoma can look like this)
37
Flow findings for resting vs activated T lymphocytes
Resting: HLA-DR-, CD25- Activated: HLA-DR+, CD25+
38
Lymphoid Aggregates
Small Lymphocytes: nuclei almost touching one another Large Cell Lymphoma & Plasma Cells: more cytoplasm between cells
39
Hemepath Cytology
- If you see 2 distinct populations- you may be more worried (especially if the patient is young and has LAD (eg Hodgkin) - If you see small cells transitioning to large cells with medium sized cells, then more likely to be reactive (eg EBV)
40
Flow of normal germinal center B cells
bright CD20 HLA-DR FMC-7
41
Pitfall when looking for myelofibrosis
Previous biopsy site (consider if the fibrosis is not diffuse, rather an isolated focus)
42
CD99
HPC Ewings ALL Anaplastic meningioma Merkel cell CA Synovial Sarc
43
ET-like CML
A small % of CML will present like ET, showing only thrombocytosis
44
CALR mutations
In/dels (NOT point mutations)
45
Megaloblastoid erythroblasts
glycophorin e-cadherin
46
Megakaryocyte stains
CD61 and CD42
47
MPNs reported in children
ET and CML
48
Hypermutation Testing
- Somatic hypermutation happens in V region: sequence V and compare (if it all looks the same, then it is not hypermutated) - Sometimes in FL this can happen inthe J region, which messes up primer attachment to J (in these cases will see t(14;18) but not IgH rearrangment; if add kappa then increase sensitivity from 80% to 90%)
49
Primary DLBCL of Liver
Very deadly, survival \< 6 mos?
50
Parafollicular CLL
know it exists
51
BCL2 in nodal marginal zone lymphoma
positive? negative in reactive?
52
Lymphoid depleted LN
HIV node
53
"Monocytic/Histiocytic Proliferation"
\*BE CAREFUL with this dx! Whenever a myeloid sarcoma does not express the CD43 or MPO, don't immediately go down this monocytic route! Often it is something else (and benign!!) 2 examples I've seen: giant cell poor tenosynovial giant cell tumor (?desmin pos? synovium is modified monocytic cells), lymphoid depleted "burnt out" HIV lymphadenitis

Hematopathology (15 decks)

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