Module 1 Heme: Non-Hodgkin and Hodgkin's Lymphoma, CLL Flashcards
The next lymphoid neoplasm that will be discussed is Burkitt’s Lymphoma. Which is considered what kind of lymphoma?
Non-Hodgkin Lymphoma of medium B cells caused by EBV
–starts in the lymph nodes
What are the three types of Burkitt’s Lymphoma?
- African (Endemic)
- -100% associated with EBV
- -Cervical lymph node (submandibular) most commonly affected
- -doubling time =24 hours - American (Sporadic)
- -15% association with EBV
- -mesenteric lymph node most commonly affected - Immunosuppression type (AIDS and post transplant patients): 25% EBV
In slide 11: pic of an African boy with what?
Extranodal sites in the jaw and it grows very fast!
- -doubling time is 24 hours
- –jaw mass is painless
What is the translocation is Burkitt’s Lymphoma?
t(8.14): translocation between c-myc and heavy chain of Ig
–uncontrolled proliferation of b cells (hence why its a b cell lymphoma)
KI67 is positive in Burkitt’s Lymphoma, why?
Marker for super fast cell proliferation
–non specific
What is the presentation for Burkitt’s Lymphoma?
African: fever, weight loss, and night sweats (called B symptoms)
American: obstruction due to the location of the ilial celical valve
What do you see on lymph node biopsy for a patient with Burkitt’s Lymphoma?
- Excisional Lymph Node Biopsy (good for all lymphomas): safe in that it wont spread
- Lymph Node Biopsy: shows starry sky appearance (slide 11 blue dotted cell are the cancer cells and they are in sheets of malignant B cells) (Clear spaces are macrophages engulfing necrotic debris)
Why is there necrotic debris seen when a lymph node biopsy is done?
Because the nodes are growing so fast therefore they are outgrowing their blood supply
Apoptotic Bodies are seen in the lymph nodes of Burkitt’s Lymphoma, why?
No expression of BCL2 (anti-apoptotic gene on Ch.18)
- -so lots of apoptotic bodies
- -highly eosinophilic
What is the other name for Burkitt’s Lymphoma?
Small, non cleaved lymphoma
What do you see on flow cytometry for patients with Burkitt’s Lymphoma?
CD 10, 19,20 (B cell markers)
-surface IgM
What tumor marker is used for response to treatment in Burkitt’s Lymphoma?
LDH (response to treatment because its a tumor maker)
What is the prognosis for Burkitt’s Lymphoma?
Poor Prognosis
- -due to B symptoms
- -extranodal spread to the blood (meningitis, brain, liver, spleen, bone marrow –results in pancytopenia)
What is the treatment for Burkitt’s Lymphoma?
Chemotherapy
–very good response because of the rate of growth
Radiotherapy (be careful this can lead to development of myelodysplastic syndrome)
Remember that KI67 is positive and BCL2 is negative
:)
The next lymphoid neoplasm we are going to speak about is Diffuse Large B cell lymphoma.. What are some features?
Most common type of lymphoma in adults, accounting for 50% of adult Non-Hodgkins Lymphoma’s.
What are some morphological features of Diffuse Large B cell lymphoma?
—Neoplastic B cell are large (At least 3 to 4x the size of resting lymphocytes) and vary in appearance.