Morphology - Ch. 13 Flashcards
Neutrophils with abnormally dark and coarse granules
Toxic granules (abnormal azurophilic granules) - due to sepsis or inflammatory disease
Sky-blue cytoplasmic puddles w/in neutrophils
Döhle bodies - due to sepsis or inflammatory disease
Many immature granulocytes appearing in blood during severe infection
Leukemoid reaction - reactive leukocytosis
Swollen, painful LNs with prominent reactive germinal centers w/ numerous mitotic figures, macrophages w/ particulate debris, many neutrophils, and follicular necrosis in the centers
Acute lymphadenitits - due to infection
LNs w/ large oblong germinal centers surrounded by collar of small naive B cells, polarized germinal centers with centroblasts and centrocytes w/in a network of follicular dendritic cells and debris-containing macrophages
Follicular hyperplasia
Causes of follicular hyperplasia
RA, toxo, early HIV
Telling reactive hyperplasia instead of neoplastic (5)
- Preserved LN architecture
- Varied shape/size of follicles
- Mitotic figures
- Macrophages
- Light and dark zones
Large T cells with round nuclei, open chromatin, prominent nucleoli, and pale cytoplasm in the paracortical LN region
Immunoblasts (immature T cells) - normal
Expanded T-cell zones, diminished follicles, hypertrophy of sinusoidal and vascular endothelial cells, and infiltrating macrophages and eosinophils
Paracortical hyperplasia
Causes of paracortical hyperplasia
Acute viral infections (ex. mono)
Increased number and size of cells lining lymphatic sinusoids (LNs), increased macrophages, expanded/distended sinuses
Sinus histiocytosis
Causes of sinus histiocytosis
Reactive hyperplasia OR cancers draining into the LN (based on other findings)
Hypercellular marrow packed w/ lymphoblasts that have scant basophilic cytoplasm, nuclei larger than normal and convoluted, stippled chromatin, and rimmed nucleoli. Marcophages ingesting dead tumor cells give “starry sky”
Acute lymphoblastic leukemia/lymphoma (ALL)
Myeloblasts (AML) vs. Lymphoblasts (ALL)
Lymphoblasts - TdT
Myeloblasts - MPO
Small lymphocytes w/ round or slightly irregular nuclei, condensed chromatin, and scant cytoplasm in the LNs, blood, BM, spleen, portal tracts. Smudge cells in blood.
Chronic lymphocytic leukemia / Small lymphocytic lymphoma (CLL/SLL)
Areas of small inactive lymphocytes and large active lymphocytes w/in LNs
Proliferation centers - CLL/SLL (always)
CLL/SLL –> rapidly enlarging mass w/in LN or spleen
Richter syndrome - transformation to diffuse large B-cell lymphoma
Small cells in LN w/ irregular/cleaved nuclear contours and scant cytoplasm
Centrocytes - follicular hyperplasia or follicular lymphoma
Large cells in LN w/ open nuclear chromatin, several nucleoli, and modest cytoplasm
Centroblasts - follicular hyperplasia or follicular lymphoma
LNs - nodular/diffuse pattern w/ centrocytes and centroblasts w/in reactive follicular dendritic cells and macrophages and T cells
Blood - modest increased WBC
Follicular lymphoma
Large B cells w/ either round/oval nucleus appearing vesicular or multilobed/cleaved nuclei, open chromatin, prominent nucleoli, abundant cytoplasm
Diffuse large B-cell lymphoma
Diffuse infiltrate or intermediate-sized lymphoid cells with round/oval nuclei, coarse chromatin, several nucleoli, and moderate cytoplasm. High mitotic index, many apoptotic cells, and interspersed phagocytes causing “starry sky”
Burkitt lymphoma
BM - tumor cells w/ slightly clumped chromatin, 2-5 nucleoli, and royal blue cytoplasm w/ clear vacuoles
Burkitt lymphoma
Punched-out defects of soft, gelatinous, red tumor tissue within vertebral column, ribs, skull pelvis, etc. Excess plasma cells w/ perinuclear clearing and eccentrically placed nucleus w/in the BM.
Multiple myeloma
Plasma cells w/ vesicular chromatin and prominent single nucleolus
Plasmablasts - multiple myeloma (maybe)
Multinucleated plasma cells
Multiple myeloma (maybe)
Plasma cells w/ fiery red cytoplasm
Flame cells - multiple myeloma (maybe)
Plasma cells w/ multiple grapelike cytoplasmic droplets
Mott cells - multiple myeloma (maybe)
Plasma cells w/ globular inclusions of globules
Russell bodies (cytoplasm) or Dutcher bodies (nucleus) - multiple myeloma (maybe)
Red cells in blood to stick together in linear arrays
Rouleaux formation - multiple myeloma (and others)
BM - infiltrate of lymphocytes, plasma cells, plasmacytoid lymphocytes, and mast cell hyperplasia. PAS-positive inclusions of Ig in cytoplasm (Russel) or nucleus (Dutcher) of some plasma cells. Dissemination to LNs, spleen, liver.
Lymphoplasmacytic lymphoma
LNs - Homogenous population of small lymphocytes with irregular/clefted nuclear contours surround reactive germinal centers
Other - polyp-like lesions in bowel
Mantle cell lymphoma
Blood - Leukemic cells with various nuclei, moderate pale blue cytoplasm w/ threadlike/bleblike extensions
Marrow - Diffuse infiltrate of similar cells enmeshed in extracellular matrix of reticulin fibers
Spleen - enlarged, beefy red, heavily infiltrated red pulp
Hairy cell leukemia
LNs - Pleomorphic mixture of variably sized malignant T cells, infiltrate of eosinophils and macrophages, and neoangiogenesis
Peripheral T-cell lymphoma - unspecified
Large anaplastic cells that cluster about venules and infiltrate lymphoid sinuses (like carcinoma)
Anaplastic Large-Cell Lymphoma
Horseshoe-shaped (embryoid) nuclei and voluminous cytoplasm
Hallmark cells - Anaplastic Large-Cell Lymphoma
Tumor cells w/ multilobed nuclei in “cloverleaf” or “flower” appearance
Adult T-Cell Leukemia/Lymphoma
CLA+, CCR4+, CCR10+ cells w/ marked infolding of nuclear membrane (cerebriform appearance) w/in skin –> LNs, BM, blood
Mycosis Fungoides
Blood - Large CD3+ or CD56+ lymphocytes w/ abundant blue cytoplasm and few coarse azurophilic granules
BM - sparse interstitial lymphocytic infiltrates
Large Granular Lymphocytic Leukemia
Destructive nasopharyngeal mass w/ CD56+ (or CD3+) tumor cells w/ large azurophilic granules in cytoplasm; cells invade small vessels causing ischemic necrosis
Extranodal NK/T-Cell Lymphoma
Large cells w/ multiple nuclei or single nucleus w/ multiple lobes, each w/ a large inclusion-like nucleolus, abundant cytoplasm
Reed-Sternberg cells (classical) - HL
Large cells w/ single nuclei w/ large inclusion-like nucleolus and abundant cytoplasm
RS cell, mononuclear variant
Large cell, folded or multilobate nuclei and abundant pale cytoplasm w/ nucleus sitting in empty hole
Lacunar cell (RS cell variant) - Nodular Sclerosis HL
Large cell, polypoid nuclei, minimal nucleoli, abundant cytoplasm
Lymphohistiocytic cell (RS cell variant) - Lymphocyte-predominance HL
RS cells in background of non-neoplastic inflammatory cells
Hodgkin lymphoma
Lacunar RS cells + eosinophils, plasma cells, and macrophages; deposition of collagen bands that divide LNs into nodules
Nodular Sclerosis HL
RS cells w/ mononuclear variants mixed w/ T cells, eosinophils, plasma cells, and macrophages
Mixed-Cellularity HL
RS cells w/ mononuclear variants mixed w/ many reactive T cells
Lymphocyte-Rich HL
RS cells and variants, few background cells
Lymphocyte Depletion HL
L&H RS cells, CD20+, CD15-, CD30-, background of follicular dendritic cells and reactive B cells
Lymphocyte Predominance HL
> 20% myeloid blasts in the bone marrow
AMLs
Delicate nuclear chromatin, 2-4 nucleoli, and voluminous cytoplasm with fine, peroxidase-positive azurophilic granules
Myeloblasts
Needle-like azurophilic granules of MPO
Auer rods
Folded or lobulated nuclei, no auer rods, nonspecific esterase-positive
Monoblasts
Megakaryocytic differentiation in AMLs is accompanied by marrow ____ due to cytokine release
Fibrosis
BM - disordered (dysplastic) differentiation affecting the erythroid, granulocytic, monocytic, and megakaryocytic lineages to varying degrees
Myelodysplastic syndromes
Erythroblasts with iron-laden mitochondria visible as perinuclear granules in Prussian-blue stained aspirates/biopsies
Ring sideroblasts - myelodysplastic RBCs
Erythroblasts w/ iron-laden mitochondria as perinuclear granules in Prussian Blue stain
Ring sideroblasts
Nuclei w/ misshapen, often polypoid, outlines
Nuclear budding abnormalities
Neutrophils w/ only 2 nuclear lobes
Pseudo-Pelger-Hüet cells
Megakaryocytes w/ multiple separate nuclei
Pawn ball megakaryocytes
Blood - pseudo-PGH cells, giant platelets, macrocytes, poikilocytes, and excess monocytes
Myelodysplastic syndromes
BM - ring sideroblasts, pseudo-PGH cells, pawn ball megakaryocytes, etc.
Myelodysplastic syndromes
BM - neoplastic promyelocytes with abnormally coarse and numerous azurophilic granules, several cells with bilobed nuclei and auer rods
Acute promyelocytic leukemia - t(15;17)
Blood - monoblasts and promonocytes w/ folded nuclear membranes
AML with monocytic maturation
AML w/ full range of myelocytic maturation, many auer rods, abnormal cytoplasmic granules
AML w/ myelocytic maturation - t(8;21)
AML w/ myelocytic and monocytic differentiation, abnormal eosinophilic precursors w/ abnormal basophilic granules
Acute myelomonocytic leukemia - inv(16)
AML w/ numerous auer rods in bundles w/ individual progranulocytes; primary granules are prominent; high incidence of DIC
Acute promyelocytic leukemia - t(15;17)
Most common AML in Down Syndrome
AML w/ megakaryocytic maturation
Hypercellular marrow w/ massively increased numbers of maturing granulocytic precursors. Sea-blue histiocytes. MAJOR blood leukocytosis (>100,000). Greatly-enlarged spleen red pulp, w/ infarcts.
Chronic myelogenous leukemia (CML)
Hypercellular marrow w/ slightly increased RBC progenitors, granulocytic precursors, and megakaryocytes. Mild organomegaly. Increased basophils and large platelets in blood.
Polycythemia vera
BM - mildly hypercellular with markedly increased megakaryocytes with some abnormally large forms, delicate reticulin fibrils, but no overt fibrosis. Blood shows abnormally large platelets and mild leukocytosis
Essential thrombocytosis
Hypercellular marrow w/ cells of all lineages, especially large dysplastic clustered megakaryocytes. Later, marrow becomes more hypercellular and diffusely fibrotic w/ cloud-like nuclear-shaped megakaryocytes and hematopoietic elements in dilated sinusoids. Extensive splenomegaly w/ subcapsular infarcts. Blood shows early release of nucleated erythroid and granulocyte progenitors. Teardrop cells in blood.
Primary myelofibrosis
