Non-Hodgkin Lymphoma - Krafts Flashcards
What is the difference betwen leukemia and lymphoma?
- Leukemia
- malignancy of hematopoietic cells
- starts in bone marrow, can spread to blood, nodes
- myeloid or lymphoid
- acute or chronic
- Lymphoma
- malignancy of hematopoietic cells
- starts in lymph nodes, can spread to blood, marrow
- lymphoid only
- Hodgkin or non-Hodgkin
***What are the causes of lymphadenopathy?
- Most common cause overall:
- benign reaction to infection
- Most common malignant cause:
- metastatic carcinoma
What characterizes Interfollicular Hyperplasia?
- Expanded area between follicles
- Mixture of cells
- Partial effacement
- part of follicle is still there somewhere
- T-cell response to some immune stimulus
- usually infection
What are the differences between follicular hyperplasia (benign) and follicular lymphoma (malignant)?
- Benign
- mantle surrounding follicle
- follicles are all different sizes and shapes
- space between follicles
- Malignant
- fat interspersed between follicles
- no mantle surrounding follicle
- follicles all generally same size and shape
- almost no space between follicles
What characterizes Non-Hodgkin Lymphoma?
- Malignant proliferation of lymphoid cells (blasts or mature cells) in lymph nodes
- Skips around (marrow → liver, node → marrow)
- harder to predict/treat
- Many subtypes
- Most are B-cell
What are the symptoms of Non-Hodgkin’s Lymphoma?
- Painless, firm lymphadenopathay
- Extranodal manifestations
- show up in bone marrow
- “B” symptoms:
- weight loss
- night sweats
- fever
- worse prognosis
What are the features of Low-Grade vs High Grade Non-Hodgkin Lymphoma?
- Low-Grade
- older patients
- Indolent (incurable)
- small, mature cells
- non-destructive
- High-Grade
- children, sometimes
- Aggressive (curable?)
- Big, ugly cells
- Destructive
What characterizes Small Lymphocytic Lymphoma?
- Small mature lymphocytes
- Same thing as CLL
- B-cell lesion
- has CD5+
- Long course
- death from infection
What is the cell morphology in SLL/CLL?
- Diffuse (small lymphocytes fill up the whole lymph node), with proliferation centers.
- Proliferation centers are pale, cloud-like areas visible at low power.
- They contain prolymphocytes and paraimmunoblasts, which are larger cells, with fine chromatin and prominent nucleoli.
- When you see these in a background of small, mature lymphocytes, it’s pretty much a clincher for SLL.
- Small, round lymphocytes with clumped chromatin, scant cytoplasm. They look just like benign, mature lymphocytes!
What morphological sign in SLL/CLL indicates an indolent but relentless clinical course (the mean survival is 10 years) and potential to evolve into large-cell lymphoma ?
Richter’s transformation
What characterizes Marginal Zone Lymphoma?
- Acutally a bunch of lymphomas
- Marginal zone pattern
- MALT lymphoma
- Mucosa associated lymphoid tissue
- Helicobactor pylori
- causes malignancy
- take it away → cure
What are the cell morphologies in Marginal Zone Lymphoma?
- Early on, this lymphoma tries to be just like the marginal zones in splenic follicles (which are pale rings around the outside of the follicle, adjacent to the mantle zone). So you’ll see a bunch of follicles with big marginal zones (which you don’t normally see in lymph nodes). Later, it becomes diffuse.
- Variety of cell types present (from small lymphocytes to larger ones with lots of cytoplasm).
What are the two common places that Malt Lymphoma shows up?
- Stomach
- Salivary glands
(lymphoepithelial lesions present)
What characterizes Mantle Cell Lymphoma?
- Mantle zone pattern
- Small angulated lymphocytes
- ***t(11;14) = bcl-1 (cyclinD1) → Ig Heavy gene
- heavy chain genes on 14 placed next to bcl-1
- increases expression
- More aggressive
What are the cell morphologies in Mantle Cell lymphoma?
Pattern: Follicular, with expanded mantle zones (early) or diffuse (later on).
Cytology: Small, angulated lymphocytes (just like those in regular old mantle zones).
