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Blood & Lymph > Non-Hodgkins Lymphoma Pathology > Flashcards

Non-Hodgkins Lymphoma Pathology Flashcards

1
Q
A

Normal lymph node

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2
Q

What is the “dark zone” of the lymph node?

A

area that is reacting to Ag → centroblasts are undergoing proliferation, somatic mutation & isotype switching

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3
Q

Centrocytes

A

small cleaved lymphocytes exhibiting surface Ab in the light zone

(centroblasts are in the dark zone)

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4
Q

mantle zone of lymph node contains _____

A

naive b-cells

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5
Q

Marginal zone (just outside mantle zone) contains ______ (2)

A
  1. naive B-cell
  2. memory B-cells

(they’re just chillin’)

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6
Q

Ki67 role in dx

A

proliferation marker for lymph follicle

(proliferation may be normal, but it can aid in dx)

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7
Q

Non-Hodgkin’s Lymphoma (malignant lymphoma) arises within the _____.

A

lymph nodes, not in bone marrow (can metastasize there though)

(or other organs rich in lymphoid tissue; leukemias arise in bone marrow and metastasize to lymph nodes. “leukemia/lymphoma” used when we aren’t sure where it started first)

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8
Q

Neoplastic cells are monoclonal, how can we tell if the cells (T cell or B cells) are monoclonal?

A
  1. B cells: light chain restriction
  2. T cells: TCR arrangement
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9
Q

CD5+ is a good dx marker for which 2 N-H lymphomas?

A
  1. SLL/CLL
  2. Mantle

(Rules out follicular and marginal zone)

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10
Q

Hodgkin’s Lymphoma (malignant lymphoma) risk factors (3)

A
  1. Immunodeficiency
  2. Chronic autoimmune diz
  3. Chronic infections

(immune system being overly stimulated)

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11
Q

2 Clinical findings of Non-Hodgkin’s Lymphoma (malignant lymphoma)

A
  1. painless lymphadenopathy
  2. B-type sx: fatigue, fever, wt. loss, night sweats

(may have extranodal sx if metastasized: abdominal pain, rash, sensorimotor, chest pain)

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12
Q

Low-grade lymphoma is well differentiated tumor; High-grade is a poorly differentiated tumor. Which has the better prognosis?

A

Low-grade

(low grade: painless lymphadenopathy, no B-symptoms; high-grade is the opposite)

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13
Q

Hodgkin’s lymphoma staging is the similar as leukemia. What is the general staging?

A

1: 1 lymph node involved or single extranodal site

1B: + systemic sx (B-sx)

2: 2+ lymph nodes on same side of diaphragm
3: both sides of diaphragm
4: extranodal involvement, both sides of diaphragm

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14
Q

How do you tell the difference between benign and malignant lymph node changes?

A
  • malignant: painful
  • benign: gets better, goes down

(bx to confirm)

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15
Q

What is the main finding that indicates a benign reactive changes (hyperplastic) of lymph nodes?

A

interfollicular area (spaces btwn follicles)

(mantle zone, dark/light zones present)

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16
Q

What is the most important immunophenotypic finding of benign changes to the lymph node?

A

bcl-2 negative (anti-apoptotic protein) in the follicle

(CD3+, CD20+ cells present)

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17
Q

Why is this a neoplastic follicle (2)?

A
  1. loss of zonal definition w/absent mantle zone (loss of polarity)
  2. No tingible body MF
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18
Q

MC form of adult indolent NHL?

A

follicular lymphoma

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19
Q

Mutation in follicular lymphoma (type of NHL)

A

t(14;18) → BCL-IgH fusion gene

(anti-apoptotic effect)

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20
Q

Key terms of histopathology that indicate follicular lymphoma?

A
  1. atypical lymphocyte
  2. cleaved v. non-cleaved

(more importantly, look for cytogenetics and immunophenotype)

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21
Q

MC type of NHL?

A

diffuse large B-cell lymphoma (also MC adult NHL)

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22
Q

Diffuse Large B-Cell lymphoma may arise from which two hematologic cancers?

A
  1. Follicular lymphoma
  2. CLL→Richter transformation
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23
Q

dx?

(left: intermediate power; right: high power)

A

Diffuse B-cell Lymphoma (high grade tumor)

(any lymph node may be affected)

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24
Q

What does this tell you?

A

CD10 is a malignant marker

(found in Burkitt lymphoma, follicular & diffuse large b-cell. Next you need to determine cytogenetics)

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25
Q

CD10+, CD19+, CD20+ w/Surface Ig + (light chain restriction) and a BCL6 rearrangement of 3q27 indicates which hematologic cancer?

A

diffuse large B cell lymphoma

(bcl-2 t(11;14) is 2nd MC)

26
Q

Diffuse B cell Lymphoma is most common in which demographic?

A

~ 60 y/o men

27
Q

Diffuse B-cell Lymphoma typically appears w/ a rapidly growing ______.

A

mass (nodal or extra nodal)

28
Q

Waldeyer ring, liver/spleen or skin are common locations of _____ in diffuse b-cell lymphoma

A

rapidly growing mass that appears

29
Q

Untreated, diffuse B-cell lymphoma prognosis

A
  • ~55% survive 5 years w/treatment (rituximab)
  • rapidly fatal w/o treatment (<1 year) → intensive chemo
30
Q

What is a dangerous side effect of chemotherapy when treating aggressive cancer?

A

tumor lysis syndrome: electrolyte dump from the dying cells

(hypercalcemia, hyperkalemia)

31
Q

Why is this follicular lymphoma (2)?

A
  1. follicular enlargement of different sizes and shapes
  2. decreased interfollicular spacing
32
Q

Follicular lymphoma is a ______-grade tumor

A

low

33
Q

The majority of follicular lymphoma have extranodal involvement, such as ______(4)

A
  1. bone marrow
  2. spleen
  3. liver, GI
  4. CNS

(note DLBCL does NOT involve bone marrow until late course)

34
Q

Bone marrow bx in follicular lymphoma will show ______

A

paratrabecular lymphoid aggregates

35
Q

Any time there is a B-cell malignancy you may see _____ (3).

A
  1. Autoimmune hemolytic anemia
  2. thrombocytopenia
  3. M-spike

(paraproteins from clonal cells → hemolytic anemia or M-spike)

36
Q

Both follicular lymphoma, DLBCL, and Mantle Cell lymphoma present at _____ stage

A

III/IV

37
Q

_______ presents as waxing and waning with painless lymphadenopathy in older adults.

A

Follicular lymphoma

38
Q

How can you tell a follicular lymphoma apart from benign changes in the lymph node?

A

benign changes will be CD5(-)

(and CD43(-); both may be nodular)

39
Q

_______ are the only 3 lymphomas that are CD5+.

A
  1. Mantle cell
  2. CLL/SLL
  3. Hairy cell

(mantle cell is CD23(-); CLL/SLL are CD23+)

40
Q

Both DLBCL, FL & Mantle Cell Lymphoma have SIg+ with light chain restriction. Which has IgM w/or w/o IgD?

A

FL

41
Q

Mantle cell (NHL) is CD23(-); CLL/SLL are CD23+. What is one other distinguishing factor between them?

A

Mantle cell has NO proliferation centers

(lymphoblastic lymphomas have homogenous proliferation cells)

42
Q

CD5+, CD10- distinguishes Mantle Cell Lymphoma from ______

A

follicular (which is CD10+)

43
Q

CD5+, CD10- distinguishes Mantle Cell Lymphoma from ______

A

follicular

44
Q

Mutation t(11;14) → cylinD1-IgH fusion indicates ______

A

Mantle Cell Lymphoma

(this allows bypass of normal G1-S phase regulation)

45
Q

Mantle cell lymphoma has a good short-term prognosis, but poor long-term without _____

A

bone marrow transplant

(usually causes organ failure)

46
Q

What is a “blastoid variant” of mantle cell lymphoma?

A

proliferative profile (even worse prognosis)

47
Q

Mantle cell lymphoma involves _____ cells, this is the reason why there is no somatic hypermutation.

A

naive B cells

(in contrast to Marginal Zone Lymphoma, which involves mature B cells)

48
Q

_______ presents as a disseminated disease in older males.

(hint: may also involve GI polyps)

A

Mantle cell lymphoma

49
Q

t(11;18) mutation, MALTomas (80% of cases) & chronic inflammation are diagnostic features of ______.

A

marginal zone lymphoma

(mature B cells; also lack of other markers you would expect to see)

50
Q

Chronic inflammation of _______3 glands can lead to Marginal zone lymphoma.

A
  1. stomach (H.pylori or celiac)
  2. salivary (Sjogren’s)
  3. thyroid (Hashimoto’s)

(may regress if this inflammation is cured, i.e. abx)

51
Q

(stomach tissue)

A

MALToma: effacement by malignant lymphocytes

(will produce GI sx: nausea, anorexia, pain)

52
Q

(stomach

A

effacement by malignant lymphocytes

53
Q

CD19/20/10+, BL6, “starry sky” histology and failure to express BCL-2 is diagnostic of ______

A

Burkitt lymphoma (the fastest growing human tumor)

(also EBV association)

54
Q

“starry sky” describes _____

A

histology of burkitt lymphoma: tingible MF phagocytizing apoptotic debris

55
Q
A

“tingible body” macrophage

56
Q
A

Burkitt lymphoma: vacuoles + deep blue cytoplasm

57
Q

t(___;___) → _____ fusion is present in the majority of Burkitt lymphoma cases

A

t(8;14) → MYC-IgH

(this leads to the Warburg effect)

58
Q

All cases of African/endemic Burkitt lymphoma are from a _____ and primarily affect the _____.

A
  • latent EBV infection
  • mandible or small intestine

(very aggressive, mass can appear w/in weeks; fastest growing human tumor)

59
Q

Sporadic Burkitt lymphoma is a common childhood cancer that is NOT associated with ______ and is commonly located in the _____.

A
  • EBV
  • distal ileum and cecum

(African/endemic burkitt is assoc. w/EBV)

60
Q

EBV & HTLV-1 are associated with which malignancy?

A

Peripheral T cell Lymphoma

(mature T cells)

61
Q

CD3+, CD4+ w/diffusely effaced LN & B-symptoms is diagnostic of _______

A

nodal cell lymphoma

(note: it is CD8(-))

Blood & Lymph (29 decks)

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