Parks 2

Question 1

What is a very important thing to consider when you find a swollen lymph node?

Answer 1

Where is it draining from?

Question 2

What is reactive lymphadenitis?

Answer 2

it is a benign condition in response to infection, inflammation or tumor; may be due to Strep or viral infection - acute nonspecific swelling of the lymph nodes due to proliferation of B or T cells in the lymph nodes in response to a bug

Question 3

A tender linear streak extending from the wrist to the upper arm; the infection spreads from the portal of entry within the superficial lymphatic vessels

Answer 3

acute lymphangitis

Question 4

If you have a cold sore on your lip (fever blister), which lymph nodes would you expect to be enlarged?

Answer 4

anterior cervical lymph nodes

**think about where that lymph drains

Question 5

What are 3 benign reactive hyperplasias?

Answer 5

1. follicular hyperplasia
2. paracortical hyperplasia
3. sinus histiocytosis

Question 6

Explain the structure of the lymph node (3 layers)

Answer 6

cortex with B cells in follicles
paracortex with T cells
medullary sinuses with macrophages

Question 7

In mono, is there a B cell reaction or a T cell reaction occuring?

Answer 7

B cells are infected by the EBV virus, but it is a T cell response (lymph node will have paracortical hyperplasia)

Question 8

With cancers, two processes can occur in regional draining lymph nodes. What are they?

Answer 8

1. metastasis

2. no metastasis but reactive changes, or sinus histiocytosis

Question 9

Is sinus histiocytosis indicative of a metastatic carcinoma?

Answer 9

no; it is commonly found in cases of breast cancer and other cancers, but it is a benign reaction

Question 10

Are all lymphoid neoplasms malignant?

Answer 10

yes

Question 11

What is the difference b/w a lymphoma and a leukemia?

Answer 11

lymphoma = mass
leukemia = bone marrow and peripheral blood

Question 12

Where can lymphomas occur?

Answer 12

anywhere in the body, even in the CNS (esp in AIDS)

Question 13

Are most non-Hodgkins lymphomas B or T cell lymphomas?

Answer 13

B cell

Question 14

After antigen recognition occurs, where does B cell maturation occur (differentiation into a plasma cell ultimately)?

Answer 14

in the germinal centers of lymph nodes

Question 15

Malignant plasma cells produce what kind of reaction?

Answer 15

monoclonal (all light chains will be the same)

Question 16

In follicular lymphomas, what is going on genetically? Why is this important?

Answer 16

translocation places BCL2 right next to IGH heavy chain, which causes BCL2 to be overexpressed; BCL2 stabilizes the mitochondrial membrane on malignant lymphocytes and decreases apoptosis of these cells

Question 17

What does BCL2 over-expression ultimately do to B cell proliferation?

Answer 17

allows malignant B cells to avoid apoptosis

**BCL2 is expressed to decrease apoptosis

Question 18

What happens genetically with diffuse large B-cell lymphoma (DLBCL)?

Answer 18

dysregulation of BCL6 leads to no germinal center formation, impaired B cell proliferation, and impaired apoptosis

Question 19

What is Rituximab used for?

Answer 19

it is a chimeric antibody for the CD20 marker on B cells - used against malignant B cells (ex: non-hodgkins lymphomas)

Question 20

What is the difference between African Burkitt’s lymphoma and sporadic lymphoma?

Answer 20

African: almost all cases associated with EBV
Sporadic: 15-20% associated with EBV; infects retroperitoneum (abdomen)

Question 21

In Burkitt’s lymphoma, what is happening on a genetic level?

Answer 21

translocation b/w MYC oncogene and Ig heavy chain gene –> causes overexpression of MYC protein to be overexpressed

**promotes proliferation and stops apoptosis

Question 22

Very aggressive B cell lymphomas associated with this disease

Answer 22

AIDS

Question 23

This is a T cell lymphoma in which the skin is the primary site

Answer 23

mycosis fungoides

**has epidermotropism - forms characteristic “nests” within the epidermis

Question 24

How does mycosis fungoides present on the skin?

Answer 24

large red plaques

Question 25

What cells are characteristic of mycosis fungoides?

Answer 25

sezary cells with cerebreform nuclei

Question 26

What is it called when sezary cells from mycosis fungoides enter the blood stream?

Answer 26

sezary syndrome

Question 27

How does Hodgkin’s lymphoma present?

Answer 27

as a mass

Question 28

What cell is characteristic of Hodgkin’s lymphoma?

Answer 28

Reed-Sternberg cell

**binucleated cell with mirror-image nuclei

Question 29

How many subclasses of Hogdkins disease are there? What are the two most common?

Answer 29

5;

1. nodular sclerosis (70%)
2. mix-cellularity (20%)

Question 30

What is happening genetically in Hodgkin’s lymphomas?

Answer 30

NF-kB turns ON genes which promote lymphocyte proliferation and survival

Question 31

What do the Reed Sternberg cells in HL do?

Answer 31

secrete lots of cytokines, some of which (IL-10 and TGF-B) suppress the TH1 response leading to cutaneous anergy

Question 32

What is a characteristic feature of nodular sclerosis hodgkin’s lymphoma?

Answer 32

mediastinal mass

tumor cells subdivided into nodules

Question 33

What are 3 symptoms that may make you think about Hodgkin’s lymphomas?

Answer 33

1. night sweats/fever
2. cough/shortness of breath
3. weight loss

Question 34

What type of cells are seen in the lymphocyte predominant type of HL?

Answer 34

popcorn reed-sternberg cells

Question 35

What is one important characteristic that we should know about Hodgkin’s lymphomas?

Answer 35

they are very predictive, because they progress in an orderly, contiguous manner

(ex: if they initially present in the chest, they will next affect the next lymph node in line)

**spleen before liver

Question 36

Contiguous flow through lymph nodes

Answer 36

Hodgkin’s lymphomas

Question 37

What is the difference between A and B symptoms in Hodgkin’s lymphomas?

Answer 37

If a pt has one or more of the following symptoms: fever, night sweats, weight loss over 10% in 6 months), they are B. If these symptoms are absent, they are A.

Question 38

Why is TB common in Hodgkin’s lymphomas?

Answer 38

cytokines inhibit TH1 diversion, and cause clinical anergy (no response to infection)