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OS Hematology/Oncology > Path/Heme Maligs III > Flashcards

Path/Heme Maligs III Flashcards

1
Q

Name some Ig promoters

A 
IgH (14q32)
Ig lambda (22q11)
Ig kappa (2p12)
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2
Q

Bcl2 and Bcl6 are overproduced in these neoplasms

A

Germinal center derived

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3
Q

Cyclin-D1 and Myc are overproduced in these neoplasms

A

naive B cell neoplasms

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4
Q

Cyclin D3 and Pax5 are overproduced in these neoplasms

A

memory B cell neoplasms

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5
Q

Where does CLL primarily manifest?

A

Peripheral blood

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6
Q

Where does follicular lymphoma primarily manifest?

A

Lymph nodes

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7
Q

Where does Burkitt’s lymphoma primarily manifest?

A

GI tract

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8
Q

CLL is derived from what type of cell?

A

Memory B cells (already class switched)

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9
Q

What is a good prognosis in CLL?

A

13q del only

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10
Q

What is a bad prognosis in CLL?

A

del(17p) (p53)

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11
Q

Immunophenotype of CLL

A

Light chain restriction (clonal)
CD5+ (odd but characteristic)
Somatic hypermutation markers

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12
Q

Two other genetic events leading to CLL

A

Trisomy 12 and del11q

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13
Q

How do smudge cells help predict prognosis of CLL?

A

> 30% is good

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14
Q

Morphology of CLl

A

Smudge cells
Pseudofollicular lymph nodes
Small lymphocytes with sparse cytoplasm and mature chromatin

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15
Q

Common presentation of CLL

A

lymphocytosis in older males with recurrent infections (hypogammaglob)

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16
Q

Common presentation of MCL and what does it mimic closely?

A

lymphocytosis in older males with recurrent infections (hypogammaglob); mimics CLL

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17
Q

Where does mantle cell lymphoma primarily manifest?

A

Lymph nodes

18
Q

What is the key difference between CLL and MCL?

A

No proliferation centers in MCL

19
Q

What immunomarkers are helpful in distinguishing CLL from MCL and how so?

A

CD20+ very strong in MCL, much weaker in CLL

20
Q

What translocation is common in MCL?

A

t(11;14) aka (IgH;CyclinD1) which is ALWAYS seen by FISH

21
Q

What is the key clinical predictor of MCL?

A

Ki-67 immunostain for mitotic rate

22
Q

Where do plasma cell neoplasms primarily manifest?

A

Bone marrow

23
Q

What are some smear and lab findings of plasma cell neoplasms?

A

Rouleaux on PB; inc total protein (antibodies)

24
Q

What would you expect to see on a plasma cell neoplasm gel?

A

IgG spike

25
Q

What are two important clinical predictors of plasma cell neoplasms?

A

B2-microglobulin (bad) and del 17p (p53) - bad

26
Q

What is the common immunophenotype of plasma cell neoplasms?

A

CD38+++
CD138+++
light chain restricted

27
Q

Describe follicular lymphoma pathogenesis

A

Failure of germinal center B-cells to undergo apoptosis because they overexpress Bcl-2 due to translocation under IgH

28
Q

What are some morphological findings of follicular lymphoma?

A

No polarity
No tingible body macrophages (no food!)
Reduced mitotic figures (bad, normally high)

29
Q

Major immunomarker of follicular lymphoma?

A

BCL-2+

30
Q

Genetic translocation in most follicular lymphomas

A

t(14;18) in 85%

31
Q

Describe the prognostication of follicular lymphoma

A

Depends highly on grade; may progress to diffuse large B cell lymphoma

32
Q

How is follicular lymphoma graded?

A

Amount of large cells (centroblasts)

33
Q

Which is bigger, centroblasts or centrocytes?

A

Centroblasts

34
Q

Diffuse large B cell lymphoma immunophenotype

A

CD19
CD20
CD10

35
Q

Name two common translocations in diffuse large b cell lymphoma

A

t(v:3) Bcl-6

t(14;18) Bcl2-IgH

36
Q

Most common presentation of Hodgkin’s

A

Males 30-50 with adenopathy

37
Q

Morphology of Classical Hodgkin’s

A

Highly variable; look for Reed-Sternberg “owl eyes” cells

Diverse background of other cells
+/- Nodular fibrous bands

38
Q

Morphology of Nodular lymphocyte predominant Hodgkin’s

A

Smaller R-S cells with less prominent nucleoli (“Popcorn cells”)

39
Q

What is a Reed-Sternberg cell?

A

Rearranged Ig genes
Constitutive NFkB expression from mut or EBV
Or other apoptosis mutations

NO Immunoglobulin expression!

40
Q

Immunophenotype of Classical Hodgkin’s

A

CD30+ (very important)
CD15+
pax5+ (b cell TF)

41
Q

Key clinical predictors of Hodgkin’s

A

Stage and histological type

42
Q

What is one way to differentiate between types of Hodgkin’s using cell surface markers?

A

Use +/- immunoglobulins on R-S cells:
+ is Nodular
- is classical

OS Hematology/Oncology (14 decks)

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