Pathology of Lymphoma

Question 1

What are the mature Lymphoid Neoplasms?

Answer 1

B cell Lymphomas
 - Follicular
 - Mantle Cell
 - Burkitt 
T Cell Lympoma
 - Adult T cell leukemia/lymphoma
 - Mycosis fungoides/Sezary Syndrome

Question 2

What are the Immature T Cell neoplasms?

Answer 2

T lymphoblastic leukemia/lymphoma

Anaplastic Large T cell Lymphoma

Question 3

What kinds of cells are more commonly found in Lymphomas?

Answer 3

B cells lymphomas are 90% of lymphomas

Question 4

Follicular Lymphoma

Answer 4

Middle age
Peripheral and central lymphadenopathy
Splenomegaly
Bone marrow involvement - most of the time
Peripheral blood involvement rare
node is nodular on excision

Low grade = centrocytes (small irregular nucleus, dark)
High grade = greater than 15 centroblasts/hpf (big round nucleus)

MARKERS
Pos: CD 19, CD 20, CD10, Bcl-2
Neg: CD 5, CD 3

Question 5

Mantle Cell Lymphoma

Answer 5

Males, 55 yrs old
Bone marrow involvement
lymphadenopathy
Liver involvement
Splenomegaly
Small bowel - lymphamatoid polyposis

MARKERS
Pos: CD 19, CD 20, CD 5, Cyclin D
Neg: CD 23, CD 3

Question 6

Burkitt Lymphoma

Answer 6

Endemic (african): #1 childhood malig, 4-7 yr, EBV+
- jaws, facial bones, (ovaries, kidneys, breast)
Sporadic: Teenager, Median age of adult 30
- Rarely Jaw, (ovaries, kidneys, breast)
Immunodeficiency-associated: HIV, often how find AIDS
- Bone marrow involvement frequent

ALL AT RISK FOR CNS INVOLVEMENT

Starry sky pattern - tingible body macrophages
- dark spot is the tingible body, lighter spot is nucleus

MARKER
Pos: CD 10, CD 19, CD 20
Neg: Bcl-2

Good response to tx, high cure rates

Question 7

Adult T cell leukemia/lymphoma

Answer 7

MATURE T cell neoplasm CD4+
HTLV-1 is the cause, retrovirus
Adults
Present: lymphadenopathy, skin lesions, hepatosplenomegaly, lymphocytosis, Hypercalcemia**

Flower Cells or cloverleaf cells

Death withing one year despite chemo

Question 8

Mycosis fungoides/Sezary Syndrome

Answer 8

One disease, two clinical manifestations
SKIN ALWAYS INVOLVED
MALIGNANT CD4+ T LYMPHOCYTES
NUCLEI HAVE FOLDED NUCLEAR MEMBRANE

Mycosis fungoides
- Premycotic (patch) phase - red patches
- Plague Phase - small raised patch in EPIDERMIS
- Tumor Phase - masses in DERMIS
progresses to involve the Lymph nodes and BM

Sezary Syndrome - 2 simultaneous manifestations

• Leukemia - Flower cells
• Generalized EXFOLIATIVE ERYTHRODERMA

Question 9

T lymphoblastic leukemia/lymphoma

Answer 9

Medical emergency
Present:
- 85% - Anterior Mediastinal mass, Cervical Nodes
- 15% - as leukemia (T - ALL)

Abrupt Stormy onset
Depressed Bone marrow - anemia, infection, thromboctyopenia (bleeding), mediastinal mass, CNS symptoms

Sheets of blasts in lymph node biopsy or bone marrow

MARKERS
Pos:
Immature markers: CD 34, Tdt, CD1a
CYTOPLASMIC CD3

Question 10

Anaplastic Large T Cell Lymphoma (ALCL)

Answer 10

Non Hodgkin Lymphoma
in children and adults

MARKERS
Pos: ALK-1 - in children - better prognosis
Neg: ALK-1 - adults - poor prognosis
All are CD 30+, EMA+, CD3-(mostly)

“Hallmark Cells” on biopsy (medium, kidney shaped nucleus, paranuclear eosinophilic region)