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Heme Exam 3 > Pathology of Lymphomas > Flashcards

Pathology of Lymphomas Flashcards

1
Q

Anaplastic large cell lymphoma is always what kind of cell?

A

T-cell bro!

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2
Q

b-cell or t-cell lymphoma more common?

A

B-cell is more common - accounts for over 90% of lymphoid neoplasms worldwide

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3
Q

lymphomas that arise from germinal center?

A

follilular
burkitt
large cell

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4
Q

lymphomas that arise from mantle zone?

A

naive b-cell mantle cell lymphoma

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5
Q

lymphomas that arise from marginal zone?

A

memory b cell
CLL/SLL
marginal zone lymphoma

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6
Q

follicular lymphoma

  • common age?
  • clinically at diagonsis?
A
  • middle age is common
  • widespread disease at Dx
  • peripheral and central lymphadenopathy
  • splenomegaly
  • BM- 40-70%
  • PB 10% (PB usually not involved)
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7
Q

follicular lymphoma germinal center made up of what cells?

A

centroblasts & centrocytes

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8
Q

follicular lymphoma low grade has what cell type?

A

mostly centrocytes

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9
Q

follicular lymphoma high grade has what cell type?

A

greater than 15 centroblasts/hpf

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10
Q

centrocyte appearance vs centroblast?

A
  • centrocytes are more condensed (condensed = mature)

- blasts are looser looking = immature

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11
Q

***follicular lymphoma positive immunephenotype? negative staining?

A

+ =CD19, CD20, CD10, and bcl-2

  • = CD5 and CD3
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12
Q

Mantle cell lymphoma

  • age group?
  • sex predominance?
  • general presentation?
  • lymphocytosis how often?
  • organs usually affects?
  • any other organs sometimes?
A
  • *-50-60s yr
  • *-male predominance
  • *-generalized lymphadenopathy, BM involvement, and liver involvement
  • lymphocytosis in 30%
  • -splenomegaly in 50% and liver common
  • small bowel involvement - lymphomatoid polyposis
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13
Q

***mantle cell lymphoma - immunophenotypes + and -?

A

+ = CD19, CD20, CD5, & cyclinD

  • = CD23 and CD3
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14
Q

Burkitt lymphoma

-3 types?

A
  • endemic BL (african)
  • sporadic BL (non african, non endemic)
  • immunodef BL
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15
Q

Endemic BL etiology:

A
  • equatorial Africa
  • most common childhood malignancy
  • 4-7 yo, EBV+ in majority
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16
Q

sporadic BL etiology:

A
  • throughout the world
  • children and young adults
  • 30-50% of all childhood lymphomas
  • med age of adult 30 yo
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17
Q

All BL patients are at risk for:

A

CNS involvement

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18
Q

Endemic BL common sites:

A
  • 50% in jaws or facial bones

- ovaries, kidneys and breasts

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19
Q

Sporadic BL common sites:

A

-majority: abdominal masses, ileo-cecal region
-also: ovaries, kidneys and breast
RARELY JAW

20
Q

Immunodeficient-associated BL common sites?

A

nodal localization and BM

21
Q

BL - morphology:

A
  • DIFFUSE MONOMORPHIC INFILTRATE of intermediate sized round to slightly irregular lymphoid cells with multiple peripherally placed nucleoi
  • high mitotic rate
  • TINGIBLE BODY MACROPHAGES PRESENT (STARY SKY)
22
Q

***STARRY SKY APPEARANCE?

A

BL!

23
Q

***BL - immunophenotype:

+ and -?

A 
\+ = CD10, CD19, CD20
- = blc-2
24
Q

BL - prognosis:

A
  • very aggressive disease

- responds well to therapy

25
Q

Adult T-cell leukemia/lymphoma

  • what kind of cell?
  • caused by what?
  • where most common?
  • age group?
A
  • Mature T-cell only CD4!
  • caused by HTLV-1
  • Central africa, caribbean, southwestern japan
  • long latency
  • OCCURS ONLY IN ADULTS
26
Q

Adult t-cell leukemia/lymphoma - presentation?

A
  • not very specific:
  • -large LN
  • -large spleen & liver
  • –hypercalcemia*
  • -skin lesions
27
Q

Case has japanese patient and some hypercalcemia disease may be?

A

Adult t-cell leukemia/lymphoma

28
Q

Type of cell in adult t-cell leukemia/lymphoma?

A

CD4 T-cell

29
Q

adult t-cell leukemia/lymphoma - appearance of cells?

A
  • appearance varies
  • immature are smooth even chromatin with high nucleus to cytpolasm ratio
  • more mature chromatin, multilobated nuclei-flower cells or cloverleaf cells
30
Q

Flower cells or clover leafs cells?

A

adult t-cell leukemia/lymphoma

not specific but need to rule out other potential Dx

31
Q

adult t-cell leukemia/lymphoma - prognosis?

A

-very aggressve and most die within 1 year w/ treatment

32
Q

new therapy for adult t-cell leukemia/lymphoma?

A

anti-CD52 antibody - alemtuzumab

33
Q

which adult t-cell leukemia/lymphoma is more indolent?

A

when skin is primarily involved

34
Q

Mycosis fungoides/Sezary syndrome-
presentation?
what cell type?
survival?

A

One disease with two clinical manifestations

  • SKIN IS ALWAYS INVOLVED***
  • malignant lymphocytes are CD4***
  • indolent disease - 8to9 yrs survival-ish
35
Q

Mycosis fungoides/Sezary syndrome- appearance for pathology?

A

malignant cells have cerebriform nuclei- highly folded nuclear membrane

36
Q

Mycosis fungoides/Sezary syndrome-

-disease progression?

A
  • skin lesions startwith premycotic (patch) phase which has few neoplastic lymphoid cells
  • PLAQUE PHASE-increased neoplastic lymphoid cells in epidermis
  • TUMOR PHASE - tumor masses, predominantly in dermis

Progresses to involved LN and BMT-

37
Q

Sezary syndrome-presentation:

A

2 simulataneous manifestations:

  • leukemia
  • generalized exfoliative eryhroderma
38
Q

t-lymphoblastic leukemia/lymphoma -

  • whats important?
  • general presentation?
A
  • immature t-cell lymphomas
  • medical emergency - patients are short of breath (SOB)
  • 85% presents as a mass in ant mediastium and cervial LN
  • 15% as leukemia - similar to B-ALL
39
Q

T-cell ALL clinical presentation?

A
  • abrupt stormy onset - within days to a few weeks of symptoms
  • depression of normal marrow: fatigue due to anemia, infection, bleeding, 2ndary to thrombocytopenia
  • MEDIASTINAL MASS, lymphadenopathy, splenomegally, hepatomegaly due to neoplastic infiltration
  • CNS; headache, vomit, nerve palsies due to meningeal spread
40
Q

T-cell ALL - morphology:

A

monotonous population of blasts similar to B-ALL
-may have more clumped chromatin
sheets of blasts in lymph node, soft tissue or bone marrow

41
Q

**T-cell ALL - immunophenotype markers:

A
  • Positive for: CD34, TdT, CD1a (IMMATURE MARKERS)

- CYTOPLASMIC CD3 + (neg for surface CD3)

42
Q

T-cell ALL - prognosis:

A
  • most T-ALL are higher risk - immature
  • more factors;
  • –under age 2
  • –presentation in adolescence or adulthood
  • –presence of philadelphia chromosome 9,22 or translocation involving MLL gene on ch11
  • –WBC>100K
43
Q

anaplastic large t-cell lymphoma (ALCL):

-etiology:

A
  • immature t-cell lymphoma
  • 10-20% of childhood lymphomas– also seen in adults
  • involved LN and extranodal sites, mediastinal disease is less frequent then HL
  • aggressive
44
Q

ALCL - immunophenotype +/- & prognosis

A
  • **-ALK-1 positive = better prognosis

* **-ALK-1 negative = poor prognosis in adults

45
Q

***distinct cell in ALCL?

A

HALLMARK CELLS - abundant cytoplasm and kidney shaped nuclei

46
Q

ALCL - immunophenotype

A

-ALK+/-, **CD30+*

  • EMA+, CD2, CD5, CD4 = positive 70%
  • CD3 negative in 75%
  • CD15 engative
47
Q

CD30 positive?

A

ALCL

Heme Exam 3 (8 decks)

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