Pictures Week 2 Flashcards
polycythemia vera
hypercellular marrow, erythroid hyperplasia, increased megs
essential thrombocythemia
increased megs: large and weird, tend to cluster
early primary myelofibrosis: looks like ET
reticulin stain shows reticulin fibers
late primary myelofibrosis
increased megs; bizarre shapes, clustering, fibrosis
mastocytosis
aggregates of bland cells, round or spindle shaped, sometimes eosinophila
Refractory cytosine with unilineage dysplasia
weird looking precursors, binucleation or irregular nuclei; can show fibrosis, high or low cellularity; megaloblastoid features
refractory anemia with ring sideroblasts
ring sideroblasts, usually with dyspoietic features (in red cell series only)
MDS with isolated del(5q)
all megs monomuclear
refractory cytosine with multilineage dysplasia
granulocytes (if affected) don’t granulate normally; nuclei don’t lobulate normally
refractory anemia with excess blasts
blasts and dyspoeitic maturation
reactive follicular hyperplasia: bacterial abscess
Paracortical expansion: infectious mononucleosis (EBV or CMV): T cells and APCs
low power: normal architecture looks effaced
high power: polymorphic cell population in paracortex
also typical of: viruses and early HIV
activated T cells
huge reactive mononuclear cells: infectious mononucleosis
NOT cookie cutter: rules out malignancy
lupus lymphadenitis: necrosis (pale area)
HIV: lymphadenopathy: burned out follicles
rectangle: residual mantle zones
circle: histiocytes where germinal centers should be
normal germinal centers requiee CD4+ follicular helper cells
dermatopathic lymphadenopathy: aggregates of histiocytes
ex: eczema, psoriasis, pemphigus
normal small germinal centers with prominent mantle zones and large pale areas (cells with lots of cytoplasm)
dermatopathic lymphadenopathy: aggregates of histiocytes
pale: lots of cytoplasm
dermatopathic lymphadenopathy
aggregates of histiocytes: lots of dark pigment is melanin from skin lesions
chronic lymphocytic leukemia/lymphoma (CLL/SLL)
pseudofollicular, effacement of normal architecture
chronic lymphocytic leukemia/lymphoma (CLL/SLL)
proliferation center: pseudofollicular, effacement of normal architecture
collections of larger cells undergoing DNA synthesis and mitosis
chronic lymphocytic leukemia/lymphoma (CLL/SLL)
small lymphocytes, little cytoplasm: smudge cells
mantle cell lymphoma (MCL)
homogeneous effacement, starry sky: no proliferation center in lymph nodes
PB: small lymphocytes, little cytoplasm: smudge cells
mantle cell lymphoma (MCL)
Ki-67 immunostain
Burkitt lympohoma
cytology: variation in nucleus size and chape; intermediate size cells with basophilic, vacuolated cytoplasm; mitotic cell to far right
tissue: usually homogeneous effacement, high growth rate, starry sky
bone marrow biopsy: plasma cell neoplasm
eccentric nucleus, clumpy chromatin, large obvious golgi: hof (clear by nucleus)
erode bone
follicular lymphoma
enlarged lymph node with many follicles
follicular lymphoma
no polarity (large to small cells); no tingible body macrophages, fewer mitotic figures than normal
BCL-2 immunostains: reactive follicular hyperplasia
BCL-2 immunostains: follicular lymphoma
lymph node with partial involvment by follicular lymphoma
Follicular lymphoma: grade 1
mostly centrocytes
Follicular lymphoma: grade 2
Follicular lymphoma: grade 3
mostly centroblasts
diffuse large B-cell lymphoma
Hodgkin lymphoma: Reed/Sternberg cells
large lympohid cells with mono or bi nucleate appearance and huge eosinophilic nucleoli
Nodular lymphocyte predominant hodgkin lymphoma
Reed/sternberg cells look like popcorn
diverse background cells: cmall lymphocytes, plasma cells, eosinophils, neutrophils, histiocytes
mycosis fungoides
tissue: bland looking lymphocytes that invade the epidermis
Pautrier micro-abscesses
bloodstream: bland lymphocytes with cerebrifrom nuclei
cytology: normal size lymphocytes with indented nuclei
Blast: hematologic malignancy
Auer rod: always diagnostic of myeloid blasts
mostly myleoperoxidase
Leuko-erythroblastic (myelophthisic) picture
Top left: nucleated red cell.
Top center: basophilic stippling and a Howell-Jolly body.
Basophilic stippling is a non-specific indicator of abnormal erythroid maturation. Howell Jolly bodies are nuclear fragments that normally get yanked out of any circulating red cells by phagocytes in places like the spleen. They are seen when abnormal erythroid maturation is taking place, or when the spleen is absent.
Top right: giant platelet
Lower left: myelocyte
Lower center: blast.
ANY 2-3 of these indicate bone marrow pathology, but not what pathology
bone marrow core biopsy: iron stain
PML-RARA
big blasts, cleaved bat wing nuclei, many cytoplasmic granules, Aeur rods in stacks
Runx1-Runx1T1
some maturation to myelocytes, occasional auer rods
CBFB-MYH11
mixed granulocyte-monocyte features, increased eosinophils in blood and marrow
AML with normal cytogenetics or complex karyotype
undifferentiated or variably granulocytic or monocytic/monoblastic
ALL:
B-ALL: BCR-ANL1, TEL-AML1 (ETV6-RUNX1), MLL rearranged
T-ALL
big agranular blasts
arrows: myelocytes (more myelocytes than metamyelocytes)
myeloproliferative disease
CML bone marrow
hypercellular with many myeloid precursors, little dysplasia and no increasein blasts
normal/reactive lymph node
top arrows: germinal centers
bottom arrow: paracortex
normal/ reactive lymph node
top pinkish purple: germinal center
bottom purple: mantle zone
CD20 immunostain: B cells
germinal centers and mantle zones
CD10 immunostain: some B cells
germinal center
CD5 or CD3 immunostain: T cells
paracortex
reactive follicular hyperplasia
lymph node hyperplasia associated with bacterial infection: variable germinal center sizes
abscess or enlarged axillary node: not typically biopsied unless suspect malignancy
plasma cell neoplasm
rouleaux: stacked RBC
normal reactive germinal center: tingible body macrophages and follicular dendritic cells
Hodgkin lymphoma: nodular sclerosing
Hodgkin lymphoma
lymphocyte rich
NLPHD: nodular lymphocyte predominant hodgkin lymphoma
nodular with mostly lymphocyte backgorund
popcorn cells (lympho-histocytic cells: L&H) instead of classic RS cells
Peripheral T cell lymphoma NOS
expanded paracortex (clusters of epitheliod histoiocytes), effacement of normal architecture
disticnt subsets of atypical cells
aplastic anemia
Pelger-Huet anamoly: bi-lobed neutrophils
MDS
Ringed sideroblasts
MDS
ALL
polycythemia vera
facial plethora (due to histamine)
Polycythemia vera
arrows: hypochromic microcytes due to iron deficiency (can present with decreased RBC mass)
increased platelets
polycythemia vera: proliferative phase
hypercellular with trilineage hematopoiesis and loos clusters of pleomorphic megs (not present in secondary PV)
Essential thrombocythemia
erythromelagia: severe burning pain and hot, congestion of the forefoot and toes
Essential thrombocythemia: large giant platelets and normal erythrocytes, mild leukocytosis, meg nuclear fragments, micromegakaryocytes
essential thrombocythemia
bone marrow: hypercellular, increase megs arranged in loose clusters; megs larger than in reactive conditions or CMl
cloud-like nuclear lobations
mild increase in reticulin fibers
chronic idiopathic myelofibrosis
giant platelets, teardrop RBC, nucleated RBC in PB
mild chornic idiopathic myelofibrosis
see fibrosis and collagen
severe chronic idiopathic myelofibrosis
CML blood smear
myelocytes in peripheral blood
MALT lymphoma of sclera: salmon color pactch of superficial ocular surface
endemic Burkitt’s lymphoma: large tumor of neck
Burkitt’s lymphoma of the large intestine: polypoid mass of large intestine
AIDS: cerebral lymphoma
generalized lymphadenopathy from diffuse large B-cell lymphoma
left: soft tissue masses in the right axillary region
right: retroperitoneal soft tissue masses; largest lisplaces left kidney
Fused PET/CT scan of non-hodgkin lymphoma
diffuse large B-cell lymphoma, T cell rich type
large poorly circumscribed, mid trabecular aggregates with heterogenous population of large atypical lympohid cells with vascular nuclei admixed with small mature lymphocytes
CD20 immunostains: nodular pattern of marrow involvement large malignant appearing B cells mixed with benign reactive small T cells
mycosis fungoides: eczmatoid lesion
mycosis fungoides: ulceration of abdominal skin
invasive
mycosis fungoides
generalized erythrodermic type
Sezary syndrome
abnromal cells in peripheral blood: cerebriform, large, and clefted nuclei with fine chromatin pattern and scanty cytoplasm
Adult T-cell leukemia/lymphoma syndrome
extensive skin involvement
common in Carribean, far east
Reed/Sternburg cells
Hodgkin lymphoma
top: cervical lymph adenopathy
bottom: Reccurrent hodgkin lymphoma of anterior mediastinum eroding through anterior chest wall
Hairy cell leukemia
multiple myeloma
Rouleaux due to abnormal immunoglobins: multiple myeloma
multiple myeloma
lytic lesions
atypical plasma cells
multiple myeloma
lytic lesions
hemorrhagic lytic lesions
spinal cord compression
multiple myeloma bone marrow
core: patchy
aspirate
Waldenstrom: lymphoplasmacytic lymphoma
Waldenstrom macroglobinemia
upper 3: bone marrow biopsy: diffuse replacement of the marrow by small lymphocytic/plasma cell population that exhibits restricted IgM immunohistochemistry
bottom: mixxed population of lymphocytic/plasmacytoid cells in marrow aspirate
AL amyloidosis: can occur in multiple myeloma
tongue, back and kidney
amyloidosis
CMV: hairy leukoplakia
blue-bruised lesions: KSHV/HHV-8: Kaposi’s sarcoma
open lesion: complication of other disease
