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SS- Heme > Pictures Week 2 > Flashcards

Pictures Week 2 Flashcards

1
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polycythemia vera

hypercellular marrow, erythroid hyperplasia, increased megs

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2
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essential thrombocythemia

increased megs: large and weird, tend to cluster

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3
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early primary myelofibrosis: looks like ET

reticulin stain shows reticulin fibers

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4
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late primary myelofibrosis

increased megs; bizarre shapes, clustering, fibrosis

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5
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mastocytosis

aggregates of bland cells, round or spindle shaped, sometimes eosinophila

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6
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Refractory cytosine with unilineage dysplasia

weird looking precursors, binucleation or irregular nuclei; can show fibrosis, high or low cellularity; megaloblastoid features

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7
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refractory anemia with ring sideroblasts

ring sideroblasts, usually with dyspoietic features (in red cell series only)

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8
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MDS with isolated del(5q)

all megs monomuclear

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9
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refractory cytosine with multilineage dysplasia

granulocytes (if affected) don’t granulate normally; nuclei don’t lobulate normally

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10
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refractory anemia with excess blasts

blasts and dyspoeitic maturation

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11
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reactive follicular hyperplasia: bacterial abscess

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12
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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

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13
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activated T cells

huge reactive mononuclear cells: infectious mononucleosis

NOT cookie cutter: rules out malignancy

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14
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lupus lymphadenitis: necrosis (pale area)

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15
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HIV: lymphadenopathy: burned out follicles

rectangle: residual mantle zones
circle: histiocytes where germinal centers should be

normal germinal centers requiee CD4+ follicular helper cells

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16
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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)

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17
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dermatopathic lymphadenopathy: aggregates of histiocytes

pale: lots of cytoplasm

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18
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dermatopathic lymphadenopathy

aggregates of histiocytes: lots of dark pigment is melanin from skin lesions

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19
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chronic lymphocytic leukemia/lymphoma (CLL/SLL)

pseudofollicular, effacement of normal architecture

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20
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chronic lymphocytic leukemia/lymphoma (CLL/SLL)

proliferation center: pseudofollicular, effacement of normal architecture

collections of larger cells undergoing DNA synthesis and mitosis

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21
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chronic lymphocytic leukemia/lymphoma (CLL/SLL)

small lymphocytes, little cytoplasm: smudge cells

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22
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mantle cell lymphoma (MCL)

homogeneous effacement, starry sky: no proliferation center in lymph nodes

PB: small lymphocytes, little cytoplasm: smudge cells

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23
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mantle cell lymphoma (MCL)

Ki-67 immunostain

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24
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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

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25
bone marrow biopsy: plasma cell neoplasm eccentric nucleus, clumpy chromatin, large obvious golgi: hof (clear by nucleus) erode bone
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follicular lymphoma enlarged lymph node with many follicles
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follicular lymphoma no polarity (large to small cells); no tingible body macrophages, fewer mitotic figures than normal
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BCL-2 immunostains: reactive follicular hyperplasia
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BCL-2 immunostains: follicular lymphoma
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lymph node with partial involvment by follicular lymphoma
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Follicular lymphoma: grade 1 mostly centrocytes
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Follicular lymphoma: grade 2
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Follicular lymphoma: grade 3 mostly centroblasts
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diffuse large B-cell lymphoma
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Hodgkin lymphoma: Reed/Sternberg cells large lympohid cells with mono or bi nucleate appearance and huge eosinophilic nucleoli
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Nodular lymphocyte predominant hodgkin lymphoma Reed/sternberg cells look like popcorn diverse background cells: cmall lymphocytes, plasma cells, eosinophils, neutrophils, histiocytes
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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
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Blast: hematologic malignancy
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Auer rod: always diagnostic of myeloid blasts mostly myleoperoxidase
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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
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bone marrow core biopsy: iron stain
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PML-RARA big blasts, cleaved bat wing nuclei, many cytoplasmic granules, Aeur rods in stacks
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Runx1-Runx1T1 some maturation to myelocytes, occasional auer rods
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CBFB-MYH11 mixed granulocyte-monocyte features, increased eosinophils in blood and marrow
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AML with normal cytogenetics or complex karyotype undifferentiated or variably granulocytic or monocytic/monoblastic
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ALL: B-ALL: BCR-ANL1, TEL-AML1 (ETV6-RUNX1), MLL rearranged T-ALL big agranular blasts
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arrows: myelocytes (more myelocytes than metamyelocytes) myeloproliferative disease
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CML bone marrow hypercellular with many myeloid precursors, little dysplasia and no increasein blasts
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normal/reactive lymph node top arrows: germinal centers bottom arrow: paracortex
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normal/ reactive lymph node top pinkish purple: germinal center bottom purple: mantle zone
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CD20 immunostain: B cells germinal centers and mantle zones
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CD10 immunostain: some B cells germinal center
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CD5 or CD3 immunostain: T cells paracortex
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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
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plasma cell neoplasm rouleaux: stacked RBC
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normal reactive germinal center: tingible body macrophages and follicular dendritic cells
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Hodgkin lymphoma: nodular sclerosing
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Hodgkin lymphoma lymphocyte rich
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NLPHD: nodular lymphocyte predominant hodgkin lymphoma nodular with mostly lymphocyte backgorund popcorn cells (lympho-histocytic cells: L&H) instead of classic RS cells
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Peripheral T cell lymphoma NOS expanded paracortex (clusters of epitheliod histoiocytes), effacement of normal architecture disticnt subsets of atypical cells
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aplastic anemia
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Pelger-Huet anamoly: bi-lobed neutrophils MDS
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Ringed sideroblasts MDS
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ALL
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polycythemia vera facial plethora (due to histamine)
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Polycythemia vera arrows: hypochromic microcytes due to iron deficiency (can present with decreased RBC mass) increased platelets
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polycythemia vera: proliferative phase hypercellular with trilineage hematopoiesis and loos clusters of pleomorphic megs (not present in secondary PV)
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Essential thrombocythemia erythromelagia: severe burning pain and hot, congestion of the forefoot and toes
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Essential thrombocythemia: large giant platelets and normal erythrocytes, mild leukocytosis, meg nuclear fragments, micromegakaryocytes
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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
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chronic idiopathic myelofibrosis giant platelets, teardrop RBC, nucleated RBC in PB
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mild chornic idiopathic myelofibrosis see fibrosis and collagen
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severe chronic idiopathic myelofibrosis
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CML blood smear myelocytes in peripheral blood
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MALT lymphoma of sclera: salmon color pactch of superficial ocular surface
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endemic Burkitt's lymphoma: large tumor of neck
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Burkitt's lymphoma of the large intestine: polypoid mass of large intestine
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AIDS: cerebral lymphoma
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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
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Fused PET/CT scan of non-hodgkin lymphoma
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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
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mycosis fungoides: eczmatoid lesion
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mycosis fungoides: ulceration of abdominal skin invasive
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mycosis fungoides generalized erythrodermic type
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Sezary syndrome abnromal cells in peripheral blood: cerebriform, large, and clefted nuclei with fine chromatin pattern and scanty cytoplasm
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Adult T-cell leukemia/lymphoma syndrome extensive skin involvement common in Carribean, far east
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Reed/Sternburg cells
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Hodgkin lymphoma top: cervical lymph adenopathy bottom: Reccurrent hodgkin lymphoma of anterior mediastinum eroding through anterior chest wall
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Hairy cell leukemia
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multiple myeloma
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Rouleaux due to abnormal immunoglobins: multiple myeloma
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multiple myeloma lytic lesions atypical plasma cells
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multiple myeloma lytic lesions hemorrhagic lytic lesions spinal cord compression
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multiple myeloma bone marrow core: patchy aspirate
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Waldenstrom: lymphoplasmacytic lymphoma
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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
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AL amyloidosis: can occur in multiple myeloma tongue, back and kidney
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amyloidosis
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CMV: hairy leukoplakia
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blue-bruised lesions: KSHV/HHV-8: Kaposi's sarcoma open lesion: complication of other disease

SS- Heme (13 decks)

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