Plasma Cell Disorder and Hodgkin Lymphoma Flashcards
Most Plasma Cell Neoplasms originate as bone marrow tumors and are detectable by measuring ______ in the serum or urine
monoclonal protein (M protein)
What does CRAB stand for?
hyperCalcemia, Renal insufficiency, Anemia, Bone lesions
When CRAB accompanies 20% nucleated cells in bone marrow, what is the diagnosis?
Plasma Cell Myeloma.
CRAB is the most important criteria for PCM
Bone marrow is normally 3%, in PCM it can be ____
about 30-40%
elevated creatinine is related to ____
kidney disfunction
in PCM which immunoglobulins are you looking to be elevated?
IgM and IgA. Other types of PCM include light chain only, and nonsecretory also IgD, IgE but these are rare.
In testing for PCM what does it mean if in a serum protein immunofixation test there are very high levels of one type of heavy chain and one type of light chain?
This is positive for PCM. The abnormal plasma cells all arise from one progenitor, have same ABs.
Which chain appears on urine test?
only the light chain.
What is rouleaux formation?
occurs in PCM. Its when RBCs stack on top of each other because of all the antibodies. ABs are + charged and RBCs are - charged. Occurs with high m protein serum levels
What do you use SPEP and SPI for?
SPEP to see which AB is high, SPI to see which AB (will show a band as opposed to a smear).
True or False: If you see the nucleolus in a plasma cell it is neoplastic.
true
Hematologic tumor is systemic or local?
systemic, can metastasize everwhere
What is MGUS?
presence of monoclonal antibody in the serum or urine with no evidence of a plasma cell myeloma.
T or F- MGUS is a precursor to PCM?
T
What is Solitary plasmacytoma?
just the singular version of PCM (which is also called multiple myeloma). a single plasmacytoma of bone which is a localized tumor of bone.
T or F? Solitary plasmacytoma of bone involves the bone marrow?
F. If it does then it is PCM.
Diagnostic criteria for Solitary plasmacytoma of bone
No CRAB. absent or low serum M protein, single bone lesion
Diagnostic criteria for MGUS?
M-spike but no CRAB or other multiple myeloma features.
What is extraosseous plasmacytoma and where do they typically occur?
localized plasma cell tumors that arise in tissues outside of the bone marrow. 75% occur in the upper respiratory tract.
CHL (Classic Hogkin Lymphoma) and NLPHL (nodular lymphocyte-predominant Hodgkin’s lymphoma) are both lymphomas involving what?
B cells
CHL and NLPHL both originate where?
B cells in the germinal center
What are the four types of CHL?
- Nodular sclerosis most common 70% of all cases
- Lymphocyte-rich (best prognosis)
- Lymphocyte depleted (most aggressive)
- Mixed cellularity (associated with Eosinophils)
What are RS cells?
Reed sternberg cells. Found in CHL.
- They are large B cells
- multiple lobulated nuclei
- nucleolus is large and pink-big cytoplasm
- “owl eye” nuclei
What markers do RS cells have? What do they lack that is significant?
Have CD30 and CD 15
Lack common leukocyte antigen CD45
What is the morphology of Nodular sclerosis?
- Classic Presentation is an enlarging cervical or mediastinal lymph node in a young adult, usually female.
- Lymph node is divided by bands of sclerosis most important
- RS cells are present in lacunar cells.
What is mixed cellularity CHL?
- Second most frequent subtype, 20-30%
- Lack of broad bands of collagen seen in nodular sclerosis CHL* probably most important.*
- Frequent in children and older patients
- B symptoms
Epstein-Barr virus (EBV) infection in ~75% of cases
What is lymphocyte rich CHL?
Not much on this one…
- Classic RS cells are present though rare most important
- lacks the broad bands of collagen seen in NSHL patients -B cell symptoms
When do you typically see lymphocyte depleted CHL?
in older patients and those with HIV
Typical characteristics of lymphocyte depleted CHL?
numerous RS cells many of which will look cancerous. The RS cells are abundant and can form clusters.
What is a typical radiographic finding of plasma cell myeloma?
Bone “punch outs” where osteoclasts have thinned the bone out significantly.
What is a smoldering myeloma?
Well its like a fire that has gone out… the coals still smolder but they are inactive as far as firemaking goes.
Smolderimg myeloma is inactive myeloma. It is AKA indolent myeloma
Where are the typical locations of plasma cell myelomas and plasmacytomas?
PCM= marrow Plasmacytoma= bone and extraosseous
