Plasma Cell Disorders and Hodgkin Lymphoma

Question 1

Most Plasma Cell Neoplasms originate as bone marrow tumors and are detectable by measuring ______ in the serum or urine

Answer 1

monoclonal protein (M protein)

Question 2

What does CRAB stand for?

Answer 2

hypercalcemia, renal insufficiency, anemia, bone lesions

Question 3

When CRAB accompanies 20% nucleated cells in bone marrow, what is the diagnosis?

Answer 3

Plasma Cell Myeloma.

CRAB is the most important diagnostic test for PCM

Question 4

Bone marrow is normally 3%, in PCM it can be ____

Answer 4

about 30-40%

Question 5

elevated creatinine is related to ____

Answer 5

kidney disfunction

Question 6

in PCM which immunoglobulins are you looking to be elevated?

Answer 6

IgM and IgA. Other types of PCM include light chain only, and nonsecretory also IgD, IgE but these are rare.

Question 7

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?

Answer 7

This is positive for PCM. The abnormal plasma cells all arise from one progenitor, have same ABs.

Question 8

Which chain appears on urine test?

Answer 8

only the light chain.

Question 9

What is rouleaux formation?

Answer 9

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

Question 10

What do you use SPEP and SPI for?

Answer 10

SPEP to see which AB is high, SPI to see which AB (will show a band as opposed to a smear).

Question 11

True or False: If you see the nucleolus in a plasma cell it is neoplastic.

Answer 11

true

Question 12

Hematologic tumor is systemic or local?

Answer 12

systemic, can metastasize everwhere

Question 13

What is MGUS?

Answer 13

presence of monoclonal antibody in the serum or urine with no evidence of a plasma cell myeloma.

Question 14

T or F- MGUS is a precursor to PCM?

Answer 14

T

Question 15

What is Solitary plasmacytoma?

Answer 15

just the singular version of PCM (which is also called multiple myeloma). a single plasmacytoma of bone which is a localized tumor of bone.

Question 16

T or F? Solitary plasmacytoma of bone involves the bone marrow?

Answer 16

F. If it does then it is PCM.

Question 17

Diagnostic criteria for Solitary plasmacytoma of bone

Answer 17

No CRAB. absent or low serum M protein, single bone lesion

Question 18

Diagnostic criteria for MGUS?

Answer 18

low M protein levels

marrow plasmacytosis

Question 19

What is extraosseous plasmacytoma and where do they typically occur?

Answer 19

localized plasma cell tumors that arise in tissues outside of the bone marrow.
75% occur in the upper respiratory tract.

Question 20

CHL and NLPHL are both lymphomas involving what?

Answer 20

B cells

Question 21

CHL and NLPHL both originate where?

Answer 21

B cells in the germinal center

Question 22

What are the four types of CHL?

Answer 22

nodular sclerosis
Lymphocyte-rich
Mixed cellularity
Lymphocyte depleted

Question 23

What are RS cells?

Answer 23

Reed sternberg cells. Found in CHL. They are:

• large (100 um compared to RBC 8 um)
• multiple lobulated nuclei
• nucleolus is large and pink
• big cytoplasm

Question 24

What markers do RS cells have? What do they lack that is significant?

Answer 24

Have CD30 and CD 15

lack common leukocyte antigen CD45

Question 25

morphology of Nodular sclerosis?

Answer 25

nodular areas surrounded by broad bands of collagen (nodular sclerosis)
lacunar cells- large tumor cells surrounded by prominent clear space. They are scattered, not clustered, at high power
Background of mixed lymphocytes

Question 26

What is mixed cellularity CHL?

Answer 26

Like NSHL there is a background of mixed lymphocytes but there is no nodular fibrosis or sclerosis- won’t see the broad bands of collagen.
If there is even a single nodule associated with fibrosis it should be labeled as NSHL

Question 27

What is lymphocyte rich CHL?

Answer 27

not alot on this
classic HRS cells are present though rare
lacks the broad bands of collagen seen in NSHL
patients present with stage III or IV B cell symptoms

Question 28

when do you typically see lymphocyte depleted CHL?

Answer 28

in older patients and those with HIV

Question 29

typical characteristics of lymphocyte depleted CHL?

Answer 29

numerous RS cells many of which will look cancerous. The RS cells are abundant and can form clusters.