Presentations - Ch. 13 Flashcards
Enlarged, painful lymph nodes that may be fluctuant, overlying skin is red
Acute nonspecific lymphadenitits - bacterial infection
Enlarged, nontender inguinal and/or axillary lymph nodes that grow slowly over time, organized collections of immune cells in nonlymphoid organs (tertiary lymphoid organs)
Chronic nonspecific lymphadenitits - chronic H. pylori gastritis or RA B-cell follicles in synovium
Child, abrupt onset, fatigue, fever, bleeding, bone pain, lymphadenopathy, organomegaly, meningitis symptoms (stiff neck, vomiting, etc.)
Explain symptoms
B-ALL (leukemia)
Fatigue = anemia Fever = neutropenic infections Bleeding = thrombocytopenia Bone pain = marrow expansion Organomegaly and neuro symptoms = neoplastic infiltration
Adolescent male, thymic mass, superior vena cava syndrome, Horner’s syndrome
T-ALL (lymphoma)
Adolescent/young adult, masses in the mandible and abdominal viscera
Endemic (EBV-associated) Burkitt lymphoma
Older adult, rapidly growing masses within LN, liver, spleen, Waldeyer ring (throat) and/or extranodal sites (GI, skin, bone, brain)
DLBCL
Adult, chronic inflammatory disease, extranodal mass, indolent
Extranodal marginal zone lymphoma
Middle age, generalized painless lymphadenopathy, marrow involvement, indolent, expanded white pulp follicles in spleen
Follicular lymphoma
Middle aged white male, pancytopenia, massive splenomegaly, atypical Mycobacterium infections
Hairy cell leukemia
Older male, disseminated disease, moderately aggressive
Mantle cell lymphoma
Older adult, lytic bone lesions, pathologic fractures, hypercalcemia, renal failure, neurologic manifestations, recurrent bacterial infections
Multiple myeloma
Isolated plasma cell mass in bone, extraosseous lesions in lungs, oronasopharynx, or nasal sinuses
Solitary plasmacytoma
Older adult, asymptomatic at diagnosis, then nonspecific symptoms (easily fatigued, weight loss), generalized lymphadenopathy, hepatosplenomegaly, periportal lymphocytic infiltrate in liver
CLL/SLL
Adult, rapidly progressive, skin lesions, generalized lymphadenopathy, hepatosplenomegaly, lymphocytosis, hypercalcemia
What else can accompany this?
Adult T cell leukemia/lymphoma - Endemic to Japan, West Africa, Caribbean
Progressive demyelinating disease
Older adult, generalized lymphadenopathy, eosinophilia, pruritis, fever, weight loss
Peripheral T-cell lymphoma, unspecified
Children/young adult, LN and soft tissue disease
Anaplastic large-cell lymphoma
Adult, destructive extranodal mass (esp. sinonasal, testis, or skin), ischemic necrosis, EBV
Extranodal NK/T-cell lymphoma
Adult, changing cutaneous patches, plaques, nodules, or generalized redness
Mycosis fungoides/Sezary syndrome
Adult, lymphocytosis, splenomegaly, neutropenia and anemia, maybe autoimmune (rheumatologic) disease
Large granular lymphocytic leukemia
Small monoclonal Ig spike
CLL/SLL
Hypogammaglobulinemia, multiple bacterial infections
CLL/SLL
10% to 15% of CLL/SLL patients may develop ___ or ___ due to autoantibodies
Hemolytic anemia or thrombocytopenia
HIV+, EBV+ neoplastic B cells, rapidly growing mass(es)
Immunodeficiency-associated large B-cell lymphoma (DLBCL subtype)
HIV+, KSHV/HHV-8, malignant pleural or ascitic effusion, cells w/ clonal IgH rearrangements, no B or T cell surface markers
Primary effusion lymphoma (DLBCL subtype)
Children/young male, mass in ileocecum or peritoneum
Sporadic (American) Burkitt Lymphoma
Older adult, asymptomatic, moderately large monoclonal Ig population in the blood (but less than 3 gm/dL)
Monoclonal gammopathy of undetermined significance (MGUS)
Asymptomatic, monoclonal Ig population in blood greater than 3 gm/dL, plasma cells are 10% to 30% of marrow cellularity
Smoldering myeloma (between MGUS and MM)
50s or 60s, many plasma cells in bone marrow, monoclonal IgM in blood, hyperviscosity
Lymphoplasmacytic lymphoma
Nonspecific symptoms, lymphadenopathy, hepatosplenomegaly, anemia, maybe autoimmune hemolysis via cold agglutinins
Lymphoplasmacytic lymphoma
Visual impairment, neurologic problems, bleeding, symptoms in cold temperatures
Hyperviscosity syndrome - due to excess IgM secretion
Salivary gland disease or thyroid gland disease or chronic gastritis
Marginal zone lymphoma - MALToma type
Rheumatoid arthritis, splenomegaly, neutropenia
Felty syndrome - due to Large granular lymphocytic leukemia
Young adult male or older male, painless lymphadenopathy, cutaneous anergy, systemic symptoms, advanced tumor stage
Mixed-Cellularity HL
Young adult, mediastinal mass, early tumor stage, lacunar cells
Nodular sclerosis HL
Older adult or HIV+ or poor country, systemic symptoms, late tumor stage, poor prognosis
Lymphocyte depletion HL
Young male, cervical or axillary lymphadenopathy, excellent prognosis
Lymphocyte predominance HL
Older adult, anemia, thrombocytopenia, neutropenia, much hemorrhaging, fever, fatigue, recurrent opportunistic infections (Pseudomonas, fungi, commensals)
AML
Older adult, maybe asymptomatic, maybe weakness, infections, hemorrhages
MDS
Middle age, slow onset, anemia and thrombocytopenia symptoms, dragging sensation in abdomen or LUQ pain, later myeloid blasts in the blood and marrow
CML
Late middle age adult, slow onset, plethora, cyanosis, headache, dizziness, HTN, GI symptoms, intense pruritis, peptic ulceration, hyperuricemia
Major risk for what?
Polycythemia vera
DVT, stroke, MI, bowel infarction, or minor hemorrhages
Older adult, elevated platelet count, thrombosis (DVT, venous thromboses, MI), hemorrhage
Essential thrombocytopenia
Throbbing and burning of hands and feet
Erythromelalgia - due to small arteriole occlusion in PCV or ET
Older adult, progressive anemia and splenomegaly, fullness in LUQ, nonspecific symptoms
Primary myelofibrosis - ealry
Under 2 yo, cutaneous lesions over front and back of trunk and scalp, hepatosplenomegaly, lymphadenopathy, pulmonary lesions, bone lesions
Multifocal multisystem Langerhans cell histiocytosis (L-S disease)
Child or older adult, eosinophilic infiltration of skull, ribs, or femur that may extend into soft tissue, diabetes insipidus
Histiocytosis X (Eosinophilic granuloma Langerhans cell histiocytosis)
Skull bone defects, diabetes insipidus, eyeball protrusion
Hand-Schuller-Christian triad – Eosinophilic granuloma
Adult, smoker, pulmonary lesion of macrophages
Pulmonary Langerhans cell histiocytosis
