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SBL Test 1 > Review: Lymphomas > Flashcards

Review: Lymphomas Flashcards

1
Q

Lymphomas are divided into what categories

A

Hodgkin’s Lymphoma

NH Lymphoma

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2
Q

What is germinal center

A

Where B-cells undergo somatic hypermutation (process B-cells undergo to produce selective Ab) and class-switching (IgM => other Ig Ab)

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3
Q

Have HL B-cells already undergone somatic hypermutation?

A

Yes => thus all monoclonal

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4
Q

What is HL?

A

Malignant proliferation of mutated B-cell in the germinal center of LN (MC cervical) due to EBV infection (most).

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5
Q

Markers of HL

A

Not usual B-cell markers:

CD15/30+
PAX5+
Surface IgG

If nodular lymphocytic predominant: CD20+ and BCL6+

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6
Q

HL is MC when?

A

Bimodal age distribution: 20 & 65. Average age = 32YO.

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7
Q

How are lymphomas different from reactive lymphocytosis?

A

Cells are monoclonal

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8
Q

How does HL spread?

A

Begins in a single, localized LN (MC = cervical = neck) and spreads in a predictable fashion.

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9
Q

Presentation of HL

A
  1. Painless mass in cervical LN (head/neck): spreads from node- node in predictable manner
  2. Mediastinal mass (if nodular sclerotic type)
  3. B-symptoms (d/t cytokines released from B- cells): fever, chills, night sweats, WL: Indicates WORSE prognosis
  4. Extranodal involvement = rare
  5. Hypercalcemia
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10
Q

What types of HL are NOT associated with EBV?

A
  1. Nodular sclerosis

2. Lymphocyte predominant

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11
Q

Which type of HL is the worse prognosis?

Who/where is it MC in?

A

Lymphocyte depleted: MC in older males, HIV and developing countries

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12
Q

RF of HL

A
  1. Prior EBV
  2. Immunosuppresion
  3. AI diseases (RA, SLE)
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13
Q

Prognosis of HL

A

Highly curable.

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14
Q

What are NHL?

A

Proliferation of MATURE B-cells.

  • Affects multiple LN and NON-contiguously
  • Extranodal involvement common (spleen, GI tract, respiratory tract) and NON-lymphoid tissue (CNS)
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15
Q

What NHL are B-cells MC in?

A

More aggressive types: Burkitt and DLBC

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16
Q

DLBL markers, MC in, genetics

A
  1. CD19+/20+
  2. BCL6/2
  3. Surface Ig

Older patients (>60)

  1. Dysregulation of BCL6 (too much or too little), which is required for formation of NL germinal centers
  2. Small % have t(14:18): translocation = BCL2-IgG fusion gene: if BCL2 rearrangements is present => usually NO BCL6 rearrangements (thus, BCL6 is NL). Thus, they could have previously been follicular lymphomas
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17
Q

Follicular B-cell lymphoma markers, MC in, genetics

A
  1. CD19/20+
  2. CD10+
  3. surface Ig,
  4. BCL6 and BCL2 in 90% of cases.

Middle aged adults (M=F); rare in AZNs

  1. (14:18) -translocation = BCL2-IgG fusion gene => overexpression of BCL2 => blocks apoptosis => uncontrolled growth of B-cells.

Germinal center B-cells usually lack Bcl2 because frequently under apoptosis, unless selected by somatic hypermutatioon.

Overexpression of Bcl2 prevents death of germinal center B cells => growth

18
Q

Burkitt Lymphoma markers, MC in, genetics

A
  1. CD19+/20+
  2. CD10+
  3. IgM
  4. BCL6
  5. NO anti-apoptotic BCL2

Children or young adults

  1. t(8:14) = ↑↑↑ c-MYC => increase transcription of genes needed for aerobic glycolysis (Warburg effect), allowing cells to make their own building blocks needed for cell growth and division.
19
Q

Mantle Cell Lymphoma markers, MC in, genetics

A
  1. CD19/20
  2. CD5*, usually a T-cell marker
  3. Cyclin D1

Adult males (50- 60 YO)

  1. t(11:14) => overexpression of cyclin D1: G1 => S phase
20
Q

Marginal Zone Lymphoma genetics

A
  1. t(11:18) translocation*
  2. t(14:18) translocation
  3. t(1:14) translocation

All upregulate BCL10 or MALT1

21
Q

Small cell lymphocytic lymphoma/ Chronic lymphocytic leukemia markers, MC in, genetics

A
  1. CD19/20+
  2. CD5+***, just like Mantle Cells
  3. CD23+
  4. Surface IgM/IgD

Older adults (60Y M)

Unlike other lymphoid malignancies, translocations rare:

  1. Trisomy 12: deletion of 11q, 13q and 17p.
  2. GOF NOTCH1 mutation  worse prognosis
22
Q

Presentation of Burkitt Lymphoma

A

Rapidly growing tumor that arises in extranodal site:

B-cell sx

    • Endemic = mass in the jaw/mandible in 4-7YO AF child
    • Sporadic = abdominal mass (ileocecum or peritoneum, ovary adrenals) in children
    • Immunodeficiency related BL = older adults with mass in LN (lymphadenopathy
23
Q

Prognosis of Burkitt cell

A

Very aggressive – rapid proliferation (fastest growing of all)

However, responds WELL to intensive chemotherapy.
Most children, young adults can be cured.

24
Q

Histology of Burkitt

A

Starry-sky morphology: sheets of highly mitotic lymphocytes with interspersed tingible body MO (have clear cytoplasms

25
Q

Presentation of Follicular Lymphoma

A
  1. Painless, generalized waxing and waning LAD (extra nodal involvement is RARE)
  2. By the time of dx, BM is almost always invaded!
  3. Indolent and non-aggressive, but Incurable and can transform into DLBL or Burkitt lymphoma
26
Q

Histology of Follicular Lymphoma

A
  1. Nodular pattern of growth: cell pattern looks similar to NL LN follicles
  2. Follicular hyperplasia
  3. If BM involved = paratrabecular LN aggregates
27
Q

treatment of follicular lymphoma

A

Treatment = palliative treatment with low dose chemo or anti-CD20 Ab when symptomatic.

28
Q

Diffuse Large B-cell Lymphhoma presentation

A

Appears as a rapidly growing mass at nodal site or extranodal site:
1. Walter ring, 1’/2’ involvement of spleen or liver, GI tract, skin, bone and brain

29
Q

Prognosis of DLBCL

A

Aggressive, rapidly fatal without treatment.

30
Q

Histology of DLBCL

A
  1. Diffuse, large B-cells

2. Obliteration of LN architecture, especially follicles

31
Q

In BM involved in DLBCL?

A

Uncommon: pts still make an adequate amount of RBC, WBC, platelets

32
Q

Which lymphomas commonly undergo a leukemic phase (malignant cells in peripheral BS)?

A
  1. Follicular B-cell (10% of cases have lymphocytosis)
  2. Mantle cell
  3. Small cell lymphocytic leukemic/ CLL
33
Q

Presentation of Mantle Cell Lymphoma

A

At time of dx: spread to bone, liver or GI tract disease (late-stage). Symptoms are due to extra nodal involvement

  1. . Painless lymphadenopathy (LAD)
  2. Extranodal involvement: gut, spleen, liver => hepatosplenomegaly
  3. Polyp like lesions (lymphomatoid polyposis) in mucosa of SI/colon
34
Q

Histology of Mantle Zone lymphoma

A

1Homogenous expanding population of small lymphoid cells in mantle zone (surrounding a small, atrophic germinal center.

35
Q

Marginal Zone Lymphoma = what is it?

A

Neoplasm of mature memory B-cells at site of chronic inflammation, due to the formation of a marginal zone.

36
Q

What rule does Marginal Zone lymphoma NOT follow?

A

RMBR; true malignancies exhibit monoclonality. This is an exception

Marginal zone lymphomas begin as reactive lymphoid neoplasia  [translocations] lymphoma. Thus, they begin as polyclonal  monoclonal transformation.

37
Q

Presentation of Marginal Zone lymphoma?

A

Presents as a mass in extranodal sites associated with chronic inflammation.
1. Sjrogens => salivary glands

  1. Hashimoto => thyroid
  2. H.Pylori => produces a MALToma in the stomach

Remains localized for prolonged periods of time

May regress if inciting agent goes away.

38
Q

What is Small cell lymphocytic lymphoma/ chronic lymhocytic leukemia?

A

Neoplasm of naïve lymphocytes (NOT lymphoblasts), called prolymphocytes.

39
Q

SLL = Lymphocyte count < _____ (leukopenia)

CLL = Lymphocyte count >_____ (leukocytosis)

A

SLL = Lymphocyte count < 5000 (leukopenia)

CLL = Lymphocyte count >5000 (leukocytosis)

40
Q

What are complications in Small cell lymphocytic lymphoma/ chronic lymphocytic leukemia?

A
  1. *Hypogammaglobinemia (usually IgG/A/M) => ↑↑↑ susceptibility to bacterial infections because disrupts NL immune function

2 Autoimmune hemolytic anemia due to production of autoAB

  1. Thrombocytopenia
  2. Richter syndrome: prolymphocytes can transform into an aggressive DLBL (Diffuse Large B-cell Lymphoma) = survival of less than 1 year.
41
Q

Presentation of Small cell lymphocytic lymphoma/ chronic lymphocytic leukemia?

A

Older patient, often asymptomatic at diagnosis and progresses slowly. If symptomatic, non-specific with recurring infections.

  1. *Non-specific symptoms = fatigue, WL, anorexia
  2. 50-60% = Generalized LAD and hepatosplenomegaly
  3. *Small monoclonal Ig “spike” is present in blood of some

low rade

42
Q

Histology findings for Small cell lymphocytic lymphoma/ chronic lymphocytic leukemia?

A
  1. Prolymphocyte centers = loose aggregates of large lymphocytes with mitotically active cells
  2. Smudge cell
  3. Scattered spherocytes (round cells)
  4. Prolymphcytes in LN

SBL Test 1 (15 decks)

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