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22 fall: path > Test 4: 6: bone marrow > Flashcards

Test 4: 6: bone marrow Flashcards

1
Q

what are the primary lymphoid organs

A

thymus
bone marrow
bursa of fabricius

(make B and T cells)

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2
Q

secondary lymphoid organs

A

▪ Spleen ▪ Lymph nodes ▪ MALT ▪ Tonsils

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3
Q

how do T cells form

A

start in bone marrow, move to thymus (cortex to medulla), mature and selected into naive CD4 or CD8, go out into the periphery

T cells move into paracortical regions of LN and periarteriolar sheaths of spleen.

will mature into helper(CD4) or cytotoxic(CD8) T cells when presented with antien peptide attached to MHC

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4
Q

how do B cells form

A

start in bone marrow, move to follicle in secondary lymphoid organ, mature into plasma cells that make antibodies

  1. Ag-independent phase in primary lymphoid tissues (BM, ileal Peyer’s patches). Following this phase, B cells express IgM and IgD on surface that signifies a mature B cell.
  2. Ag-dependent phase in secondary lymphoid tissues (spleen, LN, tonsils, Peyer’s patches). In this phase, Ag-activated mature B cells differentiate into IgM-secreting plasma cells or switch to another antibody isotype.

B cells live in follicles of lymphnodes, spleen or GALT/MALT and can see soluable Ag

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5
Q

what causes atrophy of the lymphoid system

A

Immunodeficiency disorders

Viruses: Infectious agents: e.g. CDV, EHV-1, Feline panleukopenia virus, FIV, BVDV, Hog Cholera virus

Toxins: e.g. halogenated aromatic hydrocarbons, fumonisins, aflatoxin

Chemotherapeutic agents & Ionizing radiation: e.g. azathioprine, cyclosporine, corticosteroids

Malnutrition: mediated by the hormone leptin

Cachexia

Aging

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6
Q

what are two common neoplasma

A

Thyoma
Lymphoma

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7
Q

Thymoma grows — and is assocaited with — disease

A

slowly, rarely metastazise

Myasthenia gravis (Auto-antibodies to Ach receptors and blocks function)

exfoliative dermatitis- seen most often cats, also reported dog and ra

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8
Q

Myasthenia gravis is caused by autoantibodies to ACh receptor and is exacerbated by exercise, — and may lead to —

A

megaesophagus
aspiration pneumonia

common to have thymoma that causes this

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9
Q

Thymoma are derived from the — component with variable benign lymphocytic infiltration

A

epithelial

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10
Q

Lymphoma in cats is often associated with —

A

FELV +
young cats

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11
Q

what are some things that cause small/absent lymph nodes

A
  1. Developmental disorders (hypoplasia): primary immunodeficiency disease
  2. Lack of antigenic stimulation: SPF(lab) animals
  3. Malnutrition
  4. Age
  5. Viral Infections (CDV, BVD, etc.)
  6. Radiation
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12
Q

regional or generalized enlargement of lymphnode with unknown or unspecified cause

A

Lymphadenopathy

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13
Q

explain why reactive hyperplasia causes large lymph node

A

lymph node doing its job to fight infection

antigen enters lymphnode, interacts with T cell, T cell moves into follicle and triggers selection of B cells which eventually mature into plasma cells that release antibody into the blood

will see alot of cell types = normal function

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14
Q

enlarged lymph node shows

A

lymphoid hyperplasia

many cell types, lymph node doing its job making antibody to antigen

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15
Q

what caused the enlarged lymphnode

A

drainage, could be secondary to surgery

will cause enlarged lymph node, but not dangerous

can see widened subcapsular sinus filled with edema and lots of RBC

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16
Q

what causes lymphandenitis

A

lymph node tissue replaced by inflammatory cells (neutrophils ect)

acute: soft, red, edema
chronic: capsule, firm, painful

can be caused by bacteria, virus, fungu, protozoa

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17
Q

enlarged lymph node caused by

A

FIP lymphadenitis

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18
Q

enlarged lymphnode that ruptured is caused by what bacteria?

A

strangles

strep equi ssp equi

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19
Q

what causes casseous lymphadenitis

A

C. pseudotuberculosis

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20
Q

what kind of cancer spreads to lymphnodes

A

carcinomas (epithelial origin)

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21
Q

what kind of cancer, effects Bernese Mtn Dogs, Rotties and golden retrievers

A

histiocytic sarcoma

round cell tumor
interstitial dendritic cell origin

lymphoma, plasma cell, mast cell, histiocytic, TVT

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22
Q

localized Histiocytic Sarcoma are found

A

spleen, lymph node, lung, bone marrow, skin and subcutis especially of extremities

lymphoma, plasma cell, mast cell, histiocytic, TVT

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23
Q

disseminated histiocytic sarcoma is found

A

secondary sites are widespread, but consistently include liver and lung (with splenic primary), and hilar lymph node (with lung primary), other visceral sites and bone marrow

lymphoma, plasma cell, mast cell, histiocytic, TVT

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24
Q

what are some things that cause pigment in a lymph node

A

drainage of areas with hemosiderin (red blood cell breakdown)
melanin
tattoo
parasites

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25
Q

red pulp of the spleen does what

A

filters blood of foreign material, microorganisms and antigens

stores mature erythrocytes

preforms hematopoiesis

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26
Q

what does white pulp of spleen do?

A

T cells surround arterioles (periarteriolar lymphoid sheaths/PALS) will capture antigen and bring them to B cells inside lymphoid follicles

will mature into plasma cells that make antibodies or memory B cells

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27
Q

if you have big spleen that oozes blood when cut what three things:

A

Congestion
* Torsion: occurs in pigs and dogs (+/- GDV)
* Barbiturate euthanasia, anesthesia (dogs, horses)

Septicemia
→microbes transported to spleen→rapidly phagocytized by macrophages (e.g. Bacillus
anthracis). leads to hyperemia (increased blood flow)

Acute Hemolytic Anemias:
tries to remove broken RBC from circulation

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28
Q

big bloody spleen caused by

A

Congestion: torsion or barbiturate

septicemia

acute hemolytic anemia

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29
Q

what are some causes of large spleen with firm/meaty texture

A

chronic infection

chronic hemolytic anemia

diffuse granulomatous diease (mycobacterius, TB, Brucella)

Follicular lymphoid hyperplasia

Cancers: lympoma, mast cell, myeloma

storage diseases

extramedullary hematopoiesis: trigger signals to make new cells

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30
Q

enlarged spleen, meaty

A

lymphoma- cause pink color

type of round cell tumor: lymphoma, plasma, TVT, histiocytic, mast cell

other cancers: Lymphoma, mast cell tumor/mastocytosis, multiple myeloma, lymphoproliferative diseases

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31
Q

cat large spleen caused by

A

mast cell tumor

type of round cell tumor: lymphoma, mast, plasma, TVT, histiocytic

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32
Q

spleen of feret

A

Extramedullary hematopoiesis (EMH): hormonal or physiologic mechanisms signal synthesis of progenitor cells for systemic circulation; however, splenic EMH often incidental.

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33
Q

4 causes of nodular spleen with bloody consistency

A
  1. Hematomas (induced by nodular hyperplasia or trauma)
  2. Hemangiosarcoma
  3. Incomplete/irregular contraction of smooth muscle trabeculae that cause areas that look like pooled blood
  4. Acute splenic infarcts
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34
Q

what can cause this, bloody inside

A
  1. Hematomas (induced by nodular hyperplasia or trauma)
  2. Hemangiosarcoma
  3. Incomplete/irregular contraction
  4. Acute splenic infarcts
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35
Q
A
  1. Hematomas (induced by nodular hyperplasia or trauma)
  2. Hemangiosarcoma
  3. Incomplete/irregular contraction
  4. Acute splenic infarcts
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36
Q

spleen

A
  1. Hematomas (induced by nodular hyperplasia or trauma)
  2. Hemangiosarcoma
  3. Incomplete/irregular contraction
  4. Acute splenic infarcts
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37
Q

nodular spleen with firm consistency can be what 4 things

A
  1. Nodular hyperplasia
    Simple – lymphoid follicles Complex (previous known as fibrohistiocytic nodules) – lymphoid follicles + fibrohistiocytic proliferation
  2. Granulomas (Mycobacterium)
  3. Abscesses (Strep, Rhodococcus, Arcanobacterium, Corynebacterium)
  4. Neoplasms
    * Primary: lymphoma (including nodular indolent lymphomas), histiocytic sarcoma, leiomyosarcoma,
    fibrosarcoma, undifferentiated sarcomas.
    * Metastatic: many sarcomas and carcinoma
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38
Q

nodular hyperplasia that causes splenic nodules with firm consistency can be simple — or complex—

A

Simple – lymphoid follicles

Complex (previous known as fibrohistiocytic nodules) – lymphoid follicles + fibrohistiocytic proliferation

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39
Q

primary neoplasma that cause splenic nodules with a firm consistency are

A

lymphoma (including nodular indolent lymphomas)
histiocytic sarcoma
leiomyosarcoma
fibrosarcoma
undifferentiated sarcomas.

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40
Q

metastic neoplasms that cause splenic nodules with a firm consistency are

A

many sarcomas and carcinomas

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41
Q

what can cause abscesses in the spleen that present as splenic nodules with a firm conistency

A

Strep, Rhodococcus, Arcanobacterium, Corynebacterium

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42
Q

spleen nodular but firm

A

1.focal nodular hyperplasia: simple or complex
2.granuloma/abscess
3.neoplasia

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43
Q

nodular spleen with firm consistency

A

1.focal nodular hyperplasia: simple or complex
2.granuloma/abscess
3.neoplasia histiocytic

round cell: TVT, histio, lymphoma, mast, plasma

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44
Q
A

1.focal nodular hyperplasia: simple or complex
2.granuloma/abscess
3.neoplasia

splenic stromal sarcomas

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45
Q

3 causes of small spleens

A
  1. Developmental: immunodeficiency diseases
  2. Atrophy: aging or wasting diseases
  3. Contraction
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46
Q

baby spleen

A

Splenic Choristoma:
Developmental: normal tissue at an abnormal site. “Daughter or progeny spleens”
Acquired: traumatic rupture, “Splenosis”

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47
Q

baby spleens made by trauma or rupture are called —

A

splenosis

choristoma (normal tissue in weird place)

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48
Q
A

Siderofibrotic Plaques:
Grey-tan plaques on capsule with accumulation of iron/hematoiden and calcium

Common incidental finding in aged dogs

49
Q

why no metastatic tumors in the tonsil

A

Tonsils do not have afferent lymphatics and do not filter lymph.

Therefore, only primary or
hematogenous infections occur.

50
Q

Tonsils do not have — lymphatics and do not filter lymph. Therefore, only primary or hematogenous infections occur.

A

afferent

51
Q

small tonsils can be caused by

A

viral infections that cause immunosuppression

rare

52
Q

what kind of neoplasia in a tonsil

A

Squamous cell carcinoma
Lymphoma
Melanoma

only primary tumors- NO afferent lymphatics

53
Q
A

poly of tonsil

benign

54
Q

what kind of cancer if firm, unilateral and lobulated

A

SCC

firm because of desmoplasia

Tonsils can have only primary tumors: Squamous cell carcinoma, lymphoma, malignant melanoma

55
Q

soft, bulging, bilateral cancer of tonsils

A

lymphoma

tonsils can only get primary tumors: Squamous cell carcinoma, lymphoma, malignant melanoma

56
Q

what happens to arabian foal with SCID

A

Severe Combined Immunodeficiency

Autosomal recessive trait expressed as an absence of functional B & T lymphocytes

Defect in DNA-dependent protein kinase, an enzyme required for receptor gene rearrangements involved in maturation of B & T cells

Prone to infection and dies within 5 months

will have small thymus, spleen and lymph nodes

57
Q

animals with — will have short life span and a small thymus, spleen and lymph nodes

A

Severe Combined Immunodeficiency (SCID)

arabian foals, bassett hounds, jack russels, cardigan welsh corgis

58
Q

small cell lymphoma vs large cell lymphoma

A

small: nucleus same size as RBC

large: nucleus 2x the size of RBC

59
Q

how to figure out type of lymphoma

A

Nodular or diffuse
Cell Size (small, intermediate, large)
Mitoses/grade (indolent, low, mid, high) Immunophenotype (B or T)

60
Q

explain immunohistochemisty and how to it used to diagnosis lymphoma

A

if cell has antigen it will turn brown

used to determine phenotype of cells in a sample (B cell, T cell, NK ect)

61
Q

canine LSA is most commonly —

A

diffuse large B cell lymphoma (DLBCL) or peripheral T cell Lymphoma (PTCL)

will have LN enlargment that is soft, tan and bulging

happens in middle aged dogs- no viral causes found yet

62
Q

— is associated with peripheral T cell lymphoma in dogs

A

hypercalcemia (15%)

63
Q

— is a T cell marker

A

CD3

64
Q

— are B cell markers

A

CD79a
Pax-5

65
Q

T zone lymphoma is common in dogs and is a — subtype

A

indolent- slow growing can last for years without treatment

usually starts in mandibular lymph node

66
Q

why type of lymphoma

A

T zone lymphoma

last for years- indolent

67
Q

— is nodular, small cell, indolent, T cell in dogs

A

T zone lymphoma

68
Q

— is diffuse, large cell, high grade, B cell in dogs

A

Diffuse large B cell lymphoma

69
Q

— causes a 60x increase risk of lymphoma in cats

A

FeLV

70
Q

FeLV infects T cells and leads to — syndrome which can lead to — and —

A

Myelodysplastic syndrome

acute myeloid leukemias
T cell LSA/leukemia

71
Q

thymic lymphoma in cats can spread —

A

Thymus, mediastinum, sternal LNs or multicentric

seen in FeLV cats

72
Q

— is the most common lymphoma in cats

A

Type 2 small cell enteropathy-associated T cell lymphoma (EATL)

GI lymphoma

May arise within inflammation (IBD) and thus require PCR for antigen receptor
rearrangement testing for clonality (PARR).

73
Q

what test to diagnose EATCL

A

PARR
PCR for antigen receptor rearrangement

tests the clonality of the T cell receptor or the immunoglobulin receptor (B cell)

a genotyping study

spike= cancer
curve= inflammation

74
Q

what are some GI lymphomas in cats that are full thickness and nodule and can cause obstruction

A

Diffuse Large B cell lymphoma

Large granular lymphocyte lymphoma (most cytotoxic T cell, some NK cells)

75
Q

two forms of lymphoma that infect cows

A

BLV-associated lymphoma (Enzootic bovine leukosis):

Non-BLV lymphoma (sporadic form): most often T cell LSA

76
Q

Non-BLV lymphoma (sporadic form): most often T cell LSA has three forms

A

Calf/juvenile form: fetuses and calves (6mos)

Thymic form: beef cattle 6-24mos

Cutaneous form: young cattle 1-3yrs

Lymphoma in cows

77
Q

BLV associated lymphoma is also called

A

Enzootic bovine leukosis

78
Q

BLV-associated lymphoma causes

A

Polyclonal B lymphocyte lymphocytosis

that can develop into leukemia/lymphoma

infects:Superficial/abdominal LN, retrobulbar, abomasum, heart, uterus, spleen, kidney.

survival: 6-8 years

79
Q

Non-BLV lymphoma is most often — cells

A

T cell

80
Q

BLV invades and integrates into the genome of infected B cells, resulting in a — lymphocytosis in about 30% of cattle. In approximately 1-5% of BLV-infected cattle, a single clone will emerge, leading to the development of B cell —

A

polyclonal B lymphocyte

leukemia/lymphoma.

81
Q

— is the most common lymphoma in horses

A

T cell rich B cell lymphoma

82
Q

thymomas in dogs are associated with what condition

A

Myasthenia gravis

83
Q

common sequela of Myasthenia gravis

A

aspiration pneumoma

assiciated with thymomas in dogs

84
Q

FeLV assiciated lymphoma in cats in seen primarly in what location

A

mediastinal and multicentric

85
Q

spleen from a 14 year old lab. Diagnosis?

no blood ooze

A

Lymphoma, mast cell tumor/mastocytosis, multiple myeloma, lymphoproliferative diseases

chronic disease
follicular lymphoid hyperplasia
neoplasia
storage disease
extramedullary hematopoiesis

86
Q

spleen
diagnosis

A
  1. Hematomas (induced by nodular hyperplasia or trauma)
  2. Hemangiosarcoma
  3. Incomplete/irregular contraction
  4. Acute splenic infarcts
87
Q

which of the following does not cause enlarged lymph nodes

metastatic mammary carcinoma
X-SCID
lymphoma
mycobacterium bovis

A

X-SCID

basset-hound
small/no lymphoi organs

death in months

88
Q

which of the following is not a common cause of aquired immunodeficency

parvo
corticosteroids
malnutrition
DNA-PKs mutation
canine distemper

A

DNA-PKs mutation

89
Q

what are some causes of acquired immunodeficiencies

A
  • Pregnancy
  • Aging
  • Malnutrition
  • Toxins (poly-chlorinated -brominated biphenyls, iodine, lead, cadmium, methylmercury, DDT)
  • Drugs (corticosteroids, chemotherapeutic agents (cyclosporin A, cyclophosphamide…)
  • Viral infections
90
Q

Peripheral blood reticulocytosis accompanies — , i.e., anemias resulting in marrow erythroid hyperplasia.

A

regenerative anemias

91
Q

Anemias secondary to erythroid hypoplasia are —

A

non-regenerative.

92
Q

what type of anemia has reticulocytes present?

A

regenerative

secondary to erythroid hyperplasia

93
Q

What are potential causes for an increase in the M:E?

A

myeloid hyperplasia
erythroid hypoplasia

94
Q

What are potential causes for a decrease in the M:E?

A

decrease in M:E

decrease in M- hypoplasia- anemia, iron deficiency, malnutiriton

increase in E: hyperplasia- regenerative anemia

95
Q

How might you distinguish a decrease in the M:E secondary to erythroid hyperplasia from a decrease secondary to myeloid hypoplasia?

A

erythroid hyperplasia- regenerative anemia- high polychromasia and reticulocyte

myeloid hypoplasia- leukopenia

use CBC

96
Q

Conversely how can you distinguish an increase in the M:E secondary to myeloid hyperplasia from an increase due to erythroid hypoplasia?

A

CBC

myeloid hyperplaia- high white count

erythroid hypoplasia- non-regenerative anemia

97
Q

Estimate the M:E for IMHA. Will it be high, low, normal?

A

low becuase E increases trying to make new RBC secondary to the IMHA

98
Q

What is your interpretation of the bone marrow response with regard to the CBC data for this patient (i.e. hematocrit)?
immune-mediated hemolytic anemia (IMHA).

Hematocrit = 13% (ref interval 37-55%)

Cytologic Findings: Spherocytosis and polychromasia are noted on the peripheral bloodsmear.

A

Erythroid hyperplasia

99
Q

What are some associated clinical signs you may see in your patient with IMHA

A

Signs of anemia such as pallor and weakness. If the patient has thrombocytopenia, you may also see petechiae of the mucosa and skin, and possible melena.

100
Q

What is the most likely diagnosis for this patient?
DOG

A

squamous cell carcinoma

101
Q

dog
What is the most likely diagnosis for this patient?

A

lymphoma

102
Q

cat
Based on the gross and histopathologic lesions, what is the most likely diagnosis?

A

thymic lymphoma

103
Q

cats with thymic lymphoma are — and usually have —

A

young
FeLV

104
Q

dog
Male beagle with a history of difficulty breathing and exercise intolerance.
What is the most likely diagnosis for this dog?

A

thyoma

105
Q

dogs with thyoma usually are —

A

old

106
Q

What are the possible sequelae of thyomas in this dog?

A

Myasthenia gravis, which can lead to megaesophagus and aspiration pneumonia.

107
Q

cat
What are some possible causes of this lesion?

A

Causes of necrotizing lymphadenitis include a variety of bacterial, viral, protozoal and fungal organisms. This case shows numerous intralesional fungal organisms.

108
Q

descrpition and morpholigical diagnosis

A

The nodal architecture is effaced by regions of necrosis and an extensive inflammatory cell infiltrate (neutrophils, epithelioid macrophages, giant cells). Within the lesion are numerous large round organisms.

Severe necrotizing lymphadenitis with intralesional fungal organisms (morphology consistent with Coccidioides immitis).

109
Q

dog spleen
In general, what are some possible causes of this lesion in domestic animals?

A

There are many possible causes for diffuse splenomegaly with a meaty consistency. The most common in older dogs and cats is neoplasia (lymphoma, mast cell tumor, multiple myeloma, lymphoproliferative disease).

diffuse splenomegaly with meaty conisistency: chronic disease, follicular lymphoid hyperplasia, cancer, storage disease, extramedullary hematopoiesis

110
Q

Based on the gross and histopathologic lesions, what is the cause of the splenomegaly in the dog?

large pink spleen

A

lymphoma

111
Q

ferret spleen
Based on the photomicrographs below, what is the cause of the splenomegaly in the ferret?

A

extramedullary hematopoiesis

112
Q

Based on the photomicrographs below, what is the cause of the splenomegaly in the cat?

A

mast cell tumor/mastocytosis

113
Q

Which of the species does not have a definitively confirmed viral cause of lymphoma?

A

dog

114
Q

Which of the following patients likely does NOT have increased M:E on bone marrow evaluation?

5-year-old Jack Russell terrier with severe immune mediate hemolytic anemia and thrombocytopenia

14-year-old domestic short hair cat with chronic renal failure

4-year-old female Rottweiler with pyometra

8-year-old Labrador retriever with hypothyroidism

3-year-old mixed breed dog with multiple subcutaneous abscesses

A

5-year-old Jack Russell terrier with severe immune mediate hemolytic anemia and thrombocytopenia

115
Q

To aid in a diagnosis, what concurrent test would need to be submitted?

bone marrow evaluation?

5-year-old Jack Russell terrier with severe immune mediate hemolytic anemia and thrombocytopenia

A

CBC

116
Q

A 4-month-old Arabian foal is euthanized. The necropsy reveals severe diffuse pneumonia and markedly hypoplastic thymus, spleen and lymph nodes. What is the most likely diagnosis?
Correct answer:

SCID, autosomal recessive

Chediak-Higashi Syndrome

SCID, X-linked (X-SCID)

Leukocyte Adhesion Deficiency

A

SCID, autosomal recessive

117
Q

Which of the following is/are NOT counted as myeloid in the M:E ratio determination (mark all that apply)?
Correct answer:

megakaryocyte

metarubricyte

myelocyte

band cell

basophil

A

megakaryocyte

metarubricyte

118
Q

All of the following are appropriate indications for performing a bone marrow aspirate EXCEPT?
Correct answer:

Patient with regenerative anemia and leukocytosis with normal platelet count

Patient with lymphoma

Patient with atypical immature cells in circulation

Patient with persistent nonregenerative anemia

Patient with Fever of unknown origin

A

Patient with regenerative anemia and leukocytosis with normal platelet count

22 fall: path (46 decks)

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