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Pathology > WBC, Lymph Nodes, Spleen and Thymus > Flashcards

WBC, Lymph Nodes, Spleen and Thymus Flashcards

1
Q

Decreased number of circulating leukocytes
MC involves neutrophils (NEUTROPENIA)

Deficiency of lymphocytes (LYMPHOPENIA) - less common; commonly seen in advanced HIV and other diseases

A

LEUKOPENIA

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2
Q

Clinically significant neutropenia <500/mm3

A

AGRANULOCYTOSIS

-high susceptibility to infections (Candida and Aspergillus)

-DRUG TOXICITY - MCC

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3
Q

Enlargement of a lymph node as immune response to foreign antigens; histology usually nonspecific; depends on duration of disease and type of offending agent

A

Reactive Lymphadenitis

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4
Q

7/F with OSA secondary to CHRONIC HYPERTROPHIC TONSILS, GR 3; underwent BILATERAL TONSILLECTOMY and ADENOIDECTOMY

Biopsy of the adenoids: increase in the number of germinal centers (secondary follicles) per unit area

DIAGNOSIS

A

Follicular Hyperplasia

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5
Q

27/F developed FEVER and LYMPHADENOPATHY.

Serology: heterophil antibodies (+)
Diagnosis: Infectious Mononucleosis

Lymph node biopsy: expansion of the paracortical zones imparting a mottled appearance

Diagnosis

A

Paracortical Hyperplasia

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6
Q

59/F, known case of breast cancer, underwent SENTINEL LYMPH NODE BIOPSY

Lymph node biopsy: (-) evidence of metastasis; (+) distention of lymphatic sinusoids by histiocytes

A

Sinusoidal Hyperplasia/Sinus Histiocytes

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7
Q

Neoplastic proliferation of white cells wherein the neoplastic white cells populate the peripheral blood and bone marrow which leads to peripheral blood cytopenias.

Clinical manifestations depend on the cell line/s affected

A

Leukemia

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8
Q

Neoplastic proliferation of white cells that presents as DISCRETE TISSUE MASSES

A

Lymphoma

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9
Q

4/F presents w/ PALLOR, RECURRENT URTI and EPISTAXIS

PE: increased liver span and obliterated Traube space

CBC: 35% blast count w/ lymphocytic background

BM: hypercellular marrow w/ diffuse infiltration of blast cells

Flow Cytometry: 89% bone marrow blasts

A

Acute Lymphoblastic Leukemia (ALL) (precursor B-cell ALL)

Myeloid markers: MPO, CD117, CD33 (-)
Lymphoid markers: Tdt (+)
B-cell lineage markers: CD79a, CD19 (+)
T-cell lineage markers: CD3, CD7 (-)

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10
Q

12/M presents w/ MEDIASTINAL MASS

CT: multiple mass in the abdomen and mediastinum

CBC: 40% blast count w/ lymphocytic background

BM: hypercellular marrow w/ diffuse infiltration of blast cells

Flow Cytometry: 78% bone marrow blasts

A

Precursor T-cell ALL

Myeloid markers: MPO, CD117, CD33 (-)
Lymphoid markers: Tdt (+)
B-cell lineage markers: CD79a, CD19 (-)
T-cell lineage markers: CD3, CD7 (+)

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11
Q

40/M presents w/ BLEEDING

CBC: thrombocytopenia, 15% blasts count, w/ 40% nucleated WBCs w/ Auer rods obscuring the supposed perinuclear clearing (Golgi zone) of a promyelocyte

Coags: elevated PT/PTT

FISH: (+) t(15;17) PML-RARA

A

Acute Promyelocyte Leukemia (WHO Class I)

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12
Q

36/M, known case of HODGKIN LYMPHOMA stage IIIB underwent chemotherapy w/ alkylating agents developed recurrent epistaxis

PE: increased liver span and obliterated Traube space

CBC: anemia, thrombocytopenia, leukocytosis (200 000/mm3) w/ 40% blast count

BM: hypercellular marrow w/ diffuse infiltration of blast cells

Flow cytometry: 92% BM blasts

A

Acute Myeloid Leukemia (AML
Therapy Related AML (WHO Class II)

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13
Q

68/M, w/ MULTIPLE LYMPHADENOPATHY

CBC: 300 000/mm3 w/ 95% lymphocytes

PBS: lymphocytosis w/ SMUDGE CELLS

BM: hypercellular marrow w/ nodular lymphoid aggregates

LN Biopsy: diffuse but vaguely nodular infiltration of small lymphocytes w/ PROLIFERATION CENTERS (pseudofollicular pattern)

DIAGNOSIS

A

Chronic Lymphocytic Leukemia (CLL)

IHC: CD3 (-), CD20, CD5, CD23(+)

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14
Q

45/F apparently asymptomatic

CBC: 300 000/mm3 w/ neutrophilia, left shift (myelocytes and metamyelocytes) and 2% blast count

LAP scores: LOW

Diagnosis

A

Chronic Myelogenous Leukemia (CML)

FISH studies: (+) BCR-ABL1 t(9:22)

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15
Q

Hodgkin Lymphoma

A

Lymph node involvement: SINGLE, AXIAL group of nodes (cervical, mediastinal. para-aortic)
Spread: Contiguous
Mesenteric nodes and Waldeyer ring involvement: RARE
Extranodal presentation: RARE

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16
Q

Non-Hodgkin Lyphoma

A

Lymph node involvement: MULTIPLE, PERIPHERAL NODES
Spread: Non-contiguous
Mesenteric nodes and Waldeyer ring involvement: COMMON
Extranodal presentation: COMMON

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17
Q

23/F, Filipino w/ ling standing SOLITARY LEFT LATERAL MASS w/ fever and night sweats
PPD (+)

LN Biopsy: mixed infiltrate of inflammatory cells w/ large cells w/ multiple nuclei, each of which has a nucleolus (Owl eye) nuclei; (-) fibrous nodules

A

Mixed Cellularity HL.

IHC: CD15(+) and CD30 (+)

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18
Q

23/F, Filipino w/ ling standing SOLITARY LEFT LATERAL MASS w/ fever and night sweats
PPD (+)

LN Biopsy: (+) fibrous nodules, (+) scattered cells, (-) necrosis

A

Nodular Sclerosis HL (Grade 1)

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19
Q

23/F, Filipino w/ ling standing SOLITARY LEFT LATERAL MASS w/ fever and night sweats
PPD (+)

LN Biopsy: SCANt lymphocytic infiltrate w/ predominance o large pleomorphic cells; some of which look like RS cells

A

Lymphocyte-depleted HL

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20
Q

Processes that distort the marrow architecture, such as deposits of metastatic cancer or granulomatous disorders, can cause the abnormal release of immature precursors into the peripheral blood. This finding is referred to as

A

Leukoerythroblastosis

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21
Q

MYELOID

A

erythroid (RBCs)
granulocytic - neutrophils, eosinophils, basophils
monocytic
megakaryocytic - platelets

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22
Q

LYMPHOID

A

lymphocytes (B and T cells)
plasma cells (from B cells)
natural killer (NK) cells

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23
Q

MCC in children

A

ALL

24
Q

Early childhood
BM failure

t(12;21), t(9;22)

A

B Cell ALL

25
Q

Adolescents males

thymic masses
lymphadenopathy
splenomegaly

NOTCH-1 (70%)

A

T Cell ALL

26
Q

MCC of agranulocytosis

A

Drug Toxicity

27
Q

Histologic findings in ALL

A

LYMPHOBLASTS - scant basophilic cytoplasm and larger nuclei

Hypercellular marrow with LYMPHOBLASTS

PAS (+)

28
Q

Unique metastatic sites of ALL

A

CNS
testis

29
Q

Neoplastic proliferation of myeloid precursor

> 20% myeloblasts in BM

A

AML

FAB M3 - BEST prognosis
Therapy related - POOR prognosis

30
Q

Peculiar manifestations of AML

A

DIC (APML)
Mucocutaneous deposits (AML w/ monocytic differentiation)
Myeloid sarcoma (soft tissue mass)

31
Q

Acute Promyelocytic Leukemia (APML)

associated with DIC

A

t (15;17)
AUER RODS - needle like azurophilic granules in cytoplasm

FAGGOT CELLS - w/ numerous Auer rods

32
Q

MC leukemia of adults in WESTERN world

AUTOIMMUNE

constitutional symptoms
hepatosplenomegaly, lymphadenopathy

immune abnormalities: infection or AIHA or ITP

A

CLL/SLL

CLL > 5000
SLL <5000

33
Q

Histologic findings of CLL/SLL

A

SHEETS OF SMALL LYMPHOCYTES
PROLIFERATION CENTERS - pathognomonic
SMUDGE CELLS - disrupted cells from smearing

34
Q

Notable sequela of CLL

A

RICHTER SYNDROME - progression to DLCBL

35
Q

BCR-ABL t(9;22)
Philadelphia chromosome

splenomegaly (extramedullary hematopoiesis)

ACCELERATED PHASE - worsening anemia or thrombocytopenia with BASOPHILIA

BLAST CRISIS - resembles acute leukemia

A

CML

36
Q

Morphology of CML

A

HYPERCELLULAR MARROW W/ SEA BLUE HISTIOCYTES

WBC >100 000/mm3

LOW leukocyte alkaline phosphatase (LAP)

blast <10%

THROMBOCYTOSIS

37
Q

3 PHASES OF CML

A

CHRONIC phase

ACCELERATED phase
*10-19%
*increased WBC count (unresponsive to therapy)
*increased splenomegaly

BLAST crisis
*>20%
*CHLOROMA - solid focus of leukemia outside BM

38
Q

Danger signs of CML

A

INCREASED blast count
INCREASED basophil count
DECREASED platelet count

39
Q

Single AXIAL group of nodes

CONTIGUOUS

painless lymphadenopathy

LN –> spleen –> liver –> BM

fever, night sweats, weight loss

A

HODGKIN LYMPHOMA

nodular sclerosis - MC!
mixed cellularity
lymphocyte rich
lymphocyte depletion - least common; worst prognosis; PLHIV
nodular lymphocyte predominance - young adult

40
Q

Fundamental molecular abnormality in HODGKIN LYMPHOMA

A

NF-kB activation

41
Q

The most important prognostic variable in Hodgkin Lymphoma

A

STAGE

42
Q

Treatment for Hodgkin Lymphoma

A

Radiotherapy
Chemotherapy
Anti-CD30 (Brentuxumab)
Immune Checkpoint Inhibitors

43
Q

MULTIPLE PERIPHERAL NODES

NON - CONTIGUOUS

(+) mesenteric nodes and Waldeyer ring involvement
(+) extranodal presentation

A

NON - HODGKIN LYMPHOMA

44
Q

NON HODGKIN LYMPHOMA

PERIPHERAL B CELL LYMPHOMAS

SMALL CELL LYMPHOCYTIC PROLIFERATION

A

Small lymphocytic lymphoma
Mantle cell lymphoma
Follicular lymphoma
Marginal zone lymphoma

45
Q

NON HODGKIN LYMPHOMA

PERIPHERAL B CELL LYMPHOMAS

AGGRESSIVE B CELL LYMPHOMAS

A

Diffuse large B cell lymphoma (DLCBL)
Burkitt lymphoma

46
Q

PERIPHERAL T CELL AND NK CELL LYMPHOMAS

A

Anaplastic large cell lymphoma
Mycosis fungoides/Sezary syndrome

47
Q

MC Non Hodgkin Lymphoma

A

Diffuse large B cell lymphoma (DLCBL)

48
Q

Associated w/ LATENT EBV infection
HIGH MITOTIC INDEX + NUMEROUS APOPTOTIC CELLS

STARRY SKY PATTERN

royal blue cytoplasm + clear cytoplasmic vacuoles

A

BURKITT LYMPHOMA

t(8;14)

ONE OF THE FASTEST GROWING HUMAN TUMOR

49
Q

splenomegaly
pancytopenia and DRY TAP on BM aspiration
monocytopenia

HAIR-LIKE PROJECTIONS

A

HAIRY CELL LEUKEMIA (HCL)

50
Q

MC indolent lymphoma of adults

painless
generalized lymphadenopathy

follicular architecture with uniformly sized follicles with thinned mantle zones

CENTROBLASTS AND CENTROCYTES

A

FOLLICULAR LYMPHOMA

BCL2; t(14;18)

51
Q

Peripheral B cell lymphomas that arise in sites of CHRONIC INFLAMMATION

A

MARGINAL ZONE LYMPHOMA

H.pylori - stomach
Sjogren syndrome - salivary gland
Hashimoto thyroiditis - thyroid gland

52
Q

Most important plasma cell neoplasm

A

Multiple Myeloma

53
Q

65-70 years

Clinical features: CRAB
HyperCalcemia (increased secretion of cytokines [eg, IL-1, TNF-a, RANK-L] by malignant plasma cells osteoclast activity)
Renal involvement
Anemia
Bone lytic lesions (“punched out” on X-ray A ) Ž back pain

A

MULTIPLE MYELOMA

vertebral column

54
Q

Histologic findings in Multiple Myeloma

A

plasmacytosis
plasmablasts
bizarre multinucleated giant cells

FLAME CELLS
MOTT CELLS - with multiple grapelike cytoplasmic inclusions
RUSSELL BODIES - globular CYTOPLASMIC inclusions
DUTCHER BODIES - globular NUCLEAR inclusions

55
Q

Laboratory findings in Multiple Myeloma

A

ROULEAUX FORMATION
Plasma cell leukemia

HYPERCALCEMIA
MONOCLONAL GAMMOPATHY (IgG)
BENCE JONES PROTEINURIA (Ig LIGHT CHAIN)

56
Q

Laboratory findings in Multiple Myeloma

A

ROULEAUX FORMATION
Plasma cell leukemia

HYPERCALCEMIA
MONOCLONAL GAMMOPATHY (IgG)
BENCE JONES PROTEINURIA (Ig LIGHT CHAIN)

57
Q

MCC of death in multiple myeloma

A

INFECTIONS
Renal failure

Pathology (24 decks)

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