WBC Pathology I Flashcards
Histology morphology of the myeloblast:
Youngest
Scanty cytoplasm
Nucleolus
How is the promyelocyte differentiated from the myeloblast?
Primary granules are present
Immature WBC with specific granules:
Myelocyte
First immature WBC to appear in the peripheral smear; equivalent to a reticulocyte:
Intermediate cell
Most common cause of agranulocytosis:
Drug toxicity
Pathogenesis of leukopenias:
Inadequate or ineffective granulopoiesis
Increased destruction
Splenic sequestration
Kotsmann syndrome is:
Congenital inability to produce neutrophils
Peripheral WBC count is influenced by:
Size of precursor storage pools
Rate of cell release
Proportion of cells in the marginal pool
Rate of cell extravasation
Types of benign WBC proliferation in the bone marrow:
Leukocytosis
Leukemoid Reaction
Causes of neutrophilia:
Bacterial infection
Tissue necrosis
Pyogenic infection
Causes of lymphocytosis:
Chronic infection
Fungal, viral, immunologic reaction
Causes of eosinophilia:
Asthma
Allergy
Parasitic infection
Causes of monocytosis:
Chronic infection
Collagen disease
Basophilia is often indicative of:
Myeloproliferative disorder
PBS changes during a leukemoid reaction:
Toxic granules (Dohle bodies) No blasts, but stab cells present
B-cells are located in what area of the lymph node?
Follicular area
T-cells are located in what area of the lymph node?
Parafollicular area
Acute lymphadenitis in the cervical region indicates infection of:
Submandibular or neck area
Infection in the extremities manifests as acute lymphadenitis in which regions?
Axillary and inguinal regions
Three types of chronic lymphadenitis:
Follicular Hyperplasia
Parafollicular/Paracortical Hyperplasia
Sinus histiocytosis/reticular hyperplasia
In follicular hyperplasia, activated B-cells are located in the ___ while inactivated B cells are located in the ___ area:
germinal center; thin marginal
Two zones of germinal centers:
Centroblast (dark)
Centrocytes (light)
B-memory cells originate in the:
Centrocytes of the germinal center
Causes of follicular hyperplasia:
Rheumatoid arthritis
Toxoplasmosis
Early HIV
Features favoring a non-neoplastic hyperplasia:
Preservation of LN architecture
Variation in follicular shape and size
Mitotic figures and phagocytic macrophages
Characteristic cells in parafollicular hyperplasia:
Immunoblasts
Causes of parafollicular hyperplasia:
Drugs
IM
Vaccines
Hypertrophy of these cells are characteristic of sinus histiocytosis/reticular hyperplasia:
Lymphatic endothelial cells
Increase in macrophages
Structures indicative of follicular hyperplasia, located in the centrocytes:
Tingible bodies (phagocytosed B-cells)
Categories of Neoplastic proliferative states:
Lymphoid Neoplasm
Plasma cell dyscracias
Myeloid neoplasms
Histiocytoses
Originating cells of lymphoid neoplasm:
T-cells, B-cells, NK cells
3 categories of myeloid neoplasms:
Acute myeloid leukemia
Myelodysplastic syndrome
Chronic myeloproliferative disorders
Histiocytoses is a proliferation of these cells:
Macrophages and dendritic cells
Sinus histiocytosis is prominent in which cancers:
LN draining cancers (e.g. breast carcinoma)
Precursor B-cells cancers:
B Lymphoblastic Leukemia/Lymphoma (ALL)
Precursor T-cell cancers:
T lymphoblastic leukemia/lymphoma
Peripheral B-cell cancers:
Small Lymphocytic Leukemia Chronic Lymphocytic Leukemia Hairy cell leukemia Burkitt's Lymphoma Follicular Lymphoma
Peripheral T-cell cancers:
T-cell lymphoma
Anaplastic Large Cell Lymphoma
Mycosis Fungoides/Sezary Syndrome
Seen in all lymphocytic tumors, distinguishes from carcinoma:
CD 45 (Leukocyte Common Antigen)
Monocyte/macrophage antigens:
CD 14
CD 64
Stem cell antigen:
CD 34
Markers are usually ___ in B-cell lymphomas and ___ in T-cell lymphomas:
high; low
Antigens seen in Hodkin’s lymphoma:
CD 15
CD 30
Pan-B marker:
CD 19
Peripheral T-cell marker:
CD 3
Precursor T-cell markers:
CD 1, 2, 5, 7
Germinal center B-cell marker:
CD 10
Characteristics of lymphoid tumors:
Monoclonal population Mostly B cells (90%) Unique clinical presentations Immune abnormalities Mimic normal counterpart behavior Protective Ig breakdown
Symptoms of lymphadenopathy:
Multiple, painless, large, COALESCENT lymph nodes
Lymphoid tumors are grossly ____ instead of ____, as in normal LN:
fleshy, nodular, white;
smooth and tannish
Main identification of precursor B/T cell neoplasms:
+ lymphoblasts
+ TdT
Pre T-cell neoplasms usual manifest clinically as:
mediastinal mass
Cancer typically affecting adolescent males:
Acute lymphoblastic lymphoma
Cancer typically affecting 60 y/o males:
Small lymphocytic lymphoma
Mantle cell lymphoma
Difference in WBC count between SLL and CLL:
Decreased in SLL
Increased in CLL
SLL and CLL may spread from __ to __ and finally to __:
Lymph node; bone marrow; blood
What is SLL Richter syndrome:
Transformation of B-cell to prolymphocytes
Complication of SLL:
Autoimmune hemolytic anemia
Most common chromosomal abnormality in SLL:
Trisomy 12
CD markers present in SLL/CLL:
CD 19
CD 20
CD 23
CD 5
Characteristic histological finding of SLL/CLL:
Smudge cells (disrupted tumor cells)
Cancer affecting male and female middle aged individuals:
Follicular lymphomas
Genetic abnormality in follicular lymphoma:
t(14:18) bcl-2 protooncogene (apoptosis)
Distinguish histologically between follicular lympoma and follicular hyperplasia:
Well-defined germinal centers cannot be observed in follicular lymphoma
Germinal centers of follicular lymphoma are absent ___:
tingible bodies
Immunophenotype of follicular lymphoma:
CD 10
CD 19
CD 20
bcl-2 protein
If c-MYC gene is present, follicular lymphoma progresses to:
DLBL
Cancer with biphasic age profile:
Diffuse Large B-cell Lymphoma
Symptoms of DLBL:
Rapidly enlarging mass SINGLE nodal or extranodal site
DLBL genetic abnormality:
t(14:18) bcl 6
Immunophenotype of DLBL:
CD 19
CD 20
CD 10
Cancer common in children and young adults:
Burkitt’s lymphoma
Histology of Burkitt’s lymphoma:
Round cells interspersed with macrophages
Immunophenotype of Burkitt’s lymphoma:
CD 10 CD 19 CD 20 bcl-6 IgM
Burkitt’s genetic abnormality:
t(8:14) of c-MYC
Pattern characteristic of Burkitt’s:
Starry sky appearance
Characteristic of marginal zone lymphoma:
Arise from chronic inflammatory disorder
Remains localized
May regress if treated very early
Genetic abnormaity in marginal zone lymphoma:
t(11:18) or t(14:18)
Immunophenotype of Mantle cell lymphoma:
CD 19
CD 20
CD 5
CD 23
Genetic abnormality of mantle cell lymphoma:
t(11:14), increased cyclin D1
Histological picture of mantle cell lymphoma:
homogenous small lymphocytes surround compressed germinal center
This distinguishes Sezary syndrome from mycosis fungoides clinically:
Sezary syndrome is more like an exfoliative erythroderma w/o tumor phase
3 clinical stages of mycosis fungoides:
Inflammatory phase
Plaque phase
Tumor phase
Symptoms of NK cell lymphoma:
Destructive sinus masses in nasopharynx, nose, oral cavity
Cancers associated with EBV:
Burkitt’s lymphoma
NK cell lymphoma
Hodgkin’s lymphoma
Biopsy in NK cell lymphoma would show:
(-) malignancy
(+) necrotic tissues
Genetic abnormality in anaplastic large cell lymphoma:
2p23 ALK gene
Hallmark cells in anaplastic large cell lymphoma:
Horseshoe-shaped nuclei and voluminous cytoplasm
CD4 T-cell cancers:
Mycosis fungoides
Adult T-cell lymphoma/leukemia
CD8 T-cell cancers:
Anaplastic large cell lymphoma
Only lymphoma directly associated with virus:
Adult T-cell lymphoma (HTLV-1)
Characteristic of T-cell lymphoma:
Skin lesions
Hypercalcemia
Clover leaf or flower cells
Severe anaplasia
Characteristic of Hodgkin’s Lymphoma
RS cells (only tumoral cells) Polymorphic cells Single axial LN chain affected Spread is contiguous Paravertebral nodes are affected Rarely extranodal
Hodgkin’s Lymphoma is usually found in ___, except for the __ type:
males; nodular
Subtypes of Hodgkins lymphoma:
Nodular sclerosis Mixed cellularity Lymphocyte predominance Lymphocyte depletion Lymphocyte rich
Most common Hodgkins lymphoma subtype:
Nodular sclerosis
Nodular sclerosis Hodgkin’s has which RS variants?
Lacunar cell and collagen band
Mixed cellularity Hodgkins has which RS variants?
Classic and mononuclear RC cells
Hallmark cell of Lymphocyte predominance Hodgkins:
Popcorn cells (lymphohistolic)
In Hodgin’s lymphoma, the more lymphocytes present, the ___ the prognosis:
better
