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120514 cases Flashcards

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1
Q

how to differentiate reactive vs neoplastic LAD

A

duration? growth interval (rapid?)?
size? (1 cm is way too big)
location? (axilla, cervical, inguinal-if not these, then probably more concerning)

tender vs nontender? (tender means probably acute and infectious. nontender suggests more neoplastic)

fixed vs. mobile? (fixed is more concerning)

associated PE findings?

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2
Q

how to differentiate reactive vs neoplastic LAD with histology

A

LN architecture is intact or effaced (effaced suggests neoplastic)

dominant cell type? (heterogeneous in reactive LAD-has dark/light zones of germinal center)

atypia?

flow cytometry?

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3
Q

reactive causes of LAD?

A

infectious
autoimmune
drugs (phenytoin)
foreign body

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4
Q

LAD-neoplastic causes of it?

A

lymphoma
leukemic involvement
metastatic tumor

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5
Q

histologic patterns of reactive LAD

A

follicular hyperplasia (autoimmune, early HIV, toxoplasmosis)

paracortical hyperplasia (EBV, CMV, herpes, drugs)

sinus histiocytosis (draining tumors)

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6
Q

which non Hodgkin’s lymphomas are aggressive?

A

Burkitt
diffuse large B cell
mantle cell (moderate)

peripheral T cell, unspecified
anaplastic large cell
extranodal NK/T cell

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7
Q

Hodgkin’s lymphoma’s spread–what is important to note about it?

A

contiguous

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8
Q

tx for follicular lymphoma

A

chemotherapy and antiCD20 monoclonal antibody therapy

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9
Q

starry sky-what is it exactly?

A

sky is sea of tumor cells

starry part is the tingible body macrophages that eat the debris as cells turnover

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10
Q

starry sky is seen in

A

Burkitt lymphoma

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11
Q

t(11;14)

A

cyclin D1 gene (chromosome 11) translocates to Ig heavy chain gene on chromosome 14

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12
Q

t(11;14) is associated with

A

mantle cell lymphoma

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13
Q

CD5 positive

A

mantle cell lymphoma

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14
Q

t(14,18)

A

BCL2 gene translocates to Ig heavy chain gene on chromsome 14

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15
Q

BCL2 overexpression

A

follicular lymphoma

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16
Q

CD30+ and CD15+

A

Hodgkin’s lymphoma

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17
Q

Burkitt lymphoma immunophenotype

A

CD10+
CD19+
CD20+

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18
Q

extranodal marginal zone lymphoma (MALToma) immunophenotype

A

CD5-
CD10-
CD19+
CD20+

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19
Q

follicular lymphoma immunophenotype

A

CD5-
CD10+
CD19+
CD20+

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20
Q

mantle cell lymphoma immunophenotype

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A

CD5+
CD10-
CD19+
CD20+

21
Q

MOA of rituximab

Study These Flashcards
A

for therapy in FL–has improved survival for this disease

CDC
ADCC
apoptosis
ionizing radiation induced cell death

22
Q

course of follicular lymphoma

Study These Flashcards
A

generally indolent

however 40% can turn into aggressive lymphomas (diffus large B cell lymphoma, Burkitt lymphoma)

23
Q

what can cause Burkitt lymphoma?

24
Q

diagnosing B cell non Hodgkin’s lymphoma-what should you consider?

Study These Flashcards
A

architecture-nodular, follicular or diffuse?
tumor cells–are they small, medium, large? are they clefted/cleaved (FOLLICULAR LYMPHOMA), mantle, or marginal zone?

immunophenotype:
establish it’s B cell
small size lymphomas-CD5, CD10, CD23

cytogenetics:
t(14;18)–BCL2
t(11;14)–cyclinD1
t(8;14)–cMyc

25
diffuse architecture for B-NHL suggests
more aggressive: diffuse large B-cell lymphoma Burkitt lymphoma
26
what cytogenetics is assoc with Burkitt lymphoma
t(8;14) - common--c-myc translocation t(2;8) t(8;22)
27
t(11;18)
marginal zone lymphoma
28
chromosome 14 is of significance why?
has Ig heavy chain gene. this gene is heavily transcribed
29
BCL-2 role
prevents cell from apoptosis (so when placed on chromsome 18, results in indolent course of disease, NOT aggressive)
30
MALT sites- MALToma
extranodal marginal zone lymphoma in MALT sites such as gastric, thyroid, lung
31
clinical variants of Burkitt lymphoma
sporatic (ileocecal mass) endemic (EBV, breast, jaw, ovary) immunosuppression related (EBV) transformation from follicular lymphoma
32
EBV associated neoplasms
lymphomas (mostly B): endemic Burkitt lymphoma post transplant lymphoproliferative disorder extranodal NK/T cell lymphoma subsets of Hodgkin lymphoma, diffuse large B cell lymphoma, T cell lymphomas nasopharyngeal carcinoma
33
infectious EBV is transmitted how
in saliva, all the time, even in healthy people
34
EBV symptoms
first decade of life-mild cold like symptoms adolescence and beyond-infectious mononucleosis (massive expansion of CD8 T cells, increase in activated B cells with very few of those EBV infected)
35
EBV reactivation from B cells is triggered by
B cell differentiation into plasma cell poorly controlled reactivation (like if immunecompromised w/o cytotoxic T cells) is a significant risk factor for EBV-driven malignancies
36
mechanisms of EBV-induced oncogenesis
direct transformation hit and run bystander effect chronic inflammation
37
owl eyed nuclei
Reed Sternberg cells in classic Hodgkin lymphoma
38
what type of cells are Reed Sternberg cells
B lineage neoplastic cells, seen among an inflammatory cell milieu
39
Hodgkin lymphoma (compared to NHL)
Hodgkin's: localized to a SINGLE axial group of nodes orderly spread by contiguity mesenteric nodes and Waldeyer ring (pharynx) rarely involved extranodal involvement is uncommon infrequent bone marrow involvement
40
NHL (compared to Hodgkin's lymphoma)
``` more frequent involvement of multiple peripheral nodes noncontiguous spread mesenteric nodes, Waldeyer ring common extranodal involvement common frequent bone marrow involvement ```
41
morphology of Reed Sternberg cell
large size frequent binucleation eosinophlic nucleoli (owl eye)
42
classification of Hodgkin lymphoma
classical HL (nodular sclerosis HL-most common, mixed cellularity HL, etc) nodular lymphocyte predominant HL
43
popcorn cells
L&H cells in a sea of lymphocytes nodular lymphocyte predominant HL
44
nodular sclerosis HL is seen at what site
mediastinal
45
classical HL immunophenotype
CD15, CD30 + | CD20, CD45 -
46
nodular lymphocyte predominant (non-classic) HL's immunophenotype
CD15, CD30 - | CD20, CD45 +
47
dense sclerosis in HL suggests
nodular sclerosis-a type of classic HL
48
classical HL: CD20 positive or neg?
negative

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