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IHO Week 4 > Non-Hodgkin Lymphoma > Flashcards

Non-Hodgkin Lymphoma Flashcards

1
Q

What are the two main hematologic malignancies?

A
  1. Leukemia

2. Lymphoma

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2
Q

What is leukemia?

A
  • Malignancy of hematopoetic cells
  • Starts in bone marrow, can spread to blood, nodes
  • Myeloid or lymphoid
  • Acute or chronic
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3
Q

What is lymphoma?

A
  • Malignancy of hematopoietic cells
  • Starts in lymph nodes, can spread to blood, marrow
  • Lymphoid only (stem cell and lymphocyte)
  • Hodgkin or non-Hodgkin
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4
Q

With Non-hodgkin lymphoma, what usually brings people into the doctor?

A

Lymphadenopathy

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5
Q

What should you remember about the causes of lymphadenopathy??

A
  • Most common cause overall: benign reaction to infection

- Most common malignant cause: metastatic carcinoma

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6
Q

What is the most common malignancy in lymph nodes?

A

Metastatic carcinoma (CA)

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7
Q

Anatomy of lymph node:

A
  • Follicles = contain B cells (germinal center + mantle)
  • Inner part/Paracortex = contains T cells
  • Germinal center = lighter circle
  • Mantle zone = darker cells surrounding germinal center
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8
Q

What can be found in follicles?

A

-Tingible body macrophages and dark mantle outside

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9
Q

What are tingible body macrophages?

A
  • Found in follicles
  • Cell are all different
  • A lot of mitotic activity
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10
Q

What is Follicular Hyperplasia?

A
  • Benign condition where the lymph nodes has been stimulated (usually due to infection)
  • See follicles of varying shapes and sizes
  • Normal
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11
Q

What things must you know about Follicular Hyperplasia?

A
  • Large, irregular follicles
  • Mixture of cells in germinal centers
  • Tingible body macrophages
  • B-cell response to some immune stimulus
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12
Q

What does benign follicular hyperplasia look like in a lymph node?

A

-Normally the lymph nodes are soft and reddish but these have follicles/white round things too scattered throughout

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13
Q

What does a lymphoma lymph node look/feel like?

A
  • Fleshy color with little red
  • Very firm, fish-flesh feel - like sushi
  • Not very firm like you see with metastatic hyperplasia
  • Lymphoma is more squishy
  • No normal lymph node tissue left
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14
Q

What do you see in a slide of follicular hyperplasia?

A
  • All different sizes of follicles
  • Space in-between them
  • In constrast to, Lymphomas = cookie-cutter follicles
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15
Q

What things must you know about Interfollicular hyperplasia?

A

HARD TO DIAGNOSE

  • Expanded area between follicles
  • Mixture of cells
  • Partial effacement (little bit of follicle left - lymphoma usually doesn’t have any follicle left) – Benign things partially efface
  • T-cell response to some immune stimulus (usually infection)
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16
Q

What is the difference between follicular hyperplasia and follicular lymphoma?

A

Hyperplasia - benign, round germinal centers, surrounded by dark mantle zone, circles come in many shapes and sizes
Lymphoma - cancerous, no mantle zone, circles tend to be same size and are more ‘packed in’ but have less distinct/dark boarder

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17
Q

What does a benign follicle look like in comparison to a lymphoma nodule?

A

Benign - tangible body macrophages seen - see large gaps of white
Lymphoma - all small cells, tightly packed, follicle = nodule

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18
Q

What things must you know about Non-Hodgkin Lymphoma?

A
  • Malignant proliferation of lymphoid cells (blasts or mature cells) in lymph nodes
  • Skips around (ex: in inguinal area, then bone marrow, then liver)
  • Many subtypes
  • Most are B cell
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19
Q

What are three symptoms of NHL?

A
  1. Painless, firm lymphadenopathy (will not be soft and will not hurt - infected lymph node is painful and soft)
  2. Extranodal manifestations (can show up in the bone marrow - if very severe they could be getting anemic - could show up in CNS, skin, etc.)
  3. “B” symptoms: weight loss (like 20 lb. weight loss over 2 months without dieting), night sweats (you wake up drenched every hour or so where you have to change your clothes), fever (nothing to do with B lymphocytes) – patients with these symptoms tend to do worse than patients without these symptoms
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20
Q

What are the features of low grade (chronic) NHL?

A
  • Older patients
  • Indolent (incurable! - can go unnoticed for years)
  • Small, mature cells
  • Non-destructive
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21
Q

What are the features of high grade NHL?

A
  • Need to treat aggressively
  • Children, sometimes
  • Aggressive (curable?)
  • Big, ugly cells (could be pleomorphic - different shapes, mitoses all over)
  • Destructive (invade everything around them)
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22
Q

How is NHL classified?

A 
Working formulation
--Low-grade
--Intermediate-grade
--High-grade
REAL/WHO
-Divides it:
--B cell disorders
--T cell disorders
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23
Q

What cancers are low grade NHL?

A
  • Small lymphocytic lymphoma
  • Malt lymphoma
  • Follicular lymphoma
  • Mycosis fungoides
24
Q

What cancers are high grade NHL?

A
  • Large cell lymphoma
  • Lymphoblastic lymphoma
  • Burkitt Lymphoma
25
Q

What things MUST you know about small lymphocytic lymphoma?

A
  • Small, mature lymphocytes
  • Same thing as CLL
  • B-cell lesion, but CD5+ (weird!)
  • Long course; death from infection
  • Can be in lymph nodes OR bone marrow
26
Q

What does SLL/CLL look like on a slide?

A

Lymph Node:
-Big group of small, dark lymphocytes, along with areas that are cloudy/pale looking - when you look closer, the cells/areas look pale and tend to show up in clusters (proliferation center)

27
Q

What does SLL/CLL look like in the blood?

A

-Mature lymphocytes that all look very similar, B cell in nature with CD5 positivity - (monomorphic - all look the same)

28
Q

What can happen to cells in SLL/CLL?

A

Richter’s transformation: bigger/gigantic, uglier, blocky cells

29
Q

What must you know about marginal zone lymphoma?

A
  • Actually a bunch of lymphomas
  • Marginal zone pattern
  • MALT lymphoma (MALT = mucosa associated lymphoid tissue - associated with H. pylori which can cause stomach cancer and/or ulcers)
  • Helicobacter pylori
30
Q

What does marginal zone lymphoma look like on a slide?

A
  • Marginal zone pattern

- Benign follicles - lymphoma forming zones that will eventually blend together and disappear as disease progresses

31
Q

What is the difference between marginal zone cells and small lymphocytes?

A

Marginal zone - more cytoplasm so nuclei are pushed apart more - looks paler –> sometimes these cells get into blood
Small lymphocytes - less cytoplasm, look darker

32
Q

What can you see in MALT lymphoma?

A
  • Tumors/growths in GI tract (seen with endoscopy)

- Lymphoepithelial lesions (lymphocytes start invading/chewing into the epithelium - malignant!!)

33
Q

What happens if you treat MALT lymphoma at an early stage with antibiotics?

A

Lymphoma goes away - one of the only neoplasms associated with a bacteria!

34
Q

What things MUST you know about mantle cell lymphoma?(EXAM)

A
  • BORING
  • Mantle zone pattern
  • Small angulated lymphocytes
  • t(11;14)-EXAM!! - bcl-1 and IgH
  • More aggressive
35
Q

What translocation is associated with AML-M3?

A

t(15;17)

36
Q

What is bcl-1?

A

Same thing as cyclin D1.It allows cell to get through the cel cycle. If you put this by an Ig heavy chain gene, you can get an over proliferation!

37
Q

Where is mantle cell lymphoma in a slide? What do mantle zone lymphoma cells tend to look like?

A
  • It’s the mantle surrounding a benign germinal center

- Small, irregular, dark with very little cytoplasm (tend to be angulated

38
Q

What MUST you know about follicular lymphoma?

A
  • Follicular pattern (later diffuse)
  • Small cleaved cell, mixed or large cell (because of the development through the germinal center)
  • Grade 1, 2, 3
  • t(14;18) - IgH and bcl-2
  • Will see small cells with deep cleft in the middle =
39
Q

What will you see in grade 3 follicular lymphoma?

A

Small cells with a deep cleft in the middle

40
Q

What does follicular lymphoma look like: in lymph nodes, on slide, in spleen?

A 
Lymph Node
-Fish-flesh appearance & feeling
-Has round white areas = lymphoma follicles on node
Slide
-Many follicles, about the same size
-Very close together
Spleen
-Can see some reddish/splenic tissue
-Follicular pattern still seen
41
Q

What do you see in the blood of follicular lymphoma (EXAM!!)?

A

“Butt cells” - must investigate if you ever see these!

42
Q

Where does follicular lymphoma aggregate in the bone marrow?

A

Right next to the trabecule, cells are closer together (paratrabecular aggregates)
-Many CD20/B cells

43
Q

What are B symptoms?

A

Weight loss, night sweats, fever

44
Q

What MUST you know about mycosis fungicides/Sezary Syndrome? (EXAM!!)

A

Sezary = leukemia type!

  • Skin lesions
  • Blood involvement
  • Cerebriform lymphocytes (look like little brains)
  • T-cell immunophenotype
45
Q

What is the disease progression for Mycosis fungicides/Sezary syndrome?

A
  • It starts as flat, localized lesions
  • Then can progress to Erythroderma = skin very red, scaly, involves entire body
  • Then, it can raise into a plaque and then a nodule (this is where the mushroom related name comes from) - red, violacius, purple in color
  • Can cause very rarely = lionie faces
46
Q

What two things will you see in a stain of mycosis fungicides?

A
  1. Pautrier microabscess - lymphocytes in weird, irregular shape
  2. Sezary cells - have deep cleft, two hemispheres, outside of cytoplasm is irregular (not smooth), cerebriform appearance of the nucleus
47
Q

What things MUST you know about Diffuse Large-Cell Lymphoma?

A
  • Large B cells - almost always B cell in nature
  • Extranodal involvement (move around quickly!)
  • Grows rapidly - more aggressive this way
  • Bad prognosis!
48
Q

What does Diffuse Large-Cell Lymphoma look like on a slide?

A
  • No follicles, completely effaced, has gone through capsule, diffuse pattern, icky-looking, large cells
  • Cell type doesn’t change prognosis
49
Q

What MUST you know about lymphoblastic lymphoma?

A
  • Two types: B and T
  • Lymphoblasts in diffuse pattern
  • Same as ALL!
  • T-lymphoblastic lymphoma often in teenage male with mediastinal mass (relating to thymus!) - THINK T’S
  • Mass shows up on chest x-ray
  • T-lymphoblastic lymphoma = T-cell ALL
50
Q

What does Lymphoblastic Lymphoma look like on a slide?

A
  • Goes through capsule out into fat (diffuse)
  • Chromatin pattern is open, dark, smudgy
  • In T-cell you see two populations of cells
  • In B-cell you see one population of cells (all cells look pretty similar)
51
Q

What things MUST you know about Burkitt Lymphoma (EXAM!!)?

A
  • Child with fast-growing, extra nodal mass
  • Starry-sky pattern - NEED TO KNOW FOR EXAM
  • t(8;14)
  • Same as Burkitt Leukemia
  • African type (jaw) and non-african type (abdominal mass) - grows so fast you can see the growth day to day
52
Q

What is happening in the starry-sky pattern with Burkitt Lymphoma?

A
  • Cells turning over really fast, making a lot of ‘junk’

- Tingible body macrophages then eat the debris/leftovers

53
Q

What do odd cells look like in Burkitt Leukemia/Lymphoma?

A
  • Always perfectly round, cobalt blue cytoplasm
  • Very discrete, punched out vacuoles in cytoplasm
  • Dark, purple nucleus
54
Q

What things must you know about Adult T-Cell Leukemia/Lymphoma?

A
  • Japan/Caribbean basin
  • HTLV-1 (present in almost all cases)
  • Skin lesions, hypercalcemia (may or may not have bone marrow involvement - may get kidney stones)
  • Very aggressive
55
Q

What do the nuclei look like in T-cell leukemia/lymphoma?

A

-Flower-shape nuclei, deep clefts that go in and reach to the middle of the nucleus

IHO Week 4 (25 decks)

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