75. neoplastic diseases of lymphoid system (types of lymphomas)

Question 1

75-1. categorization bases of lymphomas

definition of lymphoma

Answer 1

neoplastic proliferation of lymphoid cells form a mass

arises in lymph node or extranodal tissue

Question 2

75-1. categorization bases of lymphomas

types of lymphoma (2)

Answer 2

non hodgkin lymphoma (60%)
hodgkin lymphoma (40%)

Question 3

75-1. categorization bases of lymphomas

types of hodgkin lymphoma (5)

Answer 3

nodular sclerosis HL
lymphocyte rich HL
mixed cellularity HL
lymphocyte depleted HL
nodular lymphocyte predominant HL

Question 4

75-1. categorization bases of lymphomas

classification base of non-hodgkin lymphoma (5)

Answer 4

cell type : T cell & B cell
cell size : small, intermediate, large B cell lymphoma
pattern of cell growth
expression of surface marker
cytogenetic translocation

Question 5

75-2. precursor T and B cell lymphoblastic leukemia

definition of T and B cell acute lymphoblastic leukemia

Answer 5

neoplastic proliferation of immature T & B cell (> 20%) in bone marrow

Question 6

75-2. precursor T and B cell lymphoblastic leukemia

Predominant age, related disorder of T & B ALL

Answer 6

predominant in children, especially with down syndrome

Question 7

75-2. precursor T and B cell lymphoblastic leukemia

surface marker of B-ALL (3)

Answer 7

CD10
CD19
CD20

Question 8

75-2. precursor T and B cell lymphoblastic leukemia

surface marker of T-ALL

Answer 8

from CD2 to CD8

Question 9

75-2. precursor T and B cell lymphoblastic leukemia

clinical presentation of T-ALL

Answer 9

teenager with medistinal mass (mediastinal tumor)

Question 10

75-3. chronic lymphocytic leukemia, hairy cell leukemia

definition of chronic lymphocytic leukemia (CLL)

Answer 10

neoplastic proliferation of naive B cell

Question 11

75-3. chronic lymphocytic leukemia, hairy cell leukemia

surface marker of CLL (2)

Answer 11

CD5

CD20

Question 12

75-3. chronic lymphocytic leukemia, hairy cell leukemia

Cellular morphology of CLL (2)

Answer 12

increased lymphocyte
smudge cell (ruptured CLL cell)

Question 13

75-3. chronic lymphocytic leukemia, hairy cell leukemia

complication of CLL (4)

Answer 13

lymphadenopathy
hypogammaglobulinemia
autoimmune hemolytic anemia
transformation to diffuse large B cell lymphoma

Question 14

75-3. chronic lymphocytic leukemia, hairy cell leukemia

definition of hair cell leukemia

Answer 14

neoplastic proliferation of mature B cell

Question 15

75-3. chronic lymphocytic leukemia, hairy cell leukemia

diagnosis of hairy cell leukemia

Answer 15

cells are positive to tartrate resistant acid phosphate (TRAP)

Question 16

75-3. chronic lymphocytic leukemia, hairy cell leukemia

clinical features of hairy cell leukemia (2)

Answer 16

splenomegaly

dry tap on bone marrow aspiration (due to marrow fibrosis)

Question 17

75-4. multiple myeloma and related plasma cell disorders

definition of multiple myeloma

Answer 17

malignant proliferation of plasma cells in the bone marrow

Question 18

75-4. multiple myeloma and related plasma cell disorders

characteristics of multiple myeloma (2)

Answer 18

most common primary malignancy of bone

most common malignant lesion of bone

Question 19

75-4. multiple myeloma and related plasma cell disorders

clinical features of multiple myeloma (6)

Answer 19

bone pain with hypercalcemia : plasma cell activate RANK, activate osteoclast
elevated serum protein : M spike on serum protein electrophoresis (SPEP)
increased risk of infection : monoclonal antibody with lack of antigenic diversity
rouleaux formation of RBC : serum protein decreases charge of RBC
primary AL amyloidosis : free light chain deposit in tissue
proteinuria : free light chain is excreted in urine as Bence Jones protein, cuase renal failure

Question 20

75-4. multiple myeloma and related plasma cell disorders

name of multiple myeloma related plasma cell diorders (2)

Answer 20

monoclonal gammopathy of undetermined significance (MGUS)

waldenstrom macroglobulinemia

Question 21

75-4. multiple myeloma and related plasma cell disorders

characteristics of MGUS (4)

Answer 21

shows M spike on SPEP
no other features of multiple myeloma (hypercalcemia, AL amyloidosis, protein uria)
common in elderly
can develop multiple myeloma

Question 22

75-4. multiple myeloma and related plasma cell disorders

characteristics of waldenstrom macroglobulinemia (6)

Answer 22

shows M spike
lymphadenopathy
visual and neurologic defect : due to hyperiscosity of IgM
bleeding
no hypercalcemia
no renal dysfunction

Question 23

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma

category of follicular lymphoma, mantle cell lymphoma, MALT-lymphoma

Answer 23

NHL, especially small B cell lymphoma

Question 24

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma

definition of follicular lymphoma

Answer 24

neoplastic proliferation of small B cells that form follicle like nodule

Question 25

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma characteristics of follicular lymphoma (2)

Answer 25

present in late adulthood | painless lymphadenopathy

Question 26

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma genes related to follicular lymphoma

Answer 26

BCL2 on chromosome 18 translocated to chromosome 14 | - cause inhibition of apoptosis by overexpress Bcl2

Question 27

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma important complication of follicular lymphoma

Answer 27

progression to diffuse large B cell lymphoma

Question 28

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma differentiation of follicular lymphoma with reactive follicular hyperplasia (4)

Answer 28

disruption of normal lymph node architecture lack of tingle body macrophage in germinal center Bcl2 expression in follicle monoclonality

Question 29

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma definition of mantle cell lymphoma

Answer 29

neoplastic proliferation of small B cell that expand the mantle zone

Question 30

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma characteristic of mantle cell lymphoma (2)

Answer 30

present in late adulthood | painless lymphadenopathy

Question 31

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma gene related to mantle cell lymphoma

Answer 31

cycline D1 gene on chromosome 11 translocated to chromosome 14 -overexpression of cyclin D1 promote G1/S transition

Question 32

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma definition of MALT lymphoma

Answer 32

type of marginal zone lymphoma, mucosa associated lymphoid tissue (MALT)

Question 33

75-5. follicular lymphoma, mantle cell lymphoma, MALT-lymphoma cause of MALT lymphoma (2)

Answer 33

``` autoimmune disorder (sjogren syndrome, hashimoto thyroiditis) chronic infection (H. pylori infection) ```

Question 34

75-6. diffuse large B cell lymphoma, burkitt lymphoma category of diffuse large B cell lymphoma & burkitt lymphoma

Answer 34

NHL, large B cell & intermediate sized B cell lymphoma

Question 35

75-6. diffuse large B cell lymphoma, burkitt lymphoma definition of large B cell lymphoma

Answer 35

neoplastic proliferation of large B cell that grows diffusely in sheets

Question 36

75-6. diffuse large B cell lymphoma, burkitt lymphoma characteristics of large B cell lymphoma (3)

Answer 36

most common form of NHL clinically aggressive sporadic or transition from follicular lymphoma

Question 37

75-6. diffuse large B cell lymphoma, burkitt lymphoma definition of burkitt lymphoma

Answer 37

neoplastic proliferation of intermediate sized B cell associated with EBV

Question 38

75-6. diffuse large B cell lymphoma, burkitt lymphoma genes related to burkitt lymphoma

Answer 38

c-myc located in chromosome 8 translocated to chromosome 14 | -overexpression of c-myc promote cell growth

Question 39

75-6. diffuse large B cell lymphoma, burkitt lymphoma characteristics of burkitt lymphoma

Answer 39

extra nodal mass in child, usually in jaws | high mitotic index and 'starry sky' appearance on microscopy

Question 40

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma category of mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma

Answer 40

T cell lymphoma

Question 41

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma definition of mycosis fungoides

Answer 41

neoplastic proliferation of mature CD4 T cell, infiltrate skin

Question 42

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma skin lesions caused by mycosis fungoides (4)

Answer 42

skin rash plaque nodule pautrier microabscess (aggregate of neoplastic cells in epidermis)

Question 43

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma syndrome related to mycosis fungoides

Answer 43

sezary syndrome : generalized exofoliate erythroderma, tumor cell in peripheral blood

Question 44

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma definition of peripheral T cell lymphoma

Answer 44

heterogenous group of T cell lymphoma

Question 45

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma characteristics of peripheral T cell lymphoma (2)

Answer 45

15% of adult NHL | aggressive, poor response to therapy

Question 46

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma definition of anaplastic large cell lymphoma

Answer 46

group of non-Hodgkin lymphomas in which aberrant T cells proliferate uncontrollably

Question 47

75-7. mycosis fungoides, peripheral T cell lymphoma, anaplastic large cell lymphoma characteristics of anaplastic large cell lymphoma (4)

Answer 47

mostly in lymph node large pleomorphic cells express CD30 T cell markers aggressive good response to chemotherapy

Question 48

75-8. Hodgkin lymphoma definition of hodgkin lymphoma

Answer 48

neoplastic proliferation of Reed-Sternberg cell

Question 49

75-8. Hodgkin lymphoma about Reed Sternberg cell (5)

Answer 49

``` large B cell multiple nuclei prominent nucleoli secrete cytokine : cause fever, chills, weight loss, night sweats positive for CD15 and CD30 ```

Question 50

75-8. Hodgkin lymphoma location of hodgkin lymphoma

Answer 50

single or chain of lymph node

Question 51

75-8. Hodgkin lymphoma types of hodgkin lymphoma (5)

Answer 51

``` nodular sclerosis HL lymphocyte rich HL mixed cellularity HL lymphocyte depleted HL lymphocyte predominance HL ```

Question 52

75-8. Hodgkin lymphoma characteristics of nodular sclerosis HL (3)

Answer 52

most common type of HL enlarged cervical / mediastinal lymph node usually in young adult, female

Question 53

75-8. Hodgkin lymphoma morphology of nodular sclerosis HL (2)

Answer 53

lymph node is divided by sclerosis | presence of lacunar cell

Question 54

75-8. Hodgkin lymphoma characteristics of lymphocyte rich HL (2)

Answer 54

best prognosis onf HL | low number of atypical cells

Question 55

75-8. Hodgkin lymphoma characteristics of mixed cellularity HL (3)

Answer 55

``` most common HL of elderly male predominance abundant eosinophil (Reed Sternberg cell produce IL-5) ```

Question 56

75-8. Hodgkin lymphoma characteristics of lymphocyte depleted HL (3)

Answer 56

low number of lymphocyte most aggressive HL usually seen in elderly and HIV positive individual

Question 57

75-8. Hodgkin lymphoma characteristics of lymphocyte predominant HL (4)

Answer 57

shows lymphohistiocytic variant Reed Sternberg cell (popcorn cell) express B cell marker (CD20) don't express CD15, C30 (RS cell marker) isolated cervical or axillary lymphadenopathy

Question 58

75-8. Hodgkin lymphoma | pathogenesis of HL

Answer 58

EBV infection

Question 59

75-8. Hodgkin lymphoma staging of Hodkin lymphoma

Answer 59

Ann arbor classification (1 to 4)