8/11- Pathology of Leukemia and Lymphoma Flashcards Preview

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Flashcards in 8/11- Pathology of Leukemia and Lymphoma Deck (63):
1

Name 2 things that distinguish acute from chronic leukemias

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2

Name 3 morphological characteristics seen in Hodgkin lymphomas distinguish them from non-Hodgkin lymphoma

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3

How is a lymphoma different from a leukemia

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4

How can you distinguish myeloid blasts form lymphoid blasts?

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5

What is the difference between a leukemoid reaction and leukemia?

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6

What cells/organs/tissue comprise the lymphoid system?

- B cells, T cells, NK cells

- Lymphoid organs: lymph nodes, thymus, spleen, tonsils, adenoids

- Less well organized tissue: MALT (GI Peyer's patches), bone marrow, skin 

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7

What is this? 

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Lymph node

8

Describe the architecture of a lymph node

Cortex: B cell zone, follicles

Paracortex: T cell zone, T cells, histiocytes, high endothelial venules (HEVs)

Medulla 

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9

B cell Development Process (flowchart/picture)

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10

T cell Development Process (flowchart/picture)

- Originate in bone marrow and move to thymus to mature

- Initially 4- and 8-

- Become either 4+ (Th) or 8+ (CTL) 

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11

What are some cell surface markers involved in lymphocyte development?

B cells:

- Very young: CD34 (SC marker)

- CD19 -> CD10 -> CD20 -> sIg

T cells:

- Very young: CD34

- CD2, CD7

- CD5

- CD4, CD8

- At then end, either: (CD3 + CD8) or (CD3 + CD4) 

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12

Overall, list the CDs of B cells and T cells

B-cells: think in the 20s

- CD19, 20, 22, 23 (and Ig)

T-cells: think single digits

- CD2, 3, 5, 7, 4, 8

13

What are characteristics of neoplastic conditions of the hematopoietic-lymphoid system?

- Clonal diseases of hematopoietic cells

- Usually resemble their benign counterparts in morphology and immunophenotype

- Many have recurrent cytogenetic abnormalities (often translocations)

14

What are a few names for hematopoietic tumors?

- Lymphomas

- Leukemias

15

What are a few names for solid tumors?

- Carcinomas

- Sarcomas

16

Key features of Hematopoietic tumors vs. Solid tumors

Hematopoeitic tumors:

- Systemic disease

- Replacement of normal marrow or LN elements

- Circulating tumor cells in the peripheral blood

Solid tumors:

- Localized growth

- Invasion

- Metastasis

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17

What are main differences between leukemias and lymphomas?

Leukemia: marrow based; any Hp lineage

Lymphoma: LN based (or anything non-marrow); lymphoid lineage

18

Key characteristics of leukemias?

- Malignant marrow-based neoplasms

- Can be of any hematopoietic lineage (e.g. lymphoid, granulocytic, megakaryocytic, and erythroid)

- Acute or chronic

- Often involve the peripheral blood 

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19

Key characteristics of lymphomas?

- Malignancies of the immune system, arising in extramedullary sites (outside the BM)

- Arise from lymphocytes (B, T, or rarely NK cells)

- Arise from cells at different stages of maturation/development

- Cell of origin determines morphology and clinical course

- Diverse group clinically and morphologically

20

How to distinguish between a lymphoid leukemia vs. a lymphoma

- Lymphocytes normally reside in the bone marrow, peripheral blood, and lymphoid tissues

- Malignancies of these cells may have the same distribution

- The distinction is generally based on the predominant clinical manifestation (blood and bone marrow = leukemia, lymph node = lymphoma)

21

Example of differentiating lymphoid leukemia and lymphoma: Acute lymphoblastic leukemia vs. Lymphoblastic lymphoma

Acute lymphoblastic leukemia

- Blasts in teh blood and bone marrow

- Express immature markers

Lymphoblastic lymphoma

- Cells infiltrate thymus or lymph nodes

- Express immature markers

- "Blastic morphology"

Both have blasts, they're just in different places! 

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22

How are lymphomas and leukemias classified (by WHO)?

Entities distinguished by:

- Clinical features

- Morphology

- Immunophenotype (markers or CDs the cells express)

- Genotype (cytogenetics, molecular diagnostics)

Based on specific clinicopathologic entities when possible

23

What features are used to classify leukemias as either acute or chronic?

- Cell maturity

- Clinical course

- Age of pt

24

What is seen in acute vs. chronic leukemia in regard to:

- Cell maturity

- Clinical course

- Age of patient

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25

What cells are involved in acute leukemia?

BLASTS! 

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26

What is shown here?

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BLASTS (Acute Leukemia)

- Medium to large

- High N/C ratio

- Fine chromatin

- +/- nucleoli

27

What cells are involved in chronic leukemia?

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28

What is shown here? 

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More mature cells in chronic leukemia (CML)

29

Cells involved in Myeloid vs. Lymphoid cell lines?

Non-lymphoid:

- Granulocytic

- Monocytic

- Eosinophilic

- Basophilic

- Erythroid

- Megakaryocytic

Lymphoid

- B cell

- T cell

- NK cell

30

How to tell if blasts are lymphoid vs. myeloid?

Myeloid

- Larger

- More cytoplasm

- More prominent nucleoli

- +/- Auer rods

Lymphoid

- Smaller

- Scant cytoplasm

- Small to no nucleoli

31

What is this? 

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Lymphoid blasts

- Smaller

- Scant cytoplasm

- Small to no nucleoli

32

What is this? 

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Myeloid blasts

- Larger

- More cytoplasm

- More prominent nucleoli

- +/- Auer rods

33

What is the only 100% myeloid morphologic marker?

Auer rods!!! 

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34

Provide leukemia names based on their status as either myeloid/lymphoid and acute/chronic

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35

What cells are seen in:

- Acute myeloid leukemia (AML)

- Acute lymphoblastic leukemia (ALL)

- Chronic myelogenous leukemia (CML)

- Chronic lymphocytic leukemia (CLL)

- AML: myeloblasts

- ALL: lymphoblsats

- CML: neutrophils and myeloid precursors

- CLL: mature B lymphocytes 

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36

AML Immunophenotype: myeloid markers

(think of the 3s)

- CD13

- CD33

- May express other markers depending on the lineage and differentiation of the blasts

37

AML Immunophenotype: immature markers (blasts)

- CD34 (stem cell marker)

- TdT (terminal deoxynucleotidal transferase)

Can be myeloid or lymphoid; just tells you that cells are immature!

38

What is this? Don't need to know genotype 

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AML with t(8;21)

39

What is this? Key features?

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Acute promyelocytic leukemia (APL) with t(15;17)

- Granules!!

- Auer rods ("faggot cell"; lots of Auer rods)

- Bi-lobed nucleus Tend to present with DIC (coagulopathic)

40

What is this? Key features? 

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AML with inv(16)

- Eos with funny granules!)

41

What is this? Key features? 

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AML with monocytic differentiation

- Lobular, folded nucleus

42

What is this? Key features? 

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AMkL (megakaryoblastic leukemia)

43

AMkL (megakaryoblastic leukemia) is often associated with what?

Reticulin fibrosis

- When megs are up to no good, fibrosis often follows

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44

Chronic myeloid leukemias = myeloproliferative neoplasms (disorders)

THEY'RE THE SAME THING

45

What conditions are included among chronic myeloid leukemias (myeloproliferative neoplasms (disorders))?

- Chronic myelogenous leukemia

- Essential thrombocytopenia

- Polycythemia vera

- Primary myelofibrosis (Chronic idiopathic myelofibrosis)

46

Describe hematopoiesis in myeloproliferative neoplasms?

Effective but abnormal

- Hypocellular marrow

- High PB counts 

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47

Describe hematopoiesis in myelodysplastic syndromes?

Ineffective

- Hypercellular marrow

- Cytopenias in PB 

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48

What is seen here? 

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Multilineage dysplasis

- Funny looking cells of all types

49

Describe myeloproliferative and myelodysplastic disorders in terms of:

- Clonal

- PB counts

- Marrow cellularity

- Dysplastic features

- Potential for AML

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50

What is a main division in the classification of lymphomas?

Non-Hodgkin lymphomas

Hodgkin lymphoma

51

What are characteristics of Non-Hodgkin vs. Hodgkin lymphomas?

Non-Hodgkin:

- More common

- Usually have a monomorphic growth pattern

- Neoplastic cell = predominant cell

Hodgkin Lymphoma:

- Less common

- Pleomorphic growth pattern

- Neoplastic cell is rare

- Predominant cells are reactive 

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52

What cells are involved in Non Hodgkin lymphomas? Classified how? Characteristics?

B, T, and NK-cell lymphomas

- Classified in part based on maturity of the cells: lymphoblasts versus mature B and T cells

- Some have characteristic patterns of cell marker expression (those CD’s again)

- Some have characteristic genetic abnormalities: translocations – similar to the way some leukemias have recurrent genetic abnormalities Many types, corresponding to different classes of lymphocytes

53

Where in the lymphoid tissue are B cell lymphomas likely to arise?

The germinal center is a hazardous place where B cells engage in risky behavior; muck about with their genes (somatic mutations and class switching)

54

Is Follicular lymphoma Hodgkins or NHL?

NHL (It's a peripheral B cell lymphoma)

55

Characteristics of Follicular Lymphoma

- Non-Hodgkins Lymphoma (NHL)

- Peripheral B cell lymphoma

- Morphology and immunophenotype reminsicent of germinal center B cells

--- Nodule follicular architecture

--- Small cleaved lymphocytes

--- Looks like there are too many follicles!

56

What is shown here? 

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57

Describe Hodgkin Lymphoma

- Malignant cell = Reed Sternberg cell (RS cell)

--- Recent studies have shown RS cells are actually post germinal center B-cells

--- They have forgotten a lot of their “B-ness”

- Morphology: few RS cells in a background of lymphocytes, histiocytes, eosinophils, plasma cells, fibrosis

- Prognosis and therapy determined by stage (extent of involvement)

- Unlike NHL, has pattern of spread is orderly and contiguous

58

What is the hallmark of Hodgkin Lymphoma?

Reed-Sternberg Cell

- Very large compared to other surrounding lymphocytes

- Huge nucleoli (like owl eyes) 

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59

What is this? 

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Nodular Sclerosing Hodgkin Lymphoma

60

What are the arrows pointing to? 

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Reed-Sternberg cells

61

What are features of plasma cell neoplasms?

Have features of leukemia:

- Involve the bone marrow

Have some features of lymphoma:

- Usually doesn’t involve the peripheral blood

- Cells like to stick together and can cause more localized lesions (plasmacytomas)

Cause a lot of systemic symptoms and laboratory abnormalities

- Produce a monoclonal immunoglobulin

- Anemia, kidney problems, bone lesions, high calcium Morphology: sheets of plasma cells in the bone marrow

62

What is seen here? 

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WAY too many plasma cells (usually less than 5%)

63

What is this? 

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Plasma cells (again, way too many)