Chapter 13- White Cells, Lymph Nodes, Spleen, and Thymus

Question 1

What are the two essential properties that are required for the maintenance of hematopoiesis?

Answer 1

Pluripotency and the capacity for self-renewal (p. 581)

Question 2

In follicular hyperplasia of a lymph node, which structures become prominent?

Answer 2

Germinal centers (p. 585)

Question 3

Endemic Burkitt lymphoma is caused by what virus?

Answer 3

Epstein-Barr virus (p. 587)

Question 4

The most common form of non-Hodgkin lymphoma is ______

Answer 4

Diffuse large B-Cell lymphoma (p. 596)

Question 5

The two major histomorphologic patterns seen in follicular lymphomas are ____ and _____.

Answer 5

Small cells with irregular or cleaved nuclear contours and scant cytoplasm referred to as centrocytes AND larger cells with open nuclear chromatin, several nucleoli, and modest amount of cytoplasm referred to as centroblasts. (p. 595)

Question 6

What are the five categories of the WHO classification of lymphoid neoplasms?

Answer 6

1) Precursor B-cell neoplasms
2) Precursor T-cell neoplasms
3) Peripheral B-cell neoplasms
4) Peripheral T-cell and natural killer cell neoplasms 5) Hodgkin lymphoma (p. 588)

Question 7

Burkitt lymphoma has a characteristic histologic appearance, which is known as _______.

Answer 7

Starry sky pattern (p. 597)

Question 8

The distinctive tumor large cells found in cases of Hodgkin lymphoma are known as _______.

Answer 8

Reed Sternberg cells (p. 606)

Question 9

Describe the usual histologic appearance of the cells identified above.

Answer 9

Diagnostic Reed Sternberg cells are large cells (> or = to 45 micrometers in diameter), with multiple nuclei or a single nucleus with multiple nuclear lobes, each with a large inclusion-like nucleolus, 5-7 micrometers in diameter. (p. 607)

Question 10

Lacunar variant Reed Sternberg cells are most frequently encountered in what type of Hodgkin lymphoma.

Answer 10

Nodular Sclerosis type (p. 608)

Question 11

Name the four different subtypes of Hodgkin lymphoma.

Answer 11

1) Nodular Sclerosis
2) Mixed cellularity
3) Lymphocyte predominance 4) Lymphocyte depletion
5) Lymphocyte-rich (p. 608)

Question 12

the most common type of Hodgkin lymphoma is _______.

Answer 12

Nodular sclerosis (p. 608)

Question 13

Name the three categories of myeloid neoplasia.

Answer 13

1) Acute myelocytic leukemia, characterized by accumulation of immature myeloid cells in the bone marrow.
2) Myelodysplastic syndromes associated with ineffective hematopoiesis and associated cytopenias.
3) Myeloproliferative disorders usually associated with an increased production of one or more types of blood cells. (p. 611)

Question 14

What are the three major symptoms related to depression of marrow function in ALL?

Answer 14

1) Anemia – fatigue
2) neutropenia – fever
3) thrombocytopenia – spontaneous mucosal and cutaneous bleeding. (p. 592)

Question 15

All forms of Burkitt lymphoma are associated with translocations of the ______.

Answer 15

C-Myc gene on chromosome 8 (p. 597)

Question 16

16. What is the most common cancer of children?

Answer 16

Acute lymphoblastic leukemia (p. 590)

Question 17

What is the most common form of leukemia in adults in the Western world?

Answer 17

Chronic lymphocytic leukemia (p. 593)

Question 18

Define the myelodysplastic syndrome.

Answer 18

A group of clonal stem cell disorders characterized by maturation defects resulting in ineffective hematopoiesis and an increased risk of transformation to AML. (p. 611)

Question 19

19. The most common cytogenetic finding associated with CML is _________.

Answer 19

The Philadelphia chromosome (9;22) (q34;q11) (p. 616)

Question 20

The most common gross finding in the spleen in patients with Hodgkin disease is ___________.

Answer 20

Splenomegaly (p. 624)

Question 21

Name and describe five types of plasma cell dyscrasias (monoclonal gammopathies).

Answer 21

1) Multiple myeloma
2) Waldenstrom macroglobulinemia
3) Primary or immunocyte-associated amyloidosis
4) Monoclonal gammopathy of undetermined significance
5) Heavy-chain disease

Question 22

Multiple myeloma

Answer 22

tumorous masses scattered throughout the skeletal system.

Question 23

Waldenstrom macroglobulinemia

Answer 23

syndrome stemming from hyperviscosity of the blood caused by high levels of IgM.

Question 24

Primary or immunocyte-associated amyloidosis

Answer 24

results from a monoclonal proliferation of plasma cells secreting free light chains that are subsequently processed and deposited as amyloid.

Question 25

4) Monoclonal gammopathy of undetermined significance – instances in which M components are identified in the blood of patients having no symptoms or signs of any of the better
characterized monoclonal gammopathies.

Question 26

4) Monoclonal gammopathy of undetermined significance

Answer 26

instances in which M components are identified in the blood of patients having no symptoms or signs of any of the better
characterized monoclonal gammopathies.

Question 27

Heavy-chain disease

Answer 27

including lymphoplasmacytic lymphoma, and small bowel marginal zone lymphoma occurring in malnourished populations. (p.599)

Question 28

The light chain proteins found in patients with plasma cell dyscrasias are known as _______.

Answer 28

Bence Jones Proteins (p. 598)

Question 29

Multiple myeloma most frequently involves which organ system?

Answer 29

Skeletal system (p. 599)

Question 30

Radiographically, the lesions seen in multiple myeloma are ___________.

Answer 30

1 cm – 4 cm punched-out defects (p. 599)

Question 31

Name the four multifocal, multisystem clinicopathologic entities of Langerhans cell histiocytosis.

Answer 31

1) Acute disseminated Langerhans cell histiocytosis (Letterer-Siwe disease)
2) Unifocal and multifocal Langerhans cell histiocytosis (eosinophilic granuloma)
3) Hand- Schüller -Christian triad – multifocal, unisystem Langerhans cell histiocytosis
4) Pulmonary Langerhans cell histiocytosis – seen in adult smokers (p. 622)

Question 32

Describe the histologic components of eosinophilic granuloma

Answer 32

Langerhans cells are variably admixed with eosinophils, lymphocytes, plasma cells and neutrophils. Eosinophils are usually, but not always, a prominent component of the infiltrate. (p. 622)

Question 33

Describe the component parts of the Hand- Schüller -Christian triad.

Answer 33

Calvarial defects, diabetes insipidus, and exophthalmos (p. 622)

Question 34

Differentiate the component parts of the white and red pulp of the spleen.

Answer 34

The white pulp consists of an artery with an eccentric collar of lymphocytes, the so-called periarteriolar lymphatic sheath. The sheath expands to form lymphoid nodules composed of B lymphocytes which are capable of developing into germinal centers. The red pulp of the spleen is traversed by numerous thin-walled vascular sinusoids, separated by the splenic cords, or cords of Billroth. The endothelial lining of the sinusoid is discontinuous, providing passage of blood cells between the sinusoids and cords. (p. 623)

Question 35

Name the four major functions of the spleen that impact disease states.

Answer 35

1) Phagocytosis of blood cells and particulate matter
2) Antibody production
3) Hematopoiesis
4) Sequestration of form blood elements (p.623)

Question 36

Accessoryspleensor_______arecommonautopsyfindings.

Answer 36

Spleniculi (p. 625)

Question 37

The most common cause of massive congestive splenomegaly is __________.

Answer 37

Cirrhosis of the liver (p. 624)

Question 38

Describe the gross appearance of splenic infarcts.

Answer 38

Infarcts are characteristically pale, wedge-shaped, and subcapsular in location. The overlying capsule is covered with fibrin. (p. 625)

Question 39

Name two of the most common benign neoplasms of the spleen.

Answer 39

Lymphangioma and hemangioma (p. 625)

Question 40

Name the two types of cancer in which there is splenic involvement.

Answer 40

Myeloid and lymphoid tumors (p. 625)

Question 41

At what age does thymic involution start?

Answer 41

Puberty (p. 625)

Question 42

What are Hassall corpuscles?

Answer 42

Epithelial cells in the thymus medulla are densely packed, often spindle-shaped and have scant cytoplasm devoid of interconnecting processes. Whorls of these cells create Hassall corpuscles having keratinized cores. (p. 626)