Chapter 14 - Lymphoid Tissue Disorders

Question 0

Where in the lymphoid tissues are T cells located?

Answer 0

T cells: paracortex, thymus

Question 1

Where in the lymphoid tissues are B cells located?

Answer 1

B cells: germinal follicles

Question 2

Where in the lymphoid tissues are histiocytes located?

Answer 2

Histiocytes: sinuses, skin (Langerhans cell)

Question 3

What age ranges are affected by benign or malignant nodal enlargement?

Answer 3

Nodal enlargement: 30 usually malignant

Question 4

What is the most common cause of nodal malignancy?

Answer 4

Metastasis MC nodal malignancy

Question 5

What does painful lymphadenopathy imply?

Answer 5

Painful lymphadenopathy: inflammation

Question 6

What are the most common sites of localized painful lymphadenopathy?

Answer 6

Anterior cervical nodes/inguinal nodes MC site localized painful adenopathy

Question 7

Name two causes of generalized painful lymphadenopathy.

Answer 7

Generalized painful adenopathy: SLE, infectious mono

Question 8

What are the causes of painless lymphadenopathy?

Answer 8

Painless lymphadenopathy: metastasis or primary malignant lymphoma

Question 9

What is a possible cause of painless axillary nodes in a woman?

Answer 9

Painless axillary nodes woman: metastatic breast cancer

Question 10

What are the malignant causes of generalized painless lymphadenopathy?

Answer 10

Generalized painless adenopathy: acute/chronic leukemia; follicular B-cell lymphoma

Question 11

What does left supraclavicular node metastasis indicate?

Answer 11

Left supraclavicular node metastasis: stomach/pancreatic carcinoma

Question 12

What does hilar node metastasis indicate?

Answer 12

Hilar node metastasis: lung cancer

Question 13

What is a cause of pre-aortic node metastasis in men?

Answer 13

Pre-aortic node metastasis: testicular cancer

Question 14

What are causes of inguinal node metastasis?

Answer 14

Inguinal node metastasis men/women: penis/vulvar squamous cancer

Question 15

Describe follicular hyperplasia.

Answer 15

Follicular hyperplasia: prominent germinal follicles

Question 16

What is a key finding in dermatopathic lymphadenitis?

Answer 16

Dermatopathic lymphadenitis: melanin pigment in macrophages

Question 17

What are the characteristics of cat scratch disease?

Answer 17

Cat-scratch disease: B. henselae; granulomatous microabscesses

Question 18

What is toxoplasmosis?

Answer 18

Toxoplasmosis: mononucleosis-like syndrome with painful cervical adenopathy

Question 19

Describe the characteristics of tularemia.

Answer 19

Tularemia: zoonosis (rabbits); F. tularensis; ulceroglandular MC type

Question 20

What causes the plague?

Answer 20

Plague: Y. pestis; Yop gene protein products inhibit phagocytosis and kill phagocytes

Question 21

Describe the transmission of the plague.

Answer 21

Transmission: bite of infected fleas that have bitten infected rodents (reservoir of bacterium)

Question 22

Where does the bubonic plague mainly occur?

Answer 22

Bubonic plague mainly in Western U.S.

Question 23

What are the three main presentations of the plague?

Answer 23

Bubonic plaque (MC), septicemic plague, pneumonic plague

Question 24

If a flea transmitting Y. pestis bites a human leg, which nodes will be involved?

Answer 24

Bubonic plague: bite on leg; inguinal node involvement

Question 25

What occurs during inguinal enlargement in the plague?

Answer 25

Inguinal node enlargement: bacteria proliferate, cause edema but few inflammatory cells present; nodes rupture

Question 26

What are the characteristics of the septicemic plague?

Answer 26

Septicemic plague: endotoxemia; massive organ involvement; septicemia

Question 27

What is a good prognostic sign in breast cancer?

Answer 27

Sinus histiocytosis in axillary nodes—good prognostic sign in breast cancer

Question 28

Describe the origin of the majority of non-Hodgkin lymphomas.

Answer 28

NHL: majority B-cell origin

Question 29

What are the extranodal sites in NHL?

Answer 29

Extranodal sites: stomach (MC), CNS, Peyer patches

Question 30

What is the most common malignant lymphoma in adults and children?

Answer 30

NHL: MC malignant lymphoma adults/children

Question 31

Which viruses are risk factors for NHL?

Answer 31

EBV: Burkitt lymphoma, primary CNS lymphoma (HIV) HTLV-1: adult T-cell leukemia/lymphoma HCV: B cell lymphoma

Question 32

H. pylori is a risk factor for which type of lymphoma?

Answer 32

H. pylori: low-grade malignant lymphoma in stomach

Question 33

Which autoimmune diseases are risk factors for NHL?

Answer 33

NHL autoimmune disease: Sjögren syndrome, Hashimoto thyroiditis

Question 34

Describe the pathogenesis of NHL.

Answer 34

NHL: mutation blocks B/T cells at specific stage of development

Question 35

Precursor T-cell lymphoblastic lymphoma/leukemia is common in which age group?

Answer 35

Precursor T-cell lymphoblastic lymphoma/leukemia: common in children

Question 36

Describe the characteristics of mycosis fungoides.

Answer 36

MF: CD4 TH cell neoplasm; skin involvement (Pautrier microabscesses)

Question 37

What is Sézary syndrome?

Answer 37

Sézary syndrome: MF in leukemic phase

Question 38

Which gender is more affected by nodular sclerosing Hodgkin lymphoma?

Answer 38

Nodular sclerosing HL: female dominant

Question 39

Describe the bimodal age distribution of HL.

Answer 39

Bimodal age distribution: 15–34 years old and >50 years old

Question 40

EBV is associated with which type of HL?

Answer 40

EBV: association with mixed cellularity/lymphocyte depletion/lymphocyte rich HL

Question 41

What kind of immunity is affected in HL?

Answer 41

HL: defects in CMI; anergy

Question 42

What is the most common type of HL?

Answer 42

Nodular sclerosing classical HL: MC type of HL

Question 43

What is important in HL pathogenesis?

Answer 43

Activated NF-κB important in HL pathogenesis

Question 44

What is the neoplastic cell of HL?

Answer 44

RS cell neoplastic cell of HL

Question 45

What is required to diagnose HL?

Answer 45

RS cell required to diagnose HL

Question 46

What are the clinical findings in HL?

Answer 46

HL: fever, weight loss, night sweats; pruritus

Question 47

What is important in determining the prognosis in HL?

Answer 47

Prognosis: stage more important than type of HL

Question 48

What are the clinical findings in nodular sclerosis HL?

Answer 48

Nodular sclerosis HL: anterior mediastinal mass + single group of nodes above diaphragm

Question 49

What are the risks of treatment in HL?

Answer 49

Rx HL: ↑risk 2nd malignancies (AML, NHL)

Question 50

What are the characteristics of histiocytes?

Answer 50

Histiocytes: CD1+; Birbeck granules

Question 51

What are the characteristics of Letterer-Siwe disease?

Answer 51

Letterer-Siwe: malignant; skin involvement; lytic bone lesions

Question 52

What is the classic triad of Hand-Schüller-Christian disease?

Answer 52

HSC: lytic skull lesions, CDI, exophthalmos

Question 53

What are the chracteristics of eosinophilic granuloma?

Answer 53

Eosinophilic granuloma: benign histiocytosis; unifocal lytic lesions in bone

Question 54

What are the signs and symptoms of mast cell disorders?

Answer 54

Mast cell disease: pruritus, swelling, hyperpigmentation

Question 55

What are the characteristics of urticaria pigmentosum?

Answer 55

UP: dermatographism; lesions remain hyperpigmented

Question 56

What type of granules do mast cells have?

Answer 56

Mast cells: metachromatic granules

Question 57

What is increased in monoclonal gammopathies?

Answer 57

MG: single M protein + light chain

Question 58

What type of M protein is present in the majority of MGs?

Answer 58

Majority have IgG M protein

Question 59

What are Bence Jones proteins?

Answer 59

BJ protein: light chains in urine

Question 60

What does the serum protein electrophoresis show in MGs?

Answer 60

SPE shows monoclonal spike

Question 61

Testing the serum for free light chains is more sensitive than which type of tests?

Answer 61

Serum free light chains: more sensitive than urine tests

Question 62

Which age groups and races are affected by multiple myeloma?

Answer 62

MM: rare whites

Question 63

List the top three most common types of multiple myeloma in descending order.

Answer 63

MM: IgG > IgA > light chain myeloma

Question 64

What does evidence of end-organ damage include in multiple myeloma?

Answer 64

CRAB: calcium elevation, renal insufficiency, anemia, and bone lesions

Question 65

Describe the evolution of normal plasma cells to MM.

Answer 65

MM: MM: normal plasma cell → MGUS → myeloma

Question 66

What are the pathologic findings and skeletal system findings in MM?

Answer 66

MM: lytic lesions, plasma cells >10%; pathologic fractures, hypercalcemia

Question 67

What is the most common site of bone involvement in MM?

Answer 67

MM: vertebrae MC bone site

Question 68

Describe the renal disease caused by Bence Jones proteins in MM.

Answer 68

BJ renal disease in MM: proteinaceous casts with multinucleated giant cell reaction

Question 69

MM is associated with which type of amyloidosis?

Answer 69

MM: association with primary (AL) amyloidosis

Question 70

What are the hematologic findings in MM?

Answer 70

MM: anemia with rouleaux, ↑bleeding time (platelet aggregation defect)

Question 71

What are the common causes of death in MM?

Answer 71

MM: sepsis/renal failure common causes of death

Question 72

What is the most common MG?

Answer 72

MGUS: MC monoclonal gammopathy

Question 73

What is present in the red and white pulp of the spleen?

Answer 73

Red pulp: fixed macrophages | White pulp: B and T cells

Question 74

What are the functions of the spleen?

Answer 74

Functions: blood filtration (encapsulated bacteria), antigen trapping/processing, platelet reservoir, EMH

Question 75

What are the characteristics of Gaucher disease?

Answer 75

Gaucher disease: ↓glucocerebrosidase, ↑glucocerebroside, macrophages fibrillary appearance

Question 76

What are the characteristics of Niemann-Pick disease?

Answer 76

Niemann-Pick: ↓sphingomyelinase, ↑sphingomyelin, macrophages soap bubble appearance

Question 77

What are the clinical findings in massive splenomegaly?

Answer 77

Massive splenomegaly: infarctions with pain, friction rub, and left-sided pleural effusion

Question 78

What is the gross finding in splenomegaly in cirrhosis with portal hypertension?

Answer 78

Splenomegaly in cirrhosis with portal hypertension: sugar-coated spleen

Question 79

What is hypersplenism?

Answer 79

Hypersplenism: destruction of hematopoietic cells produces cytopenias

Question 80

What is the most common cause of hypersplenism?

Answer 80

PH MCC hypersplenism

Question 81

Splenic dysfunction increases the risk for what?

Answer 81

Splenic dysfunction: ↑risk for S. pneumoniae sepsis; HJ bodies

Question 82

Describe the mechanisms by which encapsulated pathogens cause infection in splenic dysfunction.

Answer 82

Mechanisms: ↓IgM, ↓tuftsin, ↓splenic macrophages