Haematopoietic pathology

Question 1

Describe the subtypes of Hodgkin lymphoma

Answer 1

Classic subtypes
- Nodular schlerosis
- Mixed cellularity
- Lymphocyte rich
- Lymphocyte depletion

Nodular lymphocyte predominant

Question 2

Which lymphoid neoplasm is the most common cancer of children?

Answer 2

Acute lymphoblastic leukemia/lymphomas.
B-ALL peak incidence age 3
T-ALL peak incidence adolescence

Question 3

Which mutations commonly a/w DLBCL? (3)

Answer 3

Rearrangements or mutations of BCL6 gene
t(14;18) involving BCL2 (may arise from FL)
5% of translocations involving MYC

Question 4

Follicular lymphoma is associated with which common translocation?

Answer 4

t(14;18) leading to overexpression of BCL2.

Question 5

Mantle cell lymphoma arises from which cell type?
What is the common associated mutation?

Answer 5

arises from naive B cells
A/W translocations involving the cyclin D gene.

Question 6

Hairy Cell leukemia is associated with which mutations?

Answer 6

Mutations in the BRAF serine/threonine kiase.

Question 7

Soft tissue bx from 12 year old shows the following.
What is the diagnosis and why and what ICH would you use to confirm dx?

Answer 7

Anaplastic large-cell lymphoma (ALK pos). T cell lymphoma. Large anaplastic cells, some containing horsehoe-shaped nuclei and voluminous cytoplasm (so-called hallmark cells). Tumor cells cluster around venules and infiltrate lymphoid sinuses, mimicking the appearance of metastatic carcinoma.
ALK strong and diffuse nuclear and cytoplasmic staining. CD30 + too.
NB: Hodgkin’s lymphoma is also CD30+

Question 8

small B cell panel

types/IHC/molecular

Answer 8

Question 9

Mantle cell lymphoma

Genetic pathogenesis?

Sites?

Micro?

IHC?

Cytogenetics/FISH?

Answer 9

t(11;14) results in CCND1 at 11q13 being juxtaposed with IGH at 14q32
Facilitates cell cycle progression from G1 to S phase

Sites:
Lymphadenopathy in ~ 90%
Extranodal sites of involvement are common
Gastrointestinal tract, bone marrow, spleen
Waldeyer ring, peripheral blood

Most patients have clinical stage III/IV disease

Micro: Architectural effacement by lymphoma with nodular, diffuse, or mantle-zone pattern
Monotonous population of small/medium-size cells

Immunophenotype
CD5(+), CD19(+), CD20(+), FMC-7(+), CD10(-), CD23(-/+)
Cyclin-D1 (+), SOX11(+), Ki-67 variable

Cytogenetics or FISH: t(11;14)(q13;q32) or CCND1::IGH