HEMA 2 LEC - Mature B Cell Lymphomas Part 1 Flashcards Preview

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Flashcards in HEMA 2 LEC - Mature B Cell Lymphomas Part 1 Deck (62):
1

Type of lymphoma
• Derived from various stages of B cell differentiation

MATURE B CELL LYMPHOMAS

2

Type of lymphoma
All produce monoclonal light chain Ig, clonal Ig gene rearrangements, or both

MATURE B CELL LYMPHOMAS

3

Type of lymphoma
Most common subtypes: follicular lymphoma and B cell lymphoma

MATURE B CELL LYMPHOMAS

4

• Accumulation of small lymphoid cells in PB, BM, lymphoid organs

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

5

type of lymphocytic leukemia or lymphoma presents mostly in PB and BM

CLL

6

type of lymphocytic leukemia or lymphoma presents mostly in LN

SLL

7

Morphology
• Soccer-ball : small lymphoid cells with coarse chromatin, absent or subtle nucleoli, scant cytoplasm


CLL

8

Morphology
Prolymphocytes (up to 55% of cells)

CLL

9

Morphology
Lymphoid cells with cleaved nuclei

CLL

10

FAB CLassification of CLL
>90% small mature lymphocytes,

Typical CLL

11

• Smudge cells (disintegrated lymphoid cells) – unique feature
• BM: nodular, diffuse, interstitial infiltrates of small lymphoid cells

CLL

12

• Effacement of normal nodal architecture by a diffuse proliferation of small, round lymphoid cells (Pathognomonic)
• Pseudofollicles/growth or proliferation centers

SLL

13

Used to distinguish CLL/SLL from mantle cell lymphoma: (5)

CD23, LEF1, absence of FMC7, cyclin D1, SOX11

14

What condition

• Monoclonal B-cell lymphocytosis:

15

• Asymptomatic at diagnosis, 1st indication: lymphocytosis

CLL/SLL

16

Two Divisions of CLL:
indolent, median survival: 24 years

Mutated IVGH (Ig heavy chain)

17

Two Divisions of CLL:
aggressive, median survival: 8 years

Unmutated IVGH

18

5% of patients of CLL/SLL patients develop _____ high-grade diffuse large B cell lymphoma with survival of

Richter syndrome

19

> 55% of circulating lymphoid cells have prolymphocyte morphology

prolymphocytic leukemia

20

Pathognomonic cell of B cell PLL:

prolymphocyte of medium size, round nucleus, distinct punched out nucleolus

21

LN involvement more common in what type of PLL (B or T cell)

T cell

22

how to distinguish B CELL PLL from CLL/SLL

To distinguish from CLL/SLL: cell size (2x normal) and prominent central nucleolus (PUNCHED OUT)

23

• BM: interstitial and/or nodular proliferation of prolymphocytes
• Infiltrated white and red splenic pulp

B CELL PLL

24

• BM: small to medium size neoplastic cells with round or irregular nuclei, resembling Sezary cells
• Cytoplasmic blebbing

T CELL PLL

25

high incidence of mutation in TP53 what subclass of PLL

B cell PLL

26

Treatment for PLL

monoclonal Ab against CD52

27

Definition
Small B lymphocytes with abundant cytoplasm and fine/hairy cytoplasmic projections

Hairy Cell Leukemia

28

Cell of origin of HCL

peripheral b cell of post-germinal center stage (memory B cell)

29

Found in BM and red pulp of spleen, RARE LN involvement

HCL

30

Inc in reticulin fibers

HCL

31

Expression of CD11c, CD25, CD103, TRAP

HCL

32

most specific markers; differentiates HCL from splenic marginal zone lymphoma

CD123, Annexin A1

33

In MIDDLE aged

HCL

34

Signs of this disease are splenomegaly and pancytopenia

HCL

35


Definition
• Medium-sized lymphoid cell with irregular nuclear outlines derived from follicular mantle zone

Mantle Cell Lymphoma

36

• Main site of presentation of MCL

LN

37

replacement of normal nodal architecture with a diffuse proliferation of monotonous, medium-sized lymphoid cells with irregular nuclear outlines

MCL

38

irregular nuclear outlines

MCL

39

PB involvement may mimic PLL

MCL

40

this cytogenetic abnormality is a defining feature of mantle cell lymphoma

t(11;14)

41

proto-oncogene involved in the regulation of G1 to S phase progression

Cyclin D1 (BCL1)

42

constitutively expressed through its translocation to the immunoglobulin heavy chain gene, t(11;14)

Cyclin D1 (BCL1)

43

Origin of Follicular lymphoma

Germinal center B cells

44

Morphology
• Numerous closely spaced follicles

Follicular Lymphoma

45

Morphology
Neoplastic proliferation may extend into the perinodal adipose tissue

Follicular Lymphoma

46

• Mantle zone and polarization are not present
• Neoplastic follicles with medium-sized lymphoid cells with angular or indented nuclei

Follicular Lymphoma

47

• Cytologically similar to centrocytes, with a variable admixture of large lymphoid cells

Follicular Lymphoma

48

• Prognostic significance: relative proportion of medium-sized and large lymphoid cells

Follicular Lymphoma

49

grade of FL
rare scattered large lymphocytes

grade 1-2

50

grade of FL
numerous centroblasts

Grade 3

51

Neoplastic cells express BCL-2 protein

Follicular lymphoma

52

responsible for the decreased sensitivity to apoptosis in follicular lymphoma
allows the accumulation of neoplastic lymphocytes

BCL-2 protein

53

The expression of BCL-2 by follicular lymphoma cells is due to the _______, which places the BCL2 gene under a promoter of the immu noglobulin heavy chain gene

t(14;18)(q32;q21)

54

This cytogenetic abnormality is present in 95% of follicular lymphoma

t(14;18)(q32;q21)

55

3 subtypes of Marginal Zone Lymphoma of MALT

1) nodal, 2) extranodal, 3) splenic

56

heterogenous neoplastic proliferation, small and medium lymphocytes, plasma cells, scattered large lymphoid cells

Extranodal Marginal Zone Lymphoma of MALT

57

Associated with autoimmune conditions (e.g., Sjögren syndrome, Hashimoto thyroiditis) or previous infections (Helicobacter pylori gastritis or hepatitis C)

Extranodal Marginal Zone Lymphoma of MALT

58

Characteristic feature: lymphoepithelial lesions

Extranodal Marginal Zone Lymphoma of MALT

59

helpful feature in diagnosing marginal zone lymphoma when there is a significant residual reactive component

CD43 antigen

60

• 30% of cases show a translocation involving apoptosis-inhibitor gene API2 and the MLT gene, the t(11;18)(q21;q21).

Extranodal Marginal Zone Lymphoma of MALT

61

API2 and the MLT gene, the t(11;18)(q21;q21)
What lymphoma

Extranodal Marginal Zone Lymphoma of MALT

62

most common site of Extranodal Marginal Zone Lymphoma of MALT

GIT

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