Hematopathology III Flashcards Preview

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Flashcards in Hematopathology III Deck (41):
1

What is the main difference in acute and chronic leukemias?

Acute will have blast cells and chronic will have more differentiated cells

2

What is the typical patient of Diffuse Large B-cell Lymphoma?

Older adults - median age is 60

3

How does Diffuse Large B-cell Lymphoma present?

Rapidly enlarging, symptomatic mass at single or extranodal site

4

What are the distinct subtypes of Diffuse Large B-cell Lymphoma?

Germinal Center B-cell (GCB)
Activated B-cell (ABC)

5

What is the difference in outcomes of Diffuse Large B-cell Lymphoma in GCB VS ABC?

GCB has much better survival and prognosis that ABC - different treatments are used for each type

6

Translocation of Diffuse Large B-cell Lymphoma

- t(14;18) in 30% of patients
- BCL6 rearrangement in 30-40%

VERY rare will have MYC translocations alongside one of the other two - "double hit"

7

What biomarkers will Diffuse Large B-cell Lymphoma express?

CD20

8

What is the appearance of the spleen in Diffuse Large B-cell Lymphoma?

"Fish flesh" appearance of a large expansile mass

9

What happens to the lymphocytes in Diffuse Large B-cell Lymphoma?

They become much larger than normal

10

What is the presentation of Peripheral T-Cell Lymphoma?

Lymphadenopathy, eosinophilia, pruritis, fever and weight loss

11

What is the biomarker of Peripheral T-Cell Lymphoma?

CD3+

12

What are the cells like in Peripheral T-Cell Lymphoma?

Polymorphic and heterogeneous often with eosinophilia

13

What are the patients of Hodgkin lymphoma?

Bimodal - in young adults and the in older adults

14

What is the spread of Hodgkin lymphoma?

Spreads in contiguous fashion thorough the lymphoid tissue

15

What is the characteristic cell of Hodgkin lymphoma?

Reed-Sternberg Cells

16

What type of cells does Hodgkin lymphoma arise from?

B cells

17

What is a common mechanism for the activation of classical Hodgkin lymphoma?

NF-kB activation can occur via infection by EBV is a common mechanism for Hodgkin lymphoma

18

What is the appearance of Reed-Sternberg cells?

Owl eyes - binucleated

19

What do the classical Hodgkin lymphoma cells have as biomarkers?

CD15/30

20

What are the biomarkers of nodular lymphocyte predominant Hodgkin lymphoma?

CD20/45

21

What is the most common class of Hodgkin lymphoma?

Nodular sclerosis

22

What are the classes of Hodgkin lymphoma?

- Lymphocyte rich
- Mixed cellularity
- Lymphocyte Depleted
- Nodular Sclerosis
- Nodular Lymphocyte Predominant

23

Lymphocyte rich Histology

Reactive small lymphocytes predominate, few mononuclear or classic Reed-Sternberg cells

24

Mixed cellularity

Reed-Sternberg cells and variants on a mixed cellular background including eosinophils, plasma cells, T- lymphocytes, histiocytes

25

Lymphocyte Depleted

Paucity of lymphocytes and relative abundance of Reed-Sternberg cells

26

Nodular Sclerosis

Fibrous nodular pattern, lacunar cells

27

Nodular Lymphocyte Predominant

Nodularity with predominance of mature lymphocytes and popcorn cell or L & H variant of RS cells

28

What morphology of cells are seen in nodular lymphocyte predominant Hodgkin lymphoma?

"Popcorn-like" cells

29

What is the most common plasma cell neoplasm?

Monoclonal Gammopathy of Undetermined Significance (MGUS)

30

Waldenstrom's Macrogloobulinemia

High levels of IgM M-spike and symptoms due to hyperviscocity of blood from high protein levels in the blood (most commonly associated with lymphoplasmacytic lymphoma)
- Visual distrubances
- Bleeding

31

Multiple Myeloma

The presence of monoclonal plasma cell proliferation involving bone marrow and typically skeleton at multiple sites

32

What is the proliferation of plasma cells in MM dependent upon?

Cytokines - mainly IL-6

33

What are serum and urine indications of MM?

Monoclonal protein in serum
IgG or IgA in the urine

34

What can be found in the bone marrow in MM patients?

Bone marrow showing clonal plasmacytosis or presence of a plasmacytoma

35

What are the symptoms of MM? (CRAB)

hyperCalcemia, Renal insufficiency, Anemia, Bone lesions/Back pain

36

What is seen in the skull in MM?

Punched out regions due to secretions of cytokines that increase osteoclastic activity

37

How does electrophoresis tell you about the MM diagnosis?

It can show a single strong band which is indicative of a monoclonal protein - i.e. the monoclonal antibody of MM

38

What are some of the complications of MM?

• Bone resorption: hypercalcemia, fractures
• Suppression of humoral immunity leading to recurrent infections
• Renal insufficiency - Bence-Jones proteinuria of light chains which are toxic to renal tubular epithelium
• Amyloidosis

39

What is the main patient population of MM?

Elderly - over 70 years old

40

What is the patient population of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

Older patients ~50 years

41

What is done for MGUS?

Nothing as most patients are asymptomatic - only 1% develop symptomatic plasma cell neoplasms within a year - only treat with symptoms

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