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S3B5 Pathology > Hodgkin's Lymphoma > Flashcards

Hodgkin's Lymphoma Flashcards

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1
Q

What is the name of the giant lymphocytes seen in Hodgkin’s Lymphoma?

A

Reed-Sternberg (R-S)
together= Hodgkins/Reed-Sternberg (HRS)

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2
Q

What are Hodgkin Lymphomas?

A

neoplasms w/ heterogeneous mixture of non-neoplastic inflammatory cells & accessory cells

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3
Q

What are the common features to all Hodgkin lymphomas?

A
  • arise in single axial node/group
    • spread first to anatomically contiguous lymph nodes
  • unlikely to be extranodal
  • young adults
  • flow cytometry is negative
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4
Q

Is staging more important in Non-Hodgkin Lymphoma or Hodgkin Lymphoma?

A

Hodgkin

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5
Q

What are the genetic features of Reed-Sternberg cells?

A

B-lymphocytes of germinal or post-germinal center type

have genetic signature of B lymphocytes, but do not express most B cell-specific genes (including Ig)

aneuploid

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6
Q

What virus is associated with some Hodgkin Lymphomas? Which ones?

A

EBV

classical Hodgkin lymphoma

NOT nodular lyphocyte-predominant Hodgkin lymphoma

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7
Q

What is a risk factor for developing EBV-associated Classical Hodgkin Lymphoma (CHL)?

A

immunodeficiency

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8
Q

Compare & Contrast Hodgkin Lymphoma & Non-Hodgkin Lymphoma on the following variables:

nodal involvement

type of spread

Waldeyer ring & mesenteric node involvement

extranodal presentation

A
  • Hodgkin
    • single axial group of nodes
    • orderly contiguous spread
    • Waldeyer ring & mesenteric node rarely involved
    • Extranodal presentation rare
  • Non-Hodgkin
    • multiple peripheral nodes
    • non-contiguous spread
    • Waldeyer ring & mesenteric node commonly involved
    • Extranodal presentation common
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9
Q

What aspects of the provided images are indicative of Hodgkin Lymphoma?

A

mediastinal masses

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10
Q

What is Nodular Lymphocyte Predominant Hodgkin Lymphoma?

A

nodular proliferation large neoplastic B cells (LP cells) with spherical meshwork of follicular dendritic cells

inflammatory background of non-neoplastic small lymphocytes & histiocytes

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11
Q

What is the clinical presentation of a patient with NLPHL?

A
  • middle-aged male
  • peripheral lymphadenopathy
    • cervical, axial & inguinal
  • Indolent disease (no B symptoms)
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12
Q

The provided sample from a lymph node is indicative of what condition?

A

NLPHL

nodal architecture is distorted by multiple large nodules (black solid arrows)

compressed interfollicular zones (white)

nodules have “moth eaten” appearance (blue curved arrows)

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13
Q

What laboratory results would you expect to see in a patient with NLPHL?

A

Normal CBC; no leukemic phase

Serum LDH or beta-2-microglobin are rarely elevated

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14
Q

What is the treatment & prognosis of NLPHL?

A
  • Treatment
    • depends on stage (chemo & radiation)
  • Prognosis
    • fairly frequent relapses, but responsive to therapy
    • 10 yr survival >80%
    • death may be due to refractory disease or development second malignancy
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15
Q

What type of malignancy is shown in the provided image?

A

NLPHL

lymph node is large & multinodular

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16
Q

How would you differentiate the microscopic appearance of a lymph node from a patient with NLPHL from a patient with usual reactive lymphoid follicles?

A
  • NLPHL
    • expansile nodules are larger
    • composed mainly small lymphocytes & histiocytes
    • no eosinophils or plasma cells
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17
Q

What aspects of the provided slides are indicative of NLPHL?

A

complete or partial effacement of lymph node architecture by infiltrate

LP scattered throughout & only about 1% of all cells

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18
Q

What type of cell is shown in the provided image? It makes up what percent of cells seen in sample form NLPHL?

A

LP “popcorn cell” - only 1%

multilobated nuclei with vesicular chromatin & multiple small nucleoli

multinucleated or mummified cells

round nuclei without multilobation

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19
Q

NLPHL is positive & negative for what immunophenotypes?

A

Positive: CD45, CD20

Negative: CD30, CD15

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20
Q

Is flow cytometry usually positive or negative in NLPHL?

A

negative

large neoplastic cells typically lost/overlooked b/c are so few in number

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21
Q

What is the postulated normal counterpart of the neoplastic cells seen in NLPHL?

A

germinal center B lymphocytes

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22
Q

What is the definition of Classical Hodgkin Lymphoma?

A

tumor comprised of scattered malignant lymphocytes in a mixed inflammatory background (non-neoplastic small lymphocytes, eosinophils, neutrophils, histiocytes, plasma cells, fibroblasts & collagen fibers)

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23
Q

What is the difference in the definition between CHL & NLPHL?

A

CHL: background of non-neoplastic small lymphocytes, eosinophils, neutrophils, histiocytes, plasma cells, fibroblasts & collagen

NLPHL: background inflammation of only small lymphocytes & histiocytes

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24
Q

CHL is what percentages of all Hodgkin lymphomas?

Lymphomas overall?

A

90% all Hodgkin

30% lymphomas overall

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25
CHL most commonly affects what age groups?
Bimodal 15-35 & second peak later in life
26
CHL is more commonly seen in males, except what type?
nodular sclerosis
27
What sites are most commonly involved in CHL?
lymph nodes: **cervical** (75%) mediastinal, axillary, & paraaortic primary extranodal involvement & BM involvement is rare NO leukemic phase
28
Mediastinal involvement is more common in what type of CHL?
nodular sclerosis type
29
Abdominal & splenic involvement is more common in what type of CHL?
mixed cellularity type
30
What are the key features for a cell to be diagnosed as a Reed-Sternberg cell? What about Hodgkin cells?
at least 2 nucleoli in two separate nuclear lobes if mononuclear → Hodgkin cell together are called HRS
31
What cell type is shown in the provided images?
Reed-Sternberg at least 2 nucleoli in two separate nuclear lobes
32
What are the reddish cells with the condense chromatin seen in CHL?
“mummified” cells
33
What are the four histological subtypes of CHL?
Nodular sclerosis CHL (NSCHL) Lymphocyte rich CHL (LRCHL) Mixed cellularity CHL (MCCHL) Lymphocyte depleted CHL (LDCHL)
34
What are the immunophenotypes seen in all types of CHL?
Positive: CD30, CD15 (most) Negative: CD20, CD45
35
What is the most common CHL seen in the US?
nodular sclerosis CHL
36
Nodular Sclerosis CHL most commonly occurs in what demographics?
15-35 white
37
Nodular sclerosis CHL is seen most commonly in what lymph node?
**mediastinal** (80%) & cervical
38
What is the clinical presentation of a patient with Nodular Sclerosis CHL? Treatment? Prognosis?
bulky lymphadenopathy (50%) B symptoms (40%) Treatment: chemo and/or radiation good prognosis overall
39
Describe the gross morphology of the tumor seen in nodular sclerosis CHL
enlarged, matted lymph node with nodules & fibrous bands around the nodules
40
The provided image is a sample from a patient with what type of CHL?
Nodular sclerosis CHL effacement of lymph node architecture by neoplastic nodules that are surrounded by dense, fibrous bands
41
The provided histological slide is from a sample of what type of CHL tumor? What features helped you to identify this?
**Nodular Sclerosis CHL** * Most cells are variants of HRS called lacunar cells - appear to by lying in clear area or “lake” * folded nuclear membranes, less conspicuous nucleoli & lots of clear cytoplasm * Classic HRS are also seen
42
What is the definition of Mixed cellularity CHL (MCHL)?
CHL with classic RS & Hodgkin cells in highly mixed inflammatory background in a **diffuse or interfollicular pattern without nodules or fibrosis**
43
EBV is present in what percent of Nodular Sclerosis CHL?
20%
44
EBV is present in what percent of Mixed Cellularity CHL?
75%
45
What other virus predisposes patients to developing EBV-associated MCHL?
HIV - predisposes development of EBV-associate MCHL
46
What is the most common CHL in underdeveloped countries?
MCHL
47
MCHL is most commonly seen in what demographics?
38yr M:F = 2:1
48
MCHL is most commonly found in what sites?
lymph nodes, **supraclavicular** MC mediastinal is uncommon
49
Does NSCHL or MCHL have a better prognosis?
MCHL is slightly worse
50
The provided histological slide is a sample from what type of CHL?
MCHL * complete or partial effacement of lymph node architecture * H-RS readily identifiable * background is mixture of small lymphocytes, plasma cells, histiocytes, eosinophils, & neutrophils * mild to moderate interstitial fibrosis may be present, but NO nodular collagen bands & NO thickening of capsule
51
What is the definition of Lymphocytes rich CHL?
predominance of small reactive lymphocytes associated with RS & Hodgkin cells
52
How can you differentiate Lymphocyte Rich CHL from MCHL?
**granulocytes & plasma cells** are *_infrequent_* in Lymphocyte Rich CHL
53
Lymphocyte-Rich CHL is most commonly seen in what demographics?
middle age (43) M:F = 2:1
54
What sites are most commonly involved with Lymphocyte-Rich CHL?
Lymph nodes **-Waldeyer ring** (throat) is common peripheral nodal involvement is typical (**supradiaphragmatic**) mediastinal involvement is uncommon
55
What is the clinical presentation of a patient with Lymphocyte-Rich CHL? Prognosis?
Only 10% have B symptoms typically lack bulky disease good to excellent prognosis
56
What are the two type of growth patterns seen in Lymphocyte-Rich CHL?
* Nodular variant * vague nodularity * mantle zone small lymphocytes with underlying meshwork follicular dendritic cells * Diffuse variant * similar to above but with diffuse replacement of lymph node
57
The provided histological slides are samples taken from what type of CHL tumor?
Lymphocyte-Rich CHL Lymph node replaced by large, vague nodularity HRS scattered among small lymphocytes small number histiocytes ABSENT- plasma cells, eosinophils, neutrophils
58
What is the ancillary test for Lymphocyte-Rich CHL?
* Immunophenotype & genetic tests - **HRS have features like CHL** * strong (+) CD15 & CD30 * Background **follicular dendritic network & T-cell rosettes more like NLPHL** * histiocytes also stain CD15 (+) but are more pale * activated immunoblasts are CD30 (+) but are smaller than neoplastic cells
59
What percent of Lymphocyte-Depleted CHL are EBV positive?
50%
60
Lymphocyte-Depleted CHL is most commonly seen in what demographics?
4th decade or older
61
What is the likely pathogenesis of Lymphocyte-Depleted CHL?
likely represents progression from other types of CHL
62
What is the clinical presentation of a patient with Lymphocyte-Depleted CHL?
B symptoms are frequent lymphadenopathy
63
What are the most common sites of involvement for Lymphocyte-depleted CHL?
* Lymph nodes * retroperitoneal or abdominal * peripheral lymph nodes * abdominal organs * bone marrow
64
The provided histological slides are samples taken from what type of CHL tumor?
Lymphocyte-depleted CHL * Lymph node is diffusely effaced with depletion of small lymphocytes & scant granulocytes and granulocytes

S3B5 Pathology (13 decks)

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