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Flashcards in Lymph Nodes Deck (343)
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150

SLL/CLL: Progression to DLBCL.

Occurs in 5-10% of patients.

151

SLL/CLL: Expression of cyclin D1 (3).

Dim expression in the proliferation centers occurs rarely.

No t(11;14).

Should not cause a diagnosis of mantle-cell lymphoma.

152

Follicular lymphoma: Involvement of extranodal lymphoid organs.

Occurs in most patients.

153

Follicular lymphoma: Sites of primary extranodal disease (3).

Duodenum.

Breast.

Skin.

Other sites.

154

Follicular lymphoma:

A. Mantle zones.
B. Capsule.

A. Attenuated.

B. May be ruptured, with extranodal extension of the lymphoma.

155

Follicular lymphoma: Grading.

Grade 2 has 6-15 centroblasts per hpf.

Grades 1 and 2 are considered low grade.

Grade 3A: Centrocytes and centroblasts.

Grade 3B: Centroblasts only.

156

Follicular lymphoma: Diagnosis of diffuse area consisting mainly of centroblasts.

An additional diagnosis of DLBCL is made.

157

Follicular lymphoma: Expression of CD20 on flow cytometry.

Bright.

158

Follicular lymphoma: IHC (3).

Positive: CD10, Bcl-2, Bcl-6.

159

Follicular lymphoma: Immunochemical anomalies of high-grade tumors (2).

May lack CD10.

May lack Bcl-2.

May express Mum-1.

160

Follicular lymphoma: Use of immunohistochemistry in grading.

Ki-67 . . .

- Less than 20% of cells proliferate: Low grade.
- More than 20%: High grade.

161

Follicular lymphoma: Additional immunohistochemistry.

CD21 and CD23:

- Reveal effaced germinal centers in follicular lymphoma.
- Not so in DLBCL.

162

Follicular lymphoma: Rearrangements (2).

t(14;18) :: IGH-BCL2 in most cases.

Rearrangement of BCL6 in some cases, esp. of grade 3B.

163

Follicular lymphoma: Genotype of aberrant type.

Cases that lack t(14;18) and expression of Bcl-2 have postgerminal-center genes.

164

Follicular lymphoma vs. reactive follicular hyperplasia: Proliferation rate.

Reactive follicular hyperplasia: Greater than 90%.

165

Mantle-cell lymphoma: Frequency of extranodal disease at presentation.

Present in most patients.

166

Mantle-cell lymphoma:

A. Median survival.
B. Presentation that may correlate with a better prognosis.

A. Three to four years.

B. Absence of nodal disease.

167

Mantle-cell lymphoma: Non-malignant histologic features (2).

Hyalinized small vessels.

Scattered epithelioid histiocytes containing no nuclear débris.

168

Mantle-cell lymphoma: Variants (2).

Blastoid:
- Fine chromatin.
- Twenty to thirty mitotic figures per 10 hpf.

Pleomorphic: Large, pleomorphic cells with large nucleoli.

169

Mantle-cell lymphoma: Effect of proliferation of tumor cells on prognosis (2).

Each of these can worsen the prognosis:

- Mitotic rate greater than 10 per hpf.
- Proliferation rate of greater than 40% by Ki-67.

170

Mantle-cell lymphoma: Newer immunohistochemical marker.

SOX11.

171

Mantle-cell lymphoma: Translocation.

t(11;14) :: CCND1-IGH.

172

Mantle-cell lymphoma: Immunophenotypic aberrations (2).

Rare: Absence of CD5, expression of CD23 or CD10.

Very rare: Absence of cyclin D1 and t(11;14).

173

Mantle-cell lymphoma: How to recognize cases that lack expression of cyclin D1 and t(11;14).

They express SOX11.

174

Nodal marginal-zone lymphoma: Presentation.

Asymptomatic lymphadenopathy but with disease in advanced stage.

175

Nodal marginal-zone lymphoma: Architecture.

Cells surround reactive lymphoid follicles and often infiltrate them (follicular colonization).

176

Nodal marginal-zone lymphoma: Cellular components.

Monocytoid B cells.

Plasma cells.

Immunoblasts.

177

Nodal marginal-zone lymphoma: Immunophenotype (2,1,1).

Bright: CD20, sIg.

Usually positive: Bcl-2.

Variable (50%): CD43.

178

Nodal marginal-zone lymphoma: Cytogenetics (2).

A few cases may show +3, +7, or +18.

Translocations involving BCL10 and MALT1 are not observed.

179

Nodal marginal-zone lymphoma vs. reactive lymph node with hyperplasia of monocytoid B cells (3).

Reactive lymph node:

- No expression of Bcl-2.
- No clonality plasma cells.
- No rearrangement of IGH by PCR.