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Flashcards in Lymph Nodes Deck (343)
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180

Nodal marginal-zone lymphoma vs. lymphoplasmacytic lymphoma (4).

LPL:

- Usually arises in the bone marrow.
- Increased IgM with hyperviscosity.
- Preservation of nodal architecture.
- Mutations in MYD88.

181

Lymphoplasmacytic lymphoma: Typical presentation.

Weakness and fatigue due to anemia.

182

Lymphoplasmacytic lymphoma: Neoplastic cellular components.

Small lymphocytes.

Plasma cells.

Plasmacytoid lymphocytes.

183

Lymphoplasmacytic lymphoma: Non-neoplastic cells that may be seen (3).

PAS-positive (immunoglobulin-laden) macrophages in open sinuses.

Hemosiderin-laden macrophages.

Mast cells.

184

Lymphoplasmacytic lymphoma: Mutation.

L265P in MYD88.

185

Lymphoplasmacytic lymphoma: Relation to increased IgM in the serum (2).

Some lymphoplasmacytic lymphomas secrete IgG or IgA instead of IgM.

Marginal-zone lymphomas and CLL can secrete IgM.

186

Diffuse large B-cell lymphoma: Frequency of disease in advanced stage at presentation.

About 60%.

187

Diffuse large B-cell lymphoma:

A. Frequency of extranodal disease at presentation.
B. Leading extranodal site.

A. About 40%.

B. The gastrointestinal tract.

188

Diffuse large B-cell lymphoma: Association with immunosuppression (3).

DLBCL is more common in patients with

- HIV.
- History of transplant.
- Primary immunodeficiency.

189

Diffuse large B-cell lymphoma: Infectious association.

EBV is present in most cases.

190

EBV-positive diffuse large B-cell lymphoma of the elderly.

Occurs in patients over 50 years of age

May be associated with senescence of the immune system.

191

Diffuse large B-cell lymphoma, centroblastic type: Cytology.

Nucleus: Round.

Nucleolus: Several, small.

Cytoplasm: Scant.

192

Diffuse large B-cell lymphoma, immunoblastic type: Cytology.

Nucleus: Round.

Nucleolus: Single, large, central.

Cytoplasm: Moderate, basophilic.

193

EBV-positive diffuse large B-cell lymphoma of the elderly: Histology (3).

Variably sized tumor cells.

Many admixed reactive cells.

Necrosis.

194

Diffuse large B-cell lymphoma: Expression of B-cell markers (5,4).

Positive: CD20, CD79a, Pax-5, Oct-2, Bob.1.

Variable: CD10, Bcl-2, Bcl-6, Mum-1.

195

Diffuse large B-cell lymphoma: Use in immunohistochemistry in classification.

The algorithms of Hans and Choi are not yet standardized for routine use.

196

Diffuse large B-cell lymphoma: Rate of proliferation by Ki-67.

Over 40%

197

Diffuse large B-cell lymphoma: Additional immunohistochemistry (2).

Some cases show

- Expression of CD30.
- Aberrant expression of CD5.

198

EBV-positive diffuse large B-cell lymphoma of the elderly: Immunohistochemistry (1,2).

Positive: Mum-1.

Negative: CD10, Bcl-6.

199

EBV-positive diffuse large B-cell lymphoma of the elderly: Additional ancillary test.

ISH for EBV.

200

Diffuse large B-cell lymphoma: Mutation associated with a poor prognosis.

Translocation involving c-MYC, especially when associated with

- Translocation of IGH with BCL2.
- Break in BCL6.

201

Classification of diffuse large B-cell lymphoma:

A. Basis.
B. Classes.

A. Gene-expression profiling by DNA microarrays.

B. Germinal-center type (better prognosis), activated-B-cell type.

202

Diffuse large B-cell lymphoma: Type that can mimic classical Hodgkin's lymphoma.

Anaplastic DLBCL.

203

"Gray-zone" lymphoma:

A. Definition.
B. Most common location.

A. Lymphoma that shares features with DLBCL and classical Hodgkin's lymphoma.

B. Mediastinum.

204

Diffuse large B-cell lymphoma: Relevance of immunophenotype to treatment.

CD30-positive DLBCL may respond to brentuximab vedotin.

205

Diffuse large B-cell lymphoma: Another type of "overlap" lymphoma.

One with features of DLBCL and Burkitt's lymphoma.

206

Lymphoblastic lymphoma: Types.

T-cell type: 90%, lymph nodes or mediastinum.

B-cell type: 10%, lymph nodes and extranodal sites.

207

Lymphoblastic lymphoma: Rate of progression to leukemia.

About 50%.

208

Lymphoblastic lymphoma: Prognosis.

Adults: T-LBL has better outcomes.

Children: T-LBL and B-LBL have similar outcomes.

209

Lymphoblastic lymphoma: Architecture of nodal infiltrate.

Usually diffuse; rarely paracortical.