Flashcards in Lymph Nodes Deck (343)
Nodal marginal-zone lymphoma vs. lymphoplasmacytic lymphoma (4).
- Usually arises in the bone marrow.
- Increased IgM with hyperviscosity.
- Preservation of nodal architecture.
- Mutations in MYD88.
Lymphoplasmacytic lymphoma: Typical presentation.
Weakness and fatigue due to anemia.
Lymphoplasmacytic lymphoma: Neoplastic cellular components.
Lymphoplasmacytic lymphoma: Non-neoplastic cells that may be seen (3).
PAS-positive (immunoglobulin-laden) macrophages in open sinuses.
Lymphoplasmacytic lymphoma: Mutation.
L265P in MYD88.
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.
Diffuse large B-cell lymphoma: Frequency of disease in advanced stage at presentation.
Diffuse large B-cell lymphoma:
A. Frequency of extranodal disease at presentation.
B. Leading extranodal site.
A. About 40%.
B. The gastrointestinal tract.
Diffuse large B-cell lymphoma: Association with immunosuppression (3).
DLBCL is more common in patients with
- History of transplant.
- Primary immunodeficiency.
Diffuse large B-cell lymphoma: Infectious association.
EBV is present in most cases.
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.
Diffuse large B-cell lymphoma, centroblastic type: Cytology.
Nucleolus: Several, small.
Diffuse large B-cell lymphoma, immunoblastic type: Cytology.
Nucleolus: Single, large, central.
Cytoplasm: Moderate, basophilic.
EBV-positive diffuse large B-cell lymphoma of the elderly: Histology (3).
Variably sized tumor cells.
Many admixed reactive cells.
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.
Diffuse large B-cell lymphoma: Use in immunohistochemistry in classification.
The algorithms of Hans and Choi are not yet standardized for routine use.
Diffuse large B-cell lymphoma: Rate of proliferation by Ki-67.
Diffuse large B-cell lymphoma: Additional immunohistochemistry (2).
Some cases show
- Expression of CD30.
- Aberrant expression of CD5.
EBV-positive diffuse large B-cell lymphoma of the elderly: Immunohistochemistry (1,2).
Negative: CD10, Bcl-6.
EBV-positive diffuse large B-cell lymphoma of the elderly: Additional ancillary test.
ISH for EBV.
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.
Classification of diffuse large B-cell lymphoma:
A. Gene-expression profiling by DNA microarrays.
B. Germinal-center type (better prognosis), activated-B-cell type.
Diffuse large B-cell lymphoma: Type that can mimic classical Hodgkin's lymphoma.
B. Most common location.
A. Lymphoma that shares features with DLBCL and classical Hodgkin's lymphoma.
Diffuse large B-cell lymphoma: Relevance of immunophenotype to treatment.
CD30-positive DLBCL may respond to brentuximab vedotin.
Diffuse large B-cell lymphoma: Another type of "overlap" lymphoma.
One with features of DLBCL and Burkitt's lymphoma.
Lymphoblastic lymphoma: Types.
T-cell type: 90%, lymph nodes or mediastinum.
B-cell type: 10%, lymph nodes and extranodal sites.
Lymphoblastic lymphoma: Rate of progression to leukemia.
Lymphoblastic lymphoma: Prognosis.
Adults: T-LBL has better outcomes.
Children: T-LBL and B-LBL have similar outcomes.