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Flashcards in Lymph Nodes Deck (343)
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240

Examples of "double-hit" lymphomas with acquired mutations of MYC (4).

Diffuse large B-cell lymphoma.

Follicular lymphoma.

Lymphoblastic lymphoma.

Plasma-cell myeloma.

241

"Double-hit" lymphoma arising from follicular lymphoma: Possible histologic features (6).

Diffuse growth.

Absence of centrocytes.

Blastoid growth.

Starry-sky pattern.

Very high proliferation.

Focal necrosis.

242

Angioimmunoblastic T-cell lymphoma: Typical patient.

Elderly adult with organomegaly and "B" symptoms.

243

Angioimmunoblastic T-cell lymphoma: Less common signs and symptoms (4).

Rash.

Polyarthralgia.

Pleural effusion, ascites.

244

Angioimmunoblastic T-cell lymphoma: Prognosis.

Poor.

245

Angioimmunoblastic T-cell lymphoma: Architecture (4).

Partial effacement of lymph node.

Paracortical location of tumor cells.

Paracortical vascular proliferation (high-endothelial venules).

Expansion of FDC meshworks (demonstrable by IHC for CD21, CD23).

246

Angioimmunoblastic T-cell lymphoma: Cells (2).

Tumor cells: Atypical, small to medium-sized, moderate amount of clear cytoplasm.

Other cells: Reactive small lymphocytes, immunoblasts, eosinophils, plasma cells, histiocytes.

247

Angioimmunoblastic T-cell lymphoma: Expession of T-cell antigens.

Positive: CD4.

Most of the other expected T-cell antigens are expressed, but loss of one or more is not uncommon.

248

Angioimmunoblastic T-cell lymphoma: Additional markers (4).

Positive: CD10, Bcl-6, CXCL13, PD-1.

This is the immunophenotype of follicular T-helper cells.

249

Angioimmunoblastic T-cell lymphoma: Association with EBV.

EBV is present in scattered immunoblasts in most cases.

250

Angioimmunoblastic T-cell lymphoma: PCR (2).

Monoclonal rearrangement of TCR-gamma.

Ten percent of cases: Concurrent monoclonal rearrangement of IGH.

251

Angioimmunoblastic T-cell lymphoma: Cytogenetics.

+3, +5, +X.

252

Angioimmunoblastic T-cell lymphoma vs. peripheral T-cell lymphoma, NOS (4).

PTCL-NOS:

- Tumor cells in the germinal centers or the mantle zones.
- No enlarged FDC meshworks.
- No large high-endothelial vessels.
- Presentation is usually in an early stage.

253

Anaplastic large-cell lymphoma: Epidemiology (2).

ALK-positive: Second and third decades, mostly males.

ALK-negative: Middle-aged and elderly, no predilection for gender.

254

Anaplastic large-cell lymphoma: Typical presentation.

Lymphadenopathy, extranodal disease, systemic symptoms.

255

Anaplastic large-cell lymphoma: Prognosis.

Better in ALK-positive tumors.

256

Anaplastic large-cell lymphoma: Location of infiltrate.

The sinuses.

257

Anaplastic large-cell lymphoma: Cytology.

Tumor cells are large and have eccentric reniform nuclei.

"Hallmark" cells have doughnut-shaped or wreath-like nuclei.

258

Anaplastic large-cell lymphoma: Histologic variants (3).

Common: Pleomorphic large cells with "hallmark" nuclei.

Lymphohistiocytic: Many admixed histiocytes.

Small-cell: Most small- to medium-sized tumor cells.

259

Anaplastic large-cell lymphoma: Expressed antigens (8).

Always: CD30.

Usually: CD45, EMA, Bcl-6, clusterin; TIA1, granzyme B, perforin.

260

Anaplastic large-cell lymphoma: Usually unexpressed antigens (2).

CD3, Bcl-2.

261

Anaplastic large-cell lymphoma: Expression of T-cell markers.

CD2, CD5, and/or CD4 is usually expressed.

262

Anaplastic large-cell lymphoma: "Null-cell" type.

T-cell lineage is apparent only at the genetic level.

263

Anaplastic large-cell lymphoma: Pattern of staining for ALK.

May be nuclear, cytoplasmic, or membranous, depending on the translocation.

264

Anaplastic large-cell lymphoma: Aberrant expression of antigens.

Some tumors express myeloid antigens.

265

Anaplastic large-cell lymphoma: Association with EBV.

None.

266

Anaplastic large-cell lymphoma: Cytogenetics.

t(2;5)(p23;q35): 80% of tumors.

t(1;2).

inv(2).

267

Anaplastic large-cell lymphoma: Examples of DLBCL that can mimic it (2).

ALK-positive, EMA-positive DLBCL . . .
- Positive: CD138, cIg.
- Negative: CD30, T-cell antigens.

CD30-positive DLBCL that resembles ALCL morphologically:
- Positive: B-cell antigens.
- Negative: T-cell antigens.

268

Anaplastic large-cell lymphoma vs. peripheral T-cell lymphoma, NOS (2).

PTCL, NOS:

- Better retention of T-cell antigens.
- Usually no expression of EMA.

269

Anaplastic large-cell lymphoma: Treatment.

Anti-CD30 (brentuximab vedotin) may help.