Lymph nodes and Lymphomas - Parks

Question 1

Acute nonspecific lymphadenitis can be caused by (bacteria/viruses/both)

Answer 1

both

Question 2

T/F: diffuse hyperplasia of the lymph node can be a non-malignant finding

Answer 2

true, in reactive nodes

Question 3

what are the three types of reactive hyperplasia of a lymph node?

Answer 3

1. follicular hyperplasia
2. paracortical hyperplasia
3. sinus histiocytosis (increased macrophages)

Question 4

If given the choice of a lymph node or a skin rash to biopsy, which should you do and why?

Answer 4

lymph node, will give you more information than the skin rash and will be conclusive the first time

Question 5

Bacteria cause (B/T) cell stimulation while viruses cause (B/T) cell stimulation

Answer 5

BACTERIA = B cell

Virus is T cell

Question 6

Paracortical hyperplasia is caused by expansion of what cell type?

Answer 6

T cells

Question 7

germinal center or cortical hyperplasia is caused by expansion of what cell type?

Answer 7

B cell

Question 8

T/F: in cancer, it is possible to have reactive changes to a lymph node without the presence of a met

Answer 8

true

Question 9

T/F: all lymphoid neoplasms are malignant

Answer 9

true

Question 10

(leukemia/lymphomas) form masses

Answer 10

lymphomas

Question 11

(leukemia/lymphoma) are diseases of the peripheral blood

Answer 11

leukemia

Question 12

(leukemia/lymphoma) involves the bone marrow

Answer 12

leukemia

Question 13

What are the most common sites of extranodal involvement in lymphomas? Where does it go if you have AIDS?

Answer 13

Spleen, liver, and bone marrow

Goes to brain in AIDS

Question 14

(B/T) cell lymphoma is the most common type of NHL

Answer 14

B cell; 80%

Question 15

What are the two most common types of lymphoma?

Answer 15

DLBCL and follicular lymphoma

Question 16

Where in the body do the B cell maturation steps happen?

Answer 16

In the lymph node; naive B cells leave the bone marrow and mature in the node

Question 17

What is light chain restriction?

Answer 17

When only one light chain variety is produced by a myeloma plasma cell

Question 18

If on flow you see that you are working with half lambda and half kappa chains, you know you are working with a (mono/poly)clonal population

Answer 18

polyclonal

Question 19

Describe the gross anatomical difference between DLBCL and follicular lymphoma?

Answer 19

DLBCL: DIFFUSE; just see lots of B cell proliferation all through the marrow and nodes
Follicular; see a lymph node just chalk fucking full of germinal centers

Question 20

T/F: follicular hyperplasia includes high levels of apoptosis

Answer 20

true! actively selecting for B cells with the highest affinity for binding

Question 21

csomal translocations in B cell lymphomas involves the movement of BCL2 next to the (blank) locus leading to stabilization of the mito membrane and prevention of apoptosis

Answer 21

IGVH

Question 22

Is DLBCL or follicular lymphoma the most common type?

Answer 22

follicular is most common

Question 23

DLBCL is caused by the dysregulation of BCL (2/6)

Answer 23

BCL 6

Question 24

BCL 6 is a DNA binding transcriptional (activator/repressor)

Answer 24

repressor

Question 25

Overexpression of BCL 6 leads to what three things?

Answer 25

1. no germinal center dev (hence diffuse appearance) 2. impaired B cell differentiation 3. no apoptosis

Question 26

Which CD marker is found in DLBCL?

Answer 26

CD20

Question 27

What are the two MOAs of rituximab?

Answer 27

complement mediated lysis (CDC), and ADCC (Ab depedent cell cytotox)

Question 28

EBV induced Burkitt's lymphoma is (intra/extra) nodal

Answer 28

extranodal

Question 29

Is the African or Sporadic type Burkitt's lymphoma extranodal? which is in the retroperitoneum?

Answer 29

``` African = extranodal sporadic= retroperitoneum ```

Question 30

What types of pts are at high risk of latent EBV infection?

Answer 30

HIV

Question 31

T/F: in ALL forms of Burkitt's there is a csomal translocation

Answer 31

true

Question 32

what gene is moved to be next to IGVH in burkitt's lymphoma?

Answer 32

c-MYC

Question 33

What is the role of c-myc?

Answer 33

participates in many cell processes including proliferation and apoptosis

Question 34

Is DLBCL or follicular lymphoma aggressive?

Answer 34

DLBCL

Question 35

What T cell lymphoma homes to the skin in older people?

Answer 35

Mycosis fungoides

Question 36

What T cell lymphoma shoes epidermotropism?

Answer 36

mycosis fungoides

Question 37

Mycosis fungoides can cause (blank) syndrome once it gets into the blood, as seen by cells with cerebroform nuclei

Answer 37

Sezary syndrome

Question 38

What is the characteristic cell of hodgkin's lymphoma that shows with a "mirror image' nuclei/

Answer 38

Reed sternberg cells

Question 39

What is the role of NF-kB in HL?

Answer 39

turns genes on that promote lymphocyte proliferation and survival

Question 40

What is the most common form of HL?

Answer 40

Nodular sclerosing

Question 41

T/F: all types of HL activate NF-kB

Answer 41

true

Question 42

Which form of HL has the best prognosis? The worst?

Answer 42

Best: lymphocyte predominant worst: lymphoctye depleted

Question 43

What T cell does HL suppress?

Answer 43

Th1 cells

Question 44

Suppression of Th1 cells by HL leads to T cell (blank) and infection with what two organisms?

Answer 44

T cell anergy leading to TB and listeria infections

Question 45

What are the background cells in mixed cellularity HL?

Answer 45

eosinophils and lymphocytes

Question 46

what is the major cell type in lymphocyte depleted HL?

Answer 46

reed sternberg cells

Question 47

Which lymph nodes are commonly involved in HL?

Answer 47

Bilateral hilar and mediastinal

Question 48

A yellow lymph node with white striping tells you what?

Answer 48

Yellow is the HL and the white striping is the scarring (sclerosis)

Question 49

Are normal lymph nodes flat or round?

Answer 49

flat

Question 50

Popcorn Reed Sternberg cells are seen in what variant of HL?

Answer 50

Lymphocyte predominant

Question 51

T/F: Hepatic involvement in HL always indicates splenic involvement

Answer 51

true

Question 52

(HL/NHL) moves in a linear, stepwise, predictable fashion

Answer 52

HL

Question 53

What are the three B symptoms?

Answer 53

Fevers, night sweats, and wt. loss

Question 54

How many of the three symptoms do you need to be class B HL?

Answer 54

2 out of 3

Question 55

T/F: TB is common in HL

Answer 55

true

Question 56

A negative skin test to a common ag like candida would indicate what about T cell function?

Answer 56

anergy

Question 57

T/F: you can also see B symptoms in NHL

Answer 57

true