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Lymphadenopathy Flashcards

1
Q

What organs are in the haemopoeitic system?

A

Lymph nodes
Spleen
Bone marrow

Lumphoid tissue also found in:
Gut mucosa
Salivary glands
Respiratory tract

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2
Q

How does lymph flow through lymph node?

A

Afferent lymphatic vessels in cortex>flows through intranodal sinuses>efferent vessels in medulla

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3
Q

What are centroblasts?

A

Large immature B cells in follicles of lymph node cortex

Mature into smaller centrocytes and divide and mature within the follicles when an antigen is encountered.

They differentiate into plasma cells OUTSIDE the follicles

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4
Q

Where are T cells found in the lymph nodes?

A

Between follicles and medulla

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5
Q

Where are macrophages found in lymph nodes?

A

Between sinuses and follicles

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6
Q

Antibodies associated with B cells?

A

CD19, CD20 and CD79a

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7
Q

Antibodies associated with T cells?

A

CD3, CD4, CD8

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8
Q

Where are B cells found in the lymph node?

A

In the follicles

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9
Q

Common causes of enlarged lymph nodes?

A

Infectious diseases (viral, bacterial, fungal, parasites etc.)

Immune disorders (RA, SLE, PBC, hypersensitivity)

Cancer (haematological or metastasis)

Others: (sarcoidosis and 100s of others)

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10
Q

Investigations for enlarged lymph nodes?

A

*****FNA OR BIOPSY!!!

General and ENT examination

FBC

Serology for EBV, CMV, HIV, Toxoplasma, ANA, anti ds DNA

CXR, USS, CT, MRI, PET

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11
Q

What are these histological patterns examples of? (Follicular, paracortical, sinus or combination)

A

Lymph node hyperplasia patterns

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12
Q

What causes purulent/pus filled lymph nodes?

A

Bacterial infections due to neutrophil infiltration

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13
Q

What is a granuloma?

A

A collection of macrophages surrounded my lymphocytes

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14
Q

What is the most common infective cause of swollen lymph nodes in children and YAs?

A

Infective mononucleosis (glandular fever)

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15
Q

Clinical features of glandular fever?

A

Fever
Sore throat
Swollen lymph nodes
*Splenomegaly

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16
Q

What is the monospot test?

A

For anti EBV antibodies in glandular fever

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17
Q

True/false: Biopsies are always taken for diagnosis of mono

A

False, only when malignancy suspected or atypical features

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18
Q

Histology of which disease: Non caseating granulomas with epitheloid cells, Langhan’s giant cells, asteroid bodies (Schaumann bodies)

A

Sarcoidosis

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19
Q

Test for sarcoidosis?

A

Serum ACE levels

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20
Q

Organs affected in sarcoidosis

A

Lungs, skin, lymph nodes, kidneys, eyes (and others)

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21
Q

What is mycosis fungiodes?

A

A T-cell lymphoma of the skin

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22
Q

Which type of tumour rarely spreads to lymph nodes?

A

Sarcomas

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23
Q

What cell is present in Hodgkin lymphoma?

A

Reed-Sternberg cell

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24
Q

Two types of Hodgkin lymphoma?

A

Nodular lymphocyte predominant

Classical (nodular sclerosing, lymphocyte rich, lymphocyte depleted, mixed cellularity)

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25
How are lymphomas classified in general?
Based on clinical features, immunophenotype, molecular features NO SINGLE FEATURE IS THE GOLD STANDARD
26
Indolent forms of Non-Hodgkin's lymphoma?
``` Lymphocytic lymphoma (B) Follicular lymphoma (B) ```
27
Aggressive forms of Non-Hodgkin's lymphoma?
LymphoBLASTIC lymphoma (B/T) Burkitt's lymphoma (B) Diffuse large B cell lymphoma (B) Mantle cell lymphoma (B)
28
Difference between indolent and aggressive lymphomas?
Indolent: progressive, hard to cure Aggressive: grow rapidly, may be easier to treat
29
How is clonality of a lymphoma investigated?
PCR. All cells in lymphoma are of same type
30
True/False: 85% of lymphomas are B-cell non Hodgkins
True.
31
How can morphology be used to subtyping lymphomas?
CELL SIZE Small lymphoid cells: Small lymphocytic, Follicular, Mantel cell lymphomas Intermediate: Burkitt's Large: Diffuse large B cell
32
Most common leukaemia?
CLL/small lymphocytic lymphoma
33
Age at diagnosis for CLL?
Mean 60
34
Autoimmune abnormalities of CLL
Hypegammaglobulinameia, thrombocytopaenia, haemolytic anaema
35
Histology of which leukaemia: Small lymphocytes, larger pro-lymphocytes, express CD5 and pan B markers
CLL
36
Molecular abnormalities of which leukaemia: trisomy 12, del 13q
CLL
37
Median survival of CLL? What is Richter's transformation?
4-6 years CLL can change into small lymphocytic lymphoma (aggressive form of large cell lymphoma)
38
Which lymphoma accounts for 45% of adult lymphomas?
Follicular lymphoma
39
Histology of which lymphoma: centroblasts and centrocytes. Expresses CD10, bcl2 and pan B markers
Follicular lymphoma
40
Molecular abnormalities of which lymphoma? t(14:18), bcl2 over expression
Follicular lymphoma (B)
41
Prognosis of follicular lymphoma?
Indolent, incurable Median survival 10 yrs Transforms to diffuse large B cell in 30-50% :(
42
Lymphoma associated iwht GI involvement in the form of polyps (lymphamatoid polyposis)?
Mantle cell
43
Histology of which lymphoma: Monotonous proliferation of small lymphoid cells, expressing pan B, CD5 and CyclinD1
Mantle cell lymphoma (aggressive)
44
Molecular pattern of which lymphoma? t(11:14) resulting in over expression of CYCLIN D1
Mantle cell lymphoma
45
Which lymphoma? Endemic, sporadic or HI associated, may present as leukaemia
Burkitt's lymphoma (aggressive but curable)
46
Histology of which lymphoma: intermediate cells, diffuse growth, STARRY SKY APPEARANCE, highest turnover rate. Expresses pan B, CD10, surface IgM
Burkitt's
47
Molecular pattern of which lymphoma? T(8:14) involving c-myc on chr 8
Burkitt's
48
Histology of which lymphoma: large B cells, diffuse growth pattern and expresses pan B antigens
Diffuse B cell lymphoma
49
Molecular pattern of which lymphoma: t(14:18) in 30%, Bcl6 gene mutations
Diffuse Large B Cell Lymphoma
50
Special types of diffuse large B cell lymphoma
AIDS related Body cavity based
51
Prognosis of diffuse large B cell lymphoma
Aggressive 50-60% complete remission Around 50% cure rate
52
General prognosis of T-Cell NH lymphomas?
Worse than B cell NHLs
53
Common T cell lymphomas?
Mycosis fungiodes Peripheral T cell lymphoma All these tumours express CD3 and show a T cell receptor gene rearrangement at the genetic level
54
What can predispose to MALT lymphoma?
Chronic H pylori infection Sjogrens syndrome Hashimoto thyroiditis
55
Uncommon lymph node sites to be affected by Hodgkin's?
Gut Skin Mesenteric Waldeyer's ring
56
True/false: All Hodgkins lymphomas are derived from B cells but not all of them will express B cell markers
True
57
Histology subtypes of which cell: Classic binucleate, lymphohistiocytic, lacunar, mononuclear, mummified
Reed sternberg cell
58
What antibodies stain for Classical Hodgkins? Nodular lymphocyte predominent Hodgkins?
1. CD15 and CD30 | 2. CD20
59
Classical Hodgkin's subtype affecting young adults and women?
Nodular sclerosing
60
Classical Hodgkin's subtype associated with LACUNAR RS CELLS and SCLEROTIC BANDS?
Nodular sclerosis
61
Classical Hodgkin's subtypes with good prognoses?
``` Nodular sclerosing (excellent) Mixed cellularity Lymphocyte rich (excellent) ```
62
Classical Hodgkin's subtype with CLASSIC RS CELLS?
Mixed cellularity
63
Classical Hodgkin's subtype with HISTIOCYTE RS cells?
Lymphocyte rich
64
Classical Hodgkin's subtype with isolated cervical or axillary lymphadenopathy?
Lymphocyte rich
65
Classical Hodgkin's subtype appearing as high stage disease in older men?
Lymphocyte depleted
66
Ann Arbor stages?
Stage 1: Single node/ regio affected Stage 2: >1 regions affected on same side of diapharm Stage 3: Both sides of diaphragm affected Stage 4: Widespread disease and bone marrow involvement
67
Leukaemia most common in kids?
ALL
68
Prognosis of ALL?
90% complete remission | 66% cured
69
Urine proteins present in myeloma?
Bence-Jones portein
70
Morphology of myeloma?
Sheets of mature and immature plasma cells in bone marrow
71
Median survival of myeloma?
3 years, infections and renal failure are common causes of death
72
Excess immunoglobulins in myeloma?
IgG and IgA
73
Causes of splenomegaly (CHICAGO)
Cancer Haematological malignancy Infection Congestion (portal HTN) Autoimmune (SLE, RA, haemolytic anaemia) Glycogen storage disease Other (amyloidosis, lipid storage)
74
True/false: Patients treated for HL are at higher risk of developing a second haematological malignancy
True, occurs in 15% of patients
75
True/false: B symptoms are found in 90% of Hodgkin patients
False, 40% Drinking alcohol increases pain

SBCP Pathology (24 decks)

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