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Flashcards in Lymphadenopathy and EBV Deck (22):
1

What is the transit for B cells?

Bone marrow (maturation)

Blood

Enter lymph node through High Endothelial Venule

Migrate to cortex

Begin in mantle zone as naive B cells

Clonal expansion in germinal center in response to antigen

Migrate to marginal zone and differentiate into plasma cells

Exit via efferent lymphatics

2

What is the transit for T cells?

Thymus (maturation)

Blood

Enter lymph node through High endothelial venules (HEV)

Migrate to paracortex

Clonal expansion in response to antigen

Exit via efferent lymphatics

3

What are causes of Reactive Lymphadenopathy (also is reactive more likely in children or adults)

 

Histologic patterns?

(Reactive lymphadenopathy is more common in children)

Infectious: Infectious mononucleosis/cat scratch/others

Autoimmune

 

Follicular hyperplasia: B cell expansios

Paracortical hyperplasia: T cell expansions

Sinus histiocytosis

4

What are examples of non Hodgkin lymphomas (neoplasms of mature B cells)

Burkitt lymphoma

Diffuse large B-cell lymphoma

Extranodal marginal zone lymphoma

Follicular lymphoma

Mantle cell lymphoma

5

What are examples of Neoplasms of mature T cells or NK cellS?

Peripheral T-cell lymphoma unspecified

Anaplastic large-cell lymphoma

Extranodal NK/T cell lymphoma

6

What are types of Hodgkin lymphomas?

Classical Hodgkin lymphoma

Nodular lymphocyte predominate Hodgkin lymphoma

7

Important parameters for reactive vs. neoplastic lymphadenopathies in clinical exam

Duration/growth interval?

Size (<1cm is better)?

Location (if location in area that typically does not drain, then bad)? Extent?

Tender (reactive associated) vs. Nontender (neoplastic associated)?

Fixed vs. mobile (reactive associated)?

Associated physical exam findings?

8

Causes for reactive lymphadenopathy?

Infectious

Autoimmune

Drugs

Foreign body

Castleman's disease

Sarcoidosis

Kikuchi-Fujimoto

Kimura's disease

Rosai dorfmann

9

Causes for Neoplastic lymphadenopathy

Lymphoma

Leukemic involvement (lymphoblastic lymphoma/myeloid sarcoma)

Metastatic tumor

10

What are the reactive lymphandenopathy histologic patterns?

Follicular hyperplasia- Autoimmune/early HIV/Toxoplasmosis

Paracortical hyperplasia- EBV, CMV, Herpes, drugs

Sinus histiocytosis- Draining tumors

Necrotizing- Cat scratch/bacterial/fungal/autoimmune/viral

Granulomatous-fungal, tb

Mixed

JUST KNOW THE BOLDED FIRST THREE

11

What is rituximab and what is it used for?

Mech of action?

Humanized murine IgG antibody targeting Cd20 antigen. Used to treat Follicular Lymphoma and appears to improve survival

MOA: CDC/ADCC/Apoptosis/ionizing radiation induced cell death

12

Burkitt Lymphoma

CDs?

Genotype?

How does it present?

CD10+/CD19+/CD20+

c-MYC and immunoglobulin loci: t(8;14) t(2;8) t(8;22)

Adolescent or young adults with rapidly growing extranodal masses (ileocecum); uncommonly presents as leukemia

Aggressive

3 variants:

endemic (EBV associated)

sporatic

Immunosuppression-related (EBV-associated)

13

Diffuse Large B-Cell Lymphoma

CDs?

How does it present?

CD 19+/CD20+

All ages but commonly adults. Rapidly growing mass/lymphadenopathy

Aggressive

14

15

Extranodal marginal zone lymphoma (MALToma)

CDs?

Genotype?

Features?

CD 5-/CD10-/CD19+/CD20+

t(11;18) most common creating MALT1-IAP2 fusion

Localized, associated with chronic infections or inflammatory diseases (H. pylori) or (Hashimoto's thyroiditis). Indolent. Arises in the lymphoid tissue of mucosal/epithelial-based sites in adults.

Indolent.

16

Follicular lymphoma

CDs?

Genotype?

Manifestation?

CD 5-/CD10+/CD19+/CD20+

t(14;18) BCL2-IgH fusion gene

Adults with generalized lymphadenopathy, frequent retroperitoneal involvement. Slow growth but 40% transofrm to more aggressive lymphoma (Burkitt lymphoma or Diffuse Large B-cell lymphoma)

17

Mantle cell lymphoma

CDs?

Genotype?

Manifestation?

CD 5+/CD10-/CD19+/CD20+

t(11;14) CyclinD1 overexpression

Older males with disseminated disease, frequent GI involvement; moderately aggressive

18

Peripheral T-cell lymphoma, unspecified

Cell of origin?

Features?

Helper T cell

Older adults, presents with lymphadenopathy, aggressive

19

Anaplastic Large-cell lymphoma

Cell of origin?

Genotype?

Clinical features?

Cytotoxic T cell

Rearrangement of ALK gene

Children, with lymph node and soft tissue disease. Aggressive

20

Extranodal NK/T-cell

Cell of origin?

Genotype?

Features?

NK-cell commonly or cytotoxic t cell rarely

EBV assoc

Adults with destructive extranodal masses, commonly sinonasal. Aggressive

21

Classical Hodgkin Lymphoma

What age present?

Site of involvement?

Characteristics?

CDs?

Cell of origin?

What type is most common and that we need to know and how does it characteristically present?

Adolescents

Mediastinum, cervical

Characterized by Reed Sternberg cells (large eosinophilic nucleoli (owl eye) Large size with frequent binucleation. Contiguous spread, lymph node involvement

CD 15+/CD30+/CD20-/CD45-

B cell lineage (despite not expressing CD20)

Nodular Sclerosis Hodgkin Lymphoma most common presenting with mediastinal mass

22

Nodular lymphocyte predominate Hodgkin lymphoma

Nodular collections of popcorn cells admixed with lymphocyte

CD15-/CD30-/CD20+/CD45+

B cell origin

INdolent with frequent relapses