Flashcards in Lymphocytes and lymphoma Deck (45):
List causes of lymphopenia
lymphomas- ex advanced stage Hodgkins
steroid/ immune suppressive treatment
List causes of lymphocytosis
Small mature appearing lymphocytes are seen in :
pertussis in childhood
______ are poorly differentiated cells seen in ALL
_______ lymphocytes have a large polygonal nucleus, abundant blue cytoplasm, and a few distinct red granules. They skirt the edges of nearby RBCs
______ lymphocytes are seen in viral illness, drug reactions, and have a kidney bean shaped nucleus and a few large red granules
______ lymphocytes synthesize IgM and are characteristic of Waldenstrom's macroglobulinemia
Describe the arrangement of B and T cells in lymph nodes
B cells aggregate in primary follicles, arrayed around the cortex of the lymph node, while T cells take up residence between these follicles (perifollicular region) and extend down into the
Describe the epidemiology of Hodgkins in terms of age
Bimodal distribution, common in ages 20-40 and 60-80
More common in men
What presenting symptom is common to all lymphomas?
painless swelling of lymph nodes
Hodgkin's lymphoma is ____ in 70-80% of cases
____ immune function is poor in Hodgkin lymphoma, whereas ___ immunity is more likely to be deficient in the B cell and T cell lymphomas
T cell in Hodgkin
Humoral immunity in B/T cell lymphomas
Due to abnormalities in cellular immunity in Hodgkin lymphoma, what sort of infections are patients at risk for?
Fungal, viral infections
skin test anergy
Immunoglobulin production is preserved
Reed-Sternberg cells are derived from _____ cells but usually lack CD20, CD19, CD45. They express CD____
B cells, express CD30
List some lab abnormalities seen in Hodgkins lymphoma
What is the most important prognostic marker in Hodgkin's lymphoma?
Stage of disease
Describe the characteristics of indolent lymphomas
generally slower-growing, composed of more mature cells, and, although they are often treatment-responsive, incurable.
They affect mainly older individuals.
May chose not to treat if asymptomatic
Describe the characteristics of aggressive lymphomas
faster-growing and composed of less mature cells. They generally exhibit relentless (and in some cases very rapid)
progression and are fatal if untreated. However, in contrast to low grade lymphomas, many patients can be cured with treatment.
What is the most common indolent lymphoma?
What is the most common aggressive lymphoma?
List the genetic abnormality associated with follicular lymphoma and its pathological effects
t(14;18)- IgH + Bcl-2
causes decreased apoptosis (slow growing accumulation of cells)
List the genetic abnormality associated with large cell lymphoma and its pathological effects
t(3;14)- IgH + Bcl-6
causes decreased transcription
List the genetic abnormality associated with plasmacystoid lymphoma and its pathological effects
t(9;14)- IgH + PAX5
List the genetic abnormality associated with mantle cell lymphoma and its pathological effects
t(11;14) IgH + cyclin D
causes increased proliferation
List the genetic abnormality associated with Burkitt's lymphoma and its pathological effects
t(8;14)- IgH + c-myc
causes increased proliferation
In ________ lymphoma, bcl2 is placed under control of the IgH promoter, leading to an increased _______ threshold
In ______ lymphoma, c-myc is placed under control of the IgH promoter causing _________
More than 2/3 of patients with B cell lymphomas have ____ disease at diagnosis; many have extranodal disease.
What is the most important prognostic marker in non-Hodgkins lymphoma?
What drug is used against some aggressive lymphomas, and what is its mechanism of action
Contrast the goals of treatment in aggressive vs indolent NHL
the goal of treatment in patients with indolent NHL is control of symptoms and improvement in quality of life, while the goal of treatment in a newly-diagnosed
patient with aggressive lymphoma is cure of the disease
List some prognostic markers for NHL
site (ex brain is very poor)
Describe features of infectious mononucleosis caused by EBV
fever, sore throat, fatigue, lymphadenopathy
lymphocytosis with preponderance of atypical lymphocytes
Despite the fact that EBV
preferentially infects _____, the circulating atypical lymphocytes are mainly _____ cells that
react specifically to EBV-produced antigens.
infects B cells
circulating lymphocytes are CD8+ T cells
What are SPECIFIC tests for infectious mononucleosis
assay for antibodies against components of EBV-
early rise in IgM against viral capsid antibody
IgG against VCA persists for life
Antibody against EBNA develops after several weeks
Quantitative PCR for EBV virion number
What immunophenotype is associated with CML?
Expresses CD5 and CD19, CD20, CD23
What cell types are seen in CLL?
Smudge cells, as well as normal appearing small lymphocytes
CLL will have a skewed _____ ratio
Presence of CD____ distinguishes mantle cell lymphoma from CLL
CD23- positive in CLL/ negative in mantle cell
In CLL, it is common to see a combination of immunodeficiency and a propensity towards autoantibody-mediated immune
autoimmune hemolytic anemia and immune thrombocytopenia (ITP)
What factors contribute to the immunodeficiency in CLL?
- decreased levels of normal immunoglobulins
- T cell deficiency (anergy on skin tests, poor response to vaccination, susceptible to bacterial and viral infections)
Malignant B cells in CLL secrete ______ to inhibit T cell function
immunosuppressive cytokines, ex TGF-B; cell surface receptors such as CD27
What explains the autoimmunities seen in CLL?
manifestation of dysregulation of the immune system, with resultant loss of tolerance to self-antigens.
In some cases the autoantibodies
are produced by the leukemic cells themselves, but more often they are produced by
“normal” (non-neoplastic) B-cells.
CLL can transform into _______ lymphoma
large cell lymphoma