Lymphoid Malignancies

Question 1

4 common CLL types

Answer 1

Bcell CLL, Bcell PLL, Hairy Cell Leukemia, T cell LGL Leukemia

Question 2

Bcell Cll

Answer 2

small scant cytoplasm, may express t cell marker CD5, fragile and burst producing smudge cells, lymphocytosis

Question 3

B Pll

Answer 3

PLL- either b or t type, 75% p53 mutated. More mature lymphocytes. Prolymphs large prominent nucleoili. More mature markers. 19, 20, 22, fmc7.

Question 4

Hairy Cell Leukemia

Answer 4

Hairy cell leukemia, lymphocytes not elevated. Fried egg appearance of lymphocytes in BM. Infiltration of spleen, splenomegaly. More Mature. Trap Positive. Dry Tap.

Question 5

T LGL CLL

Answer 5

lymphocytosis, anemia, thrombocytopenia, neutopenia. Assess clonality by PCR. Lots of LGL’s.

Question 6

Non Hodgkins Lymphoma

Answer 6

NHL – follicular lymphomas most common. Follicles poorly defined. Bcells have twisted nucleie. No macrophages to engulf, no apoptosis. BCL 2 translocation, overexpression, anti apoptotic.

Question 7

NHL MALT lymphoma

Answer 7

NHL MALT lymphoma. Tonsils salivary glands etc. Heterogeneous b cells. Preceded by infection like H pylori. Cells proliferate independent of antigen

Question 8

NHL Burkitt Lymphoma

Answer 8

NHL Burkitt Lymphoma – Associated with EBV.
Endemic type and sporadic type. Myc under IG promoter. Starry sky – basophillic lymphocytes on macrophage background. Extranodal involvmnent of facial bones and jaw. Common in HIV. High grade, more treatable.

Question 9

NHL Bcell appearance

Answer 9

more normal

Question 10

Lymphocyte predominant Hodking Lymphoma

Answer 10

LPHL – bcell predominant. Popcorn cells have multilobated nuclei. Reed Sternberg eosinophillic bilobed cell looks like owls eye. Also Lacunar cell.

Question 11

Compare HL and NHL

Answer 11

HL: localized, usually central nodes, contiguous spread, extranode and blood involvement rare, abnormal cells. NHL: Widespread, peripheral nodes, non contiguous speread, peripheral blood can happen, normal cells

Question 12

Multiple myeloma

Answer 12

Multiple myeloma, plasma cell proliferation in bone marrow. Lytic bone lesions. >30% plasma cell in multple myeloma. Rouleux formation due to serum Ab antibodies. Blood may stain blue. Overproduction of Ab at expense of normal Ab production.

Question 13

Bence Jones proteins

Answer 13

– free Kappa light chains in urine

Question 14

Which cytokines used to moblize blood for HSC transplantion?

Answer 14

GCSF GMCSF

Question 15

HSC CD Marker?

Answer 15

CD34

Question 16

relapse

Answer 16

minimal residual disease - some neoplastic cells in hsc line remain

Question 17

pros cord blood

Answer 17

no risk to mother or baby. Frozen, available on demand. Ethnic balance, risk of viral contamination low. Less immunogenic, less GVHD.

Question 18

Cons of cord bood

Answer 18

generally inadequate amount available for adults. GVL effect reduced due to less immugenicity.

Question 19

Conditions which preclue cord blood use

Answer 19

fever, preterm delivery, rupture of membrane, meconium, birth or genetic defects

Question 20

pan hematopoetic marker

Answer 20

CD45