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IHO Week 4 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

How do lymphomas differ in general from leukemias?

A

they start in the lymph nodes (not the bone marrow) and can only be lymphoid

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2
Q

What are the two general classifications for the lymphomas?

A

Hodgkin’s and Non-Hodgkin’s

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3
Q

Just to stay grounded…what’s the most common cause of lymphadenopathy? What’s the most common malignant cause of lymphadenopathy?

A

benign reaction to infection

metastatic carcinoma

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4
Q

What forms in the lymph nodes with antigen stimulation?

A

secondary follicles - germinal centers

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5
Q

What do we call the dark ring around one half of the germinal center?

A

mantle zone

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6
Q

What type of macrophages are located near the mantle zones of germinal centers and get stuffed with debris?

A

tingible body macropahges

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7
Q

WHat do you call it when there’s a collection of large irregular follicles that have a mixture of cells and tingible body macrophages in a B-cell response to an immune stimulus?

A

benign follicular hyperplasia

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8
Q

What do you call it when you have proliferation BETWEEN follicles?

A

benign interfollicular hyperplasia

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9
Q

What does “partial effacement” mean in the context of interfollicular hyperplasia?

A

it means the lymph nodes is not completely replaced in the proliferation process (if it was, that wouldn’t be benign)

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10
Q

How does an interfollicular hyperplasia differ from a benign follicular hyperplasia (bsides where the proliferation occurs)?

A 
follicular = B cell
interfollicular = T cell
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11
Q

Does NHL follow a predictable progression, or does it jump around?

A

it jumps around - this makes it hard to treat

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12
Q

Is NHL mostly B cell or T cell?

A

B cell

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13
Q

What are the symptoms of NHL?

A

painless but firm lymphadeopathy
extranodal manifestations
“b symptoms” - weight loss, night sweats, fever

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14
Q

If you don’t have B symptoms, what’s your classification? Better or worse prognosis?

A

A -better prognosis

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15
Q

How do low-grade and high-grade NHLs differ?

A

low: older patients, indolent (indurable), small, mature cells, non-destructive
high: can be younger patietns, aggressive (but sometimes curable), big, ugly cells, destructive

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16
Q

What are the four types of low grade NHL?

A

small lymphocytic lymphoma
malt lymphoma
follicular lymphoma
mycosis funngoides

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17
Q

What are the 3 high grade NHL?

A

large cell lymphoma
lymphoblastic lymphoma
burkitt lymphoma

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18
Q

What is small lymphocytic lymphoma the same as?

A

CLL!

it’s small mature lymphocytes, B-cells with CD5+ markers, long course, death from infection

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19
Q

What transformation can low grad elymphomas undergo to become a high grade lymphoma?

A

the Richter transformation - not a good thing

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20
Q

Describe marginal zone lymphoma.

A

It’s actually a bunch of lymphomas, but you see a marginal zone pattern of staining (an area of light-staining around a germinal center) in the lymph nodes (when normally it’s just in the spleen).

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21
Q

What’s the most common type of marginal zone lymphoma?

A

Malt lymphoma

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22
Q

What’s the odd treatment if you catch malt lymphoma early?

A

Give antibiotics against H. pylori and many of them are completely cured - biazarre

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23
Q

Describe mantle cel llymphoma.

A

you have small angulated lymphocytes in mantle zone patterns

24
Q

What’s the genetic abnormality in mantle cell lymphoma?

A

t(11:14) - you get cyclin D paired with an IgH, which is constitutively expressed, so you get constant expression of cyclin D, which helps the cell continue thoruhg the cell cycle

25
Q

Describe follicular lymphoma.

A

it’s a lymphoma that develops in a follicular pattern - but they’re not folicles. they start in the germinal center. Can be small cells (grade 1), mixed cells (grade 2) or big cells (grade 3)

26
Q

What’s the genetic abnormality in follicular lymphoma?

A

t(14:18) - Bcl2 gets paired with IgH, so you get lots of Bcl2 to protect the cells from apoptosis

27
Q

What sort of odd cell will you see in follicular lymphomas?

A

butt cells

28
Q

How do you stage a follicular lymphoma?

A

1 - single node
2 - two or more nodes on the same side of the diaphragm
3 - lymph nodes on both sides of the diaphragm
4 - diffuse extranodal involvement
(and then A or B depending on symptoms)

29
Q

How does mycosis fungoides/sezary syndrome present?

A

You get skin lesions that are often mistaken for psoriasis or eczema. They eventually become raised and almost look like mushrooms - can develop into leonine facies

30
Q

What do we call the lymphocytes seen in mycosis fungoides?

A

cerebriform lymphocytes (they look like brains)

31
Q

Is mycosis fungoides T cell or B cells?

A

T cell

32
Q

For diffuse large-cell lymphoma…B or T cells? Extranodal involvement common or uncommon? Growth slow or rapid? Prognosis good or bad?

A

B cells (usually)
extranodal involvement common
grows rapidly
bad prognosis

33
Q

What are the two types of lymphoblastic lymphoma? What is it the same as?

A

B and T

It’s the same as acute lymphoid leukemia!

34
Q

What group of patients is often affected by T cell lymphoblastic lymphoma?

A

Teenage boys with mediastinal mass

35
Q

What’s the most common presentation of Burkitt Lymphoma?

A

A child with fast-growing, extranodal mass (often in the abdomen or mandible)

36
Q

What’s the classic histology appearance of a Burkitt Lymphoma?

A

starry sky pattern

37
Q

What’s the “sky” and what’s the “stars”

A

The sky is the proliferatin lymphoblasts

the stars are tingible body macrophages

38
Q

What’s the genetic abnormality seen in Burkitt Lymphoma?

A

t(8:14) - you get c-myc paired with IgH

39
Q

What do the cells look like in Burkitt Lymphoma?

A

large - dark purple centers and beautiful dark blue rims with punched-out vacuoles

40
Q

Where in the world is adult T-cell leukemia/lymphoma found?

A

most commonly in Japan and the caribbean basin

41
Q

What virus is associated with adult T-cell lymphoma?

A

HTLV-1

42
Q

How does adult T-cell lymphoma present?

A
  1. skin lesions

2. hypercalcemia

43
Q

What cell is absolutely characteristic for Hodgkin’s Lymphoma?

A

Reed-sternberg cells - they are ENORMOUS with owl’s eyes (two big nuclei with darker nucleoli)

44
Q

Who usually gets HL?

A

younger males in their 20-30s

45
Q

HL better or worse prognosis than NHL?

A

better - because it progresses as contiguous spread, so it’s predictable and easier to treat

46
Q

For Nodular lymphocyte-predominance Hodgkin lymphoma: who gets it? with what symptom? good or bad prognosis? b or t cells?

A

young male - asymptomatic except for cervical lymphadenopathy
good prognosis
B cells

47
Q

What’s the classic variation on reed-sternberg cells you see in nodular LP hodgkins?

A

popcorn cells

48
Q

What’s the most common subtype of HL?

A

nodular sclerosis HL

49
Q

nodular sclerosis HL: good or bad prognosis?

A

good prognosis

50
Q

What’s the typical Reed-sternberg cell variant you see in nodular sclerosis HL?

A

lacunar cells

51
Q

What type of Hodgkin’s has the worse prognosis?

A

mixed cellularity HL

52
Q

Why does lymphocyte-rich hodgkin lymphome have a relatively good prognosis?

A

it’s usually localized at presentation

53
Q

What reed-sternberg variant do you see in lymphocyte-rich HL?

A

popcord cells again

54
Q

Is lymphocyte depletion HL also localized at presentation, or disseminated?

A

disseminated

55
Q

WHat’s the background made up in lymphocyte depletion HL?

A

collagen or reticulin

56
Q

For prognosis of HL, what’s more important: stage or subtype?

A

stage

57
Q

HL is often relativley easy to treat with surgery, chemo and radiation. So what’s the main concern?

A

Since these patients are relativley young, they live for a long time after chemo and radiation, so run the risk of secondary malignancy which is harder to treat

IHO Week 4 (15 decks)

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