Lymphomas and Multiple Myeloma Flashcards by Salvatore Liotta

What are the 4 typical locations for lymphomas to infiltrate?

Lymph nodes
Spleen
Thymus
Bone marrow

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What are the 2 types of lymphomas?

Hodgkins Lymphoma

2. Non-Hodgkins Lymphoma

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What type of cell will be seen in nodules or follicles?

B cells

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What type of lymphoid cell will be seen between follicles (paracortical)

T cells

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Chronic lymphocytic leukemia (CLL) in the bloodstream is the same as _______ in the tissue

Small lymphocytic lymphoma (SLL)

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What is the most common type of lymphoma in the western world?

B-cell Non-Hodgkin’s Lymphoma

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B-cell Non-Hodgkin’s Lymphoma are uncommon in children except for which type?

Burkitt Lymphoma

very aggressive
In the jawbone

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Most common type of B-cell Non-hodgkins Lymphoma?

follicular and diffuse*

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In what situation does primary non-hodgkins lymphoma occur in the brain?

HIV

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What is the most common B-cell lymphoma?

Diffuse non-hodgkins lymphoma

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Follicular (nodular) Lymphoma

low-grade
slow growing
2nd most common (behind diffuse)
older people (60s)
follicular structure is preserved and the tumor cells resemble mature lymphocytes

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Diffuse Large Cell Lymphoma

most common B-cell lymphoma

- high grade

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Histological features of diffuse B-cell Non-Hodgkins lymphoma

complete effacement of normal lymph node architecture
tissue infiltration
large lymphoblast with irregular nuclei and prominent nucleoli

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Diffuse Non-hodgkins Lymphoma: prognosis

Poor.

-high and intermediate-grade lymphomas survive only 1-2 years. Chemo can help 75% get to complete remission byt cure rate is extremely low

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Burkitt’s Lympphoma

high grade malignant tumor of lymphoid stem cells that divides rapidly

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What are the two extranodal site common in Burkitt’s lympphoma?

Mandible

2. Facial soft tissue

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Where is Burkitt’s Lymphoma commonly seen globaly?

sub-Saharan Africa

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What virus and translocation are associated with Burkitt’s lymphoma?

EBV (DNA enveloped herpes virus)

8:14 translocation

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What is a “starry sky” histology is associated with?

Burkitt Lymphoma

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Non-Hodgkins Lymphoma will give fatigue, malaise, fever, weight loss and sweating + pancytopenia, why?

hypermetabolism (rapid turnover of proliferating tumor cells)

[slide 28]

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What is the most common of the malignant lymphomas that is pathologically distinct from other lymphoid malignancies?

Hodgkin’s Disease

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Who does hodgkin’s disease affect

Bimodal distribution: 20s and 50s
Males
Whites

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Young adults who have experienced ____ infections have a three-fold increased risk of developing Hodgkin’s Disease

Study These Flashcards

EBV infection

What is the name for the classic cell in Hodgkin’s disease?

Study These Flashcards

Reed-Sternberg cell

“owl-eye cell”
“mirror image cell”

What are two factors that may play a role in increased incidence of Hodgkin's disease?

1. Genetic, high risk in siblings 2. Immune - compromised immunity - autoimmune diseases (ex. RA)

Hodgkin's Disease is associated with _________immunity and increased risk of infections, especially _______

Hodgkins disease is associated with deficient or impaired cell-mediated immunity (T-cell) Herpes Zoster

Describe the lymphadenopathy of Hodgkin's Disease?

- Firm or rubbery - focal areas of necrosis or softening - Nodes can be matted together

Hodgkin's Disease: splenic involvement correlates with what?

size of spleen

Hodgkin's Disease spleen pathology

- White pulp is enlarged | - Later red pulp is involved

What are unusual/rare at initial diagnosis of Hodgkin's Disease but involvement when disease progresses?

1. Liver | 2. Bone

Where in the liver is Hodgkin's disease extend from?

Portal area

Which type of Hodgkin's disease is the most common, and more common in women?

Nodular sclerosis HD

Which Hodgkin's disease has the worst prognosis?

Lymphocyte depletion HD

Lymphocyte Predominance Hodgkin's Disease

- uncommon - Young males - Cervical or axillary LAD - Excellent prognosis

Nodular Sclerosis Hodgkin's disease

- Most common | - Females>males

Lymphocyte depletion Hodgkin's disease

- Worst prognosis - Rare - Older patients and HIV

Which nodes are most commonly involved in Hodgkins Disease?

Cervical** - Mediastinal - Axillary

Ann Arbor Staging is associated with which disease

Hodgkin's Disease

Ann Arbor Staging: Stage I

Involvement of a single lymph node

Ann Arbor Staging: Stage II

Involvement of 2 or more lymph nodes, on the same side of the diaphragm

Ann Arbor Staging: Stage III

Involvement of lymph node regions on both sides of the diaphragm

Ann Arbor Staging: Stage IV

Disseminated extralymphatic

Treatment of Hodgkins Diseasee

1. Chemo and radiation are highly effective but. .. 2. Secondary cancers (lung, breast, NHL, AML, gastric cancer, melanocarcinomas) 3. Pulmonary fibrosis 4. Acceleration of atherosclerosis

Multiple myeloma

plasma cell neoplasm | -multiple skeletal sites

Multiple myeloma: describe the malignant transformation

single plasma cell with clonal expansion = monoclonal proliferation

How is Multiple myeloma detected?

Plasma cells make antibodies, so a monoclonal spike can be seen on protein electrophoresis (the other tall spike is albumin)

Describe what happens during normal infection in regards to serum protein electrophoresis

infection causes polyclonal activation = Broad-shaped hump

Describe what population is at higher risk for multiple myeloma

- Older than 55yrs - Male - Black

What would you expect to see high in the blood with multiple myeloma? why?

hypercalcemia due to osteoblast activation

What would you expect to see on Xray of patient with multiple myeloma?

Punched out holes in blood-forming bones: calvarium + vertebrae

Where is the most likely place for the calcium to deposit in multiple myeloma?

kidney

What are Bence-Jones Proteins?

immunoglobulin light chain casts secreted in the urine

Describe the peripheral blood changes in multiple myeloma

normochromic normocytic anemia with rouleax formation due to increased sedimentation rate

Which is done first: Serum Electrophoresis or Serum Protein Immunoelectrophoresis

Serum Electrophoresis >Serum Protein Immunoelectrophoresis (which concentrates on the gamma region)

What else about the urine contributes to the free light chains having a toxic effect on the tubular epithelial cells of the kidney?

acidic pH of the urine

What can be found in the distal tubules and collecting ducts in Multiple Myeloma?

dense, hyaline casts that are brightly eosinophilic ("pink") and glassy with angulated borders

What do people with multiple myeloma typically die of?

kidney failure or infection

Lymphomas and Multiple Myeloma Flashcards

(57 cards)