Morphology - Ch. 13 Flashcards Preview

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Flashcards in Morphology - Ch. 13 Deck (73):
1

Neutrophils with abnormally dark and coarse granules

Toxic granules (abnormal azurophilic granules) - due to sepsis or inflammatory disease

2

Sky-blue cytoplasmic puddles w/in neutrophils

Döhle bodies - due to sepsis or inflammatory disease

3

Many immature granulocytes appearing in blood during severe infection

Leukemoid reaction - reactive leukocytosis

4

Swollen, painful LNs with prominent reactive germinal centers w/ numerous mitotic figures, macrophages w/ particulate debris, many neutrophils, and follicular necrosis in the centers

Acute lymphadenitits - due to infection

5

LNs w/ large oblong germinal centers surrounded by collar of small naive B cells, polarized germinal centers with centroblasts and centrocytes w/in a network of follicular dendritic cells and debris-containing macrophages

Follicular hyperplasia

6

Causes of follicular hyperplasia

RA, toxo, early HIV

7

Telling reactive hyperplasia instead of neoplastic (5)

- Preserved LN architecture
- Varied shape/size of follicles
- Mitotic figures
- Macrophages
- Light and dark zones

8

Large T cells with round nuclei, open chromatin, prominent nucleoli, and pale cytoplasm in the paracortical LN region

Immunoblasts (immature T cells) - normal

9

Expanded T-cell zones, diminished follicles, hypertrophy of sinusoidal and vascular endothelial cells, and infiltrating macrophages and eosinophils

Paracortical hyperplasia

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Causes of paracortical hyperplasia

Acute viral infections (ex. mono)

11

Increased number and size of cells lining lymphatic sinusoids (LNs), increased macrophages, expanded/distended sinuses

Sinus histiocytosis

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Causes of sinus histiocytosis

Reactive hyperplasia OR cancers draining into the LN (based on other findings)

13

Hypercellular marrow packed w/ lymphoblasts that have scant basophilic cytoplasm, nuclei larger than normal and convoluted, stippled chromatin, and rimmed nucleoli. Marcophages ingesting dead tumor cells give "starry sky"

Acute lymphoblastic leukemia/lymphoma (ALL)

14

Myeloblasts (AML) vs. Lymphoblasts (ALL)

Lymphoblasts - TdT
Myeloblasts - MPO

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Small lymphocytes w/ round or slightly irregular nuclei, condensed chromatin, and scant cytoplasm in the LNs, blood, BM, spleen, portal tracts. Smudge cells in blood.

Chronic lymphocytic leukemia / Small lymphocytic lymphoma (CLL/SLL)

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Areas of small inactive lymphocytes and large active lymphocytes w/in LNs

Proliferation centers - CLL/SLL (always)

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CLL/SLL --> rapidly enlarging mass w/in LN or spleen

Richter syndrome - transformation to diffuse large B-cell lymphoma

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Small cells in LN w/ irregular/cleaved nuclear contours and scant cytoplasm

Centrocytes - follicular hyperplasia or follicular lymphoma

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Large cells in LN w/ open nuclear chromatin, several nucleoli, and modest cytoplasm

Centroblasts - follicular hyperplasia or follicular lymphoma

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LNs - nodular/diffuse pattern w/ centrocytes and centroblasts w/in reactive follicular dendritic cells and macrophages and T cells

Blood - modest increased WBC

Follicular lymphoma

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Large B cells w/ either round/oval nucleus appearing vesicular or multilobed/cleaved nuclei, open chromatin, prominent nucleoli, abundant cytoplasm

Diffuse large B-cell lymphoma

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Diffuse infiltrate or intermediate-sized lymphoid cells with round/oval nuclei, coarse chromatin, several nucleoli, and moderate cytoplasm. High mitotic index, many apoptotic cells, and interspersed phagocytes causing "starry sky"

Burkitt lymphoma

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BM - tumor cells w/ slightly clumped chromatin, 2-5 nucleoli, and royal blue cytoplasm w/ clear vacuoles

Burkitt lymphoma

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Punched-out defects of soft, gelatinous, red tumor tissue within vertebral column, ribs, skull pelvis, etc. Excess plasma cells w/ perinuclear clearing and eccentrically placed nucleus w/in the BM.

Multiple myeloma

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Plasma cells w/ vesicular chromatin and prominent single nucleolus

Plasmablasts - multiple myeloma (maybe)

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Multinucleated plasma cells

Multiple myeloma (maybe)

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Plasma cells w/ fiery red cytoplasm

Flame cells - multiple myeloma (maybe)

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Plasma cells w/ multiple grapelike cytoplasmic droplets

Mott cells - multiple myeloma (maybe)

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Plasma cells w/ globular inclusions of globules

Russell bodies (cytoplasm) or Dutcher bodies (nucleus) - multiple myeloma (maybe)

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Red cells in blood to stick together in linear arrays

Rouleaux formation - multiple myeloma (and others)

31

BM - infiltrate of lymphocytes, plasma cells, plasmacytoid lymphocytes, and mast cell hyperplasia. PAS-positive inclusions of Ig in cytoplasm (Russel) or nucleus (Dutcher) of some plasma cells. Dissemination to LNs, spleen, liver.

Lymphoplasmacytic lymphoma

32

LNs - Homogenous population of small lymphocytes with irregular/clefted nuclear contours surround reactive germinal centers

Other - polyp-like lesions in bowel

Mantle cell lymphoma

33

Blood - Leukemic cells with various nuclei, moderate pale blue cytoplasm w/ threadlike/bleblike extensions

Marrow - Diffuse infiltrate of similar cells enmeshed in extracellular matrix of reticulin fibers

Spleen - enlarged, beefy red, heavily infiltrated red pulp

Hairy cell leukemia

34

LNs - Pleomorphic mixture of variably sized malignant T cells, infiltrate of eosinophils and macrophages, and neoangiogenesis

Peripheral T-cell lymphoma - unspecified

35

Large anaplastic cells that cluster about venules and infiltrate lymphoid sinuses (like carcinoma)

Anaplastic Large-Cell Lymphoma

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Horseshoe-shaped (embryoid) nuclei and voluminous cytoplasm

Hallmark cells - Anaplastic Large-Cell Lymphoma

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Tumor cells w/ multilobed nuclei in "cloverleaf" or "flower" appearance

Adult T-Cell Leukemia/Lymphoma

38

CLA+, CCR4+, CCR10+ cells w/ marked infolding of nuclear membrane (cerebriform appearance) w/in skin --> LNs, BM, blood

Mycosis Fungoides

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Blood - Large CD3+ or CD56+ lymphocytes w/ abundant blue cytoplasm and few coarse azurophilic granules

BM - sparse interstitial lymphocytic infiltrates

Large Granular Lymphocytic Leukemia

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Destructive nasopharyngeal mass w/ CD56+ (or CD3+) tumor cells w/ large azurophilic granules in cytoplasm; cells invade small vessels causing ischemic necrosis

Extranodal NK/T-Cell Lymphoma

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Large cells w/ multiple nuclei or single nucleus w/ multiple lobes, each w/ a large inclusion-like nucleolus, abundant cytoplasm

Reed-Sternberg cells (classical) - HL

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Large cells w/ single nuclei w/ large inclusion-like nucleolus and abundant cytoplasm

RS cell, mononuclear variant

43

Large cell, folded or multilobate nuclei and abundant pale cytoplasm w/ nucleus sitting in empty hole

Lacunar cell (RS cell variant) - Nodular Sclerosis HL

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Large cell, polypoid nuclei, minimal nucleoli, abundant cytoplasm

Lymphohistiocytic cell (RS cell variant) - Lymphocyte-predominance HL

45

RS cells in background of non-neoplastic inflammatory cells

Hodgkin lymphoma

46

Lacunar RS cells + eosinophils, plasma cells, and macrophages; deposition of collagen bands that divide LNs into nodules

Nodular Sclerosis HL

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RS cells w/ mononuclear variants mixed w/ T cells, eosinophils, plasma cells, and macrophages

Mixed-Cellularity HL

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RS cells w/ mononuclear variants mixed w/ many reactive T cells

Lymphocyte-Rich HL

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RS cells and variants, few background cells

Lymphocyte Depletion HL

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L&H RS cells, CD20+, CD15-, CD30-, background of follicular dendritic cells and reactive B cells

Lymphocyte Predominance HL

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> 20% myeloid blasts in the bone marrow

AMLs

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Delicate nuclear chromatin, 2-4 nucleoli, and voluminous cytoplasm with fine, peroxidase-positive azurophilic granules

Myeloblasts

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Needle-like azurophilic granules of MPO

Auer rods

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Folded or lobulated nuclei, no auer rods, nonspecific esterase-positive

Monoblasts

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Megakaryocytic differentiation in AMLs is accompanied by marrow ____ due to cytokine release

Fibrosis

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BM - disordered (dysplastic) differentiation affecting the erythroid, granulocytic, monocytic, and megakaryocytic lineages to varying degrees

Myelodysplastic syndromes

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Erythroblasts with iron-laden mitochondria visible as perinuclear granules in Prussian-blue stained aspirates/biopsies

Ring sideroblasts - myelodysplastic RBCs

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Erythroblasts w/ iron-laden mitochondria as perinuclear granules in Prussian Blue stain

Ring sideroblasts

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Nuclei w/ misshapen, often polypoid, outlines

Nuclear budding abnormalities

60

Neutrophils w/ only 2 nuclear lobes

Pseudo-Pelger-Hüet cells

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Megakaryocytes w/ multiple separate nuclei

Pawn ball megakaryocytes

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Blood - pseudo-PGH cells, giant platelets, macrocytes, poikilocytes, and excess monocytes

Myelodysplastic syndromes

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BM - ring sideroblasts, pseudo-PGH cells, pawn ball megakaryocytes, etc.

Myelodysplastic syndromes

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BM - neoplastic promyelocytes with abnormally coarse and numerous azurophilic granules, several cells with bilobed nuclei and auer rods

Acute promyelocytic leukemia - t(15;17)

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Blood - monoblasts and promonocytes w/ folded nuclear membranes

AML with monocytic maturation

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AML w/ full range of myelocytic maturation, many auer rods, abnormal cytoplasmic granules

AML w/ myelocytic maturation - t(8;21)

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AML w/ myelocytic and monocytic differentiation, abnormal eosinophilic precursors w/ abnormal basophilic granules

Acute myelomonocytic leukemia - inv(16)

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AML w/ numerous auer rods in bundles w/ individual progranulocytes; primary granules are prominent; high incidence of DIC

Acute promyelocytic leukemia - t(15;17)

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Most common AML in Down Syndrome

AML w/ megakaryocytic maturation

70

Hypercellular marrow w/ massively increased numbers of maturing granulocytic precursors. Sea-blue histiocytes. MAJOR blood leukocytosis (>100,000). Greatly-enlarged spleen red pulp, w/ infarcts.

Chronic myelogenous leukemia (CML)

71

Hypercellular marrow w/ slightly increased RBC progenitors, granulocytic precursors, and megakaryocytes. Mild organomegaly. Increased basophils and large platelets in blood.

Polycythemia vera

72

BM - mildly hypercellular with markedly increased megakaryocytes with some abnormally large forms, delicate reticulin fibrils, but no overt fibrosis. Blood shows abnormally large platelets and mild leukocytosis

Essential thrombocytosis

73

Hypercellular marrow w/ cells of all lineages, especially large dysplastic clustered megakaryocytes. Later, marrow becomes more hypercellular and diffusely fibrotic w/ cloud-like nuclear-shaped megakaryocytes and hematopoietic elements in dilated sinusoids. Extensive splenomegaly w/ subcapsular infarcts. Blood shows early release of nucleated erythroid and granulocyte progenitors. Teardrop cells in blood.

Primary myelofibrosis