N. B Cell Non-Hodgkins Lymphoma (L13 & Lab4)

Question 1

What is NHL?

Answer 1

Clonal expansion of malignant T-, B- or NK lymphocytes due to genetic lesions
Stuck at a normal stage of differentiation

Question 2

How is the incidence of NHL changing?

Answer 2

Increases 3-4% every year

Question 3

How does the incidence of NHL change in relation to age?

Answer 3

Steadily increases after age 30

Question 4

What is the general prognosis for NHL patients?

Answer 4

50% die of NHL

Question 5

What condition predisposes a patient to aggressive NHL?

Answer 5

AIDs

Question 6

What is being referenced when calling a lymphoma low or high “grade”?

Answer 6

Speed of growth & general prognosis

Question 7

How can low grade lymphomas change overtime?

Answer 7

Can transform into a higher grade

Question 8

What grade is assigned to small cell lymphomas? Medium size? Large cell?

Answer 8

Small = low grade
Medium = High grade
Large = Intermediate grade

Question 9

What cytogenic abnormality is seen with Follicular Lymphoma? What is the pathophysiology?

Answer 9

t(14:18)
Ig heavy chain on 14 is constituitively expressed
BCL-2 gets heavy chain promoter –> tons of BCL-2 –> anti-apoptotic

Question 10

What cytogenic abnormality is seen with Burkitts Lymphoma? What is the pathophysiology?

Answer 10

t(8:14)
Ig heavy chain on 14 is constituitively expressed
C-Myc oncogene gets heav chain promoter –> tons of c-myc

Question 11

What is the most common type of indolent B cell lymphoma?

Answer 11

Follicular hyperplasia

Question 12

What is the normal cell equivalent of follicular lymphoma?

Answer 12

Small germinal center B cell (follicle like)

Question 13

What grade is Follicular Lyphoma?

Answer 13

Low Grade

Question 14

What should be suspected when the follicles in the lymph node touch each other?

Answer 14

Follicular Lymphoma (not reactive)

Question 15

What cytogenic abnormality is seen with Mantle Cell Lymphoma? What is the pathophysiology?

Answer 15

t(11:14)
Ig heavy chain on 14 is constituitively expressed
Cyclin D gains heavy chain promoter –> lots of cyclin D

Question 16

What is cyclin D staining diagnostic of?

Answer 16

Mantle Cell Lymphoma

Question 17

What is the normal cell version of the neoplastic cell in Mantle Cell Lymphoma?

Answer 17

Naive B cells which are located in the mantle (dark area around the follicle)

Question 18

What is the key clinical finding in mantle cell lymphoma? What can result from it?

Answer 18

Colon polyps

Obstruction of the colon

Question 19

What grade is mantle cell lymphoma?

Answer 19

Intermediate grade

Question 20

What is associated with Gastric Malt Lymphoma?

Answer 20

H pylori infection

Question 21

What is the normal equivalent of the neoplastic cells that cause gastric MALT Lymphoma?

Answer 21

Small B cells from marginal zone

Question 22

What grade is Gastric Malt Lymphoma?

Answer 22

Low grade

Question 23

What is the 5 year survival rate for Gastric MALT Lymphoma?

Answer 23

95%

Question 24

What is he standard therapy for Gastric MALT Lymphoma? When is this not effective?

Answer 24

Chemo + antibiotics

If cytogenetic abnormality, just use chemo

Question 25

What type of lymphoma is largely extranodal?

Answer 25

Gastric Malt Lymphoma

Question 26

What is a type of Marginal Cell Lymphoma?

Answer 26

Gastric Malt Lymphoma

Question 27

Is large B cell Lymphoma curable?

Answer 27

Yes | Even though aggressive. Proliferating cells are more responsive to treatment

Question 28

What is a key clinical finding of Large B Cell Lymphoma?

Answer 28

Massively enlarged submandibular gland

Question 29

What is the normal non-neoplastic version of Large B Cell lymphoma?

Answer 29

Replicating Cells of the germinal center

Question 30

What is suspected with increased expression of BCL-2 & BCL-6?

Answer 30

Large B Cell Lymphoma

Question 31

What is the prognosis for Large B Cell lymphoma when their is overexpression of Bcl-6?

Answer 31

good

Question 32

What grade is Large B Cell Lymphoma?

Answer 32

High grade

Question 33

What grade is Burkits Lymphoma?

Answer 33

High Grade

Question 34

What is the endemib form of Burkits associated with?

Answer 34

Epstein Bar Virus (EBV)

Question 35

What should be suspected when there is a starry night appearance? Does this improve or hurt prognosis?

Answer 35

Burkitts Lymphoma | Improves prognosis

Question 36

What percentage of neoplastic Burkit cells are in cell cycle? What staining property does this lead to?

Answer 36

100% | Stains with Ki67

Question 37

What is the normal equivalent of the neoplastic cells in Burkits Lymphoma?

Answer 37

Small dark no cleaved B cells in center of germinal center

Question 38

What is the pathophysiology of Multiple Myeloma?

Answer 38

Plasma Cell Dyscrasia --> monoclonal plasma cells in bone marrow --> crowding in bone marrow --> pancytopenia (impaired immunity) Bone fractures and pain

Question 39

What causes lytic bone lesions?

Answer 39

Multiple Myeloma

Question 40

How is renal insufficiency caused in multiple myeloma?

Answer 40

Monoclonal Ig lodges in glomerular capillary and damages

Question 41

What is paraproteins?

Answer 41

High levels of Ig in the urine due to Multiple Myeloma

Question 42

What is suspected with a Roleaux Formation?

Answer 42

Multiple Myeloma = excess Ig makes RBCs stick together

Question 43

What is suspected with an M spike? what does it mean?

Answer 43

Excess monoclonal Ab | Multiple Myeloma

Question 44

Complications of Multiple Myeloma?

Answer 44

``` Infection (pneumonia) Fractures Neurologic Complications Renal Injury Hyperviscosity of blood Amyloidosis ```

Question 45

If serum protein electrophloresis reveals a monoclonal gammaglobinopathy, what other test must be done to diagnos Multiple Myeloma?

Answer 45

Bone Marrow Biopsy

Question 46

If staining reveals almost exclusively kappa or lambda light chains, what should be expected?

Answer 46

Multiple myeloma

Question 47

Is there lymphadenopathy in multiple myeloma?

Answer 47

no

Question 48

What is it called when an asymptomatic individual has an spike?

Answer 48

Monoglobinopathy of Undetermined Significance (MGUS)

Question 49

What is Bence Jones Protein?

Answer 49

Free light chain Ig

Question 50

How often does burkitts lymphoma progress to leukemia?

Answer 50

Very rarely

Question 51

Do diffuse NHL lymphomas generally have a better or worse prognosis?

Answer 51

Worse