Non-Hodgkins Lymphoma Pathology Flashcards by K Medina

Normal lymph node

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What is the “dark zone” of the lymph node?

area that is reacting to Ag → centroblasts are undergoing proliferation, somatic mutation & isotype switching

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Centrocytes

small cleaved lymphocytes exhibiting surface Ab in the light zone

(centroblasts are in the dark zone)

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mantle zone of lymph node contains _____

naive b-cells

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Marginal zone (just outside mantle zone) contains ______ (2)

naive B-cell
memory B-cells

(they’re just chillin’)

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Ki67 role in dx

proliferation marker for lymph follicle

(proliferation may be normal, but it can aid in dx)

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Non-Hodgkin’s Lymphoma (malignant lymphoma) arises within the _____.

lymph nodes, not in bone marrow (can metastasize there though)

(or other organs rich in lymphoid tissue; leukemias arise in bone marrow and metastasize to lymph nodes. “leukemia/lymphoma” used when we aren’t sure where it started first)

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Neoplastic cells are monoclonal, how can we tell if the cells (T cell or B cells) are monoclonal?

B cells: light chain restriction
T cells: TCR arrangement

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CD5+ is a good dx marker for which 2 N-H lymphomas?

SLL/CLL
Mantle

(Rules out follicular and marginal zone)

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Hodgkin’s Lymphoma (malignant lymphoma) risk factors (3)

Immunodeficiency
Chronic autoimmune diz
Chronic infections

(immune system being overly stimulated)

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2 Clinical findings of Non-Hodgkin’s Lymphoma (malignant lymphoma)

painless lymphadenopathy
B-type sx: fatigue, fever, wt. loss, night sweats

(may have extranodal sx if metastasized: abdominal pain, rash, sensorimotor, chest pain)

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Low-grade lymphoma is well differentiated tumor; High-grade is a poorly differentiated tumor. Which has the better prognosis?

Low-grade

(low grade: painless lymphadenopathy, no B-symptoms; high-grade is the opposite)

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Hodgkin’s lymphoma staging is the similar as leukemia. What is the general staging?

1: 1 lymph node involved or single extranodal site

1B: + systemic sx (B-sx)

2: 2+ lymph nodes on same side of diaphragm
3: both sides of diaphragm
4: extranodal involvement, both sides of diaphragm

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How do you tell the difference between benign and malignant lymph node changes?

malignant: painful
benign: gets better, goes down

(bx to confirm)

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What is the main finding that indicates a benign reactive changes (hyperplastic) of lymph nodes?

interfollicular area (spaces btwn follicles)

(mantle zone, dark/light zones present)

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What is the most important immunophenotypic finding of benign changes to the lymph node?

bcl-2 negative (anti-apoptotic protein) in the follicle

(CD3+, CD20+ cells present)

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Why is this a neoplastic follicle (2)?

loss of zonal definition w/absent mantle zone (loss of polarity)
No tingible body MF

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MC form of adult indolent NHL?

follicular lymphoma

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Mutation in follicular lymphoma (type of NHL)

t(14;18) → BCL-IgH fusion gene

(anti-apoptotic effect)

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Key terms of histopathology that indicate follicular lymphoma?

atypical lymphocyte
cleaved v. non-cleaved

(more importantly, look for cytogenetics and immunophenotype)

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MC type of NHL?

diffuse large B-cell lymphoma (also MC adult NHL)

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Diffuse Large B-Cell lymphoma may arise from which two hematologic cancers?

Follicular lymphoma
CLL→Richter transformation

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dx?

(left: intermediate power; right: high power)

Diffuse B-cell Lymphoma (high grade tumor)

(any lymph node may be affected)

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What does this tell you?

CD10 is a malignant marker

(found in Burkitt lymphoma, follicular & diffuse large b-cell. Next you need to determine cytogenetics)

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CD10+, CD19+, CD20+ w/Surface Ig + (light chain restriction) and a BCL6 rearrangement of **3q27** indicates which hematologic cancer?

diffuse large B cell lymphoma | (bcl-2 t(11;14) is 2nd MC)

Diffuse B cell Lymphoma is most common in which demographic?

~ 60 y/o men

Diffuse B-cell Lymphoma typically appears w/ a rapidly growing \_\_\_\_\_\_.

mass (nodal or extra nodal)

Waldeyer ring, liver/spleen or skin are common locations of _____ in diffuse b-cell lymphoma

rapidly growing mass that appears

Untreated, diffuse B-cell lymphoma prognosis

* ~55% survive 5 years w/treatment (rituximab) * rapidly fatal w/o treatment (\<1 year) → intensive chemo

What is a dangerous side effect of chemotherapy when treating aggressive cancer?

tumor lysis syndrome: electrolyte dump from the dying cells (hypercalcemia, hyperkalemia)

Why is this follicular lymphoma (2)?

1. follicular enlargement of different sizes and shapes 2. decreased interfollicular spacing

Follicular lymphoma is a \_\_\_\_\_\_-grade tumor

low

The majority of follicular lymphoma have extranodal involvement, such as \_\_\_\_\_\_(4)

1. ***_bone marrow_*** 2. spleen 3. liver, GI 4. CNS (note DLBCL does NOT involve bone marrow until late course)

Bone marrow bx in follicular lymphoma will show \_\_\_\_\_\_

paratrabecular lymphoid aggregates

Any time there is a B-cell malignancy you may see _____ (3).

1. Autoimmune hemolytic anemia 2. thrombocytopenia 3. M-spike (paraproteins from clonal cells → hemolytic anemia or M-spike)

Both follicular lymphoma, DLBCL, and Mantle Cell lymphoma present at _____ stage

III/IV

\_\_\_\_\_\_\_ presents as **waxing and waning** with painless lymphadenopathy in older adults.

Follicular lymphoma

How can you tell a follicular lymphoma apart from benign changes in the lymph node?

benign changes will be CD5(-) (and CD43(-); both may be nodular)

\_\_\_\_\_\_\_ are the only 3 lymphomas that are CD5+.

1. Mantle cell 2. CLL/SLL 3. Hairy cell (mantle cell is CD23(-); CLL/SLL are CD23+)

Both DLBCL, FL & Mantle Cell Lymphoma have SIg+ with light chain restriction. Which has IgM w/or w/o IgD?

Mantle cell (NHL) is CD23(-); CLL/SLL are CD23+. What is one other distinguishing factor between them?

Mantle cell has NO proliferation centers (lymphoblastic lymphomas have homogenous proliferation cells)

CD5+, CD10- distinguishes Mantle Cell Lymphoma from \_\_\_\_\_\_

follicular (which is CD10+)

CD5+, CD10- distinguishes Mantle Cell Lymphoma from \_\_\_\_\_\_

follicular

Mutation t(11;14) → cylinD1-IgH fusion indicates \_\_\_\_\_\_

Mantle Cell Lymphoma (this allows bypass of normal G1-S phase regulation)

Mantle cell lymphoma has a good short-term prognosis, but poor long-term without \_\_\_\_\_

bone marrow transplant | (usually causes organ failure)

What is a “blastoid variant” of mantle cell lymphoma?

proliferative profile (even worse prognosis)

Mantle cell lymphoma involves _____ cells, this is the reason why there is no somatic hypermutation.

naive B cells (in contrast to Marginal Zone Lymphoma, which involves mature B cells)

\_\_\_\_\_\_\_ presents as a **disseminated** disease in older males. (hint: may also involve GI polyps)

Mantle cell lymphoma

**t(11;18)** mutation, MALTomas (80% of cases) & chronic inflammation are diagnostic features of \_\_\_\_\_\_.

marginal zone lymphoma (mature B cells; also lack of other markers you would expect to see)

Chronic inflammation of \_\_\_\_\_\_\_3 glands can lead to Marginal zone lymphoma.

1. **stomach (H.pylori or celiac)** 2. salivary (Sjogren's) 3. thyroid (Hashimoto's) (may regress if this inflammation is cured, i.e. abx)

(stomach tissue)

MALToma: effacement by malignant lymphocytes (will produce GI sx: nausea, anorexia, pain)

(stomach

effacement by malignant lymphocytes

CD19/20/10+, BL6, “starry sky” histology and failure to express BCL-2 is diagnostic of \_\_\_\_\_\_

Burkitt lymphoma (the fastest growing human tumor) (also EBV association)

“starry sky” describes \_\_\_\_\_

histology of burkitt lymphoma: tingible MF phagocytizing apoptotic debris

“tingible body” macrophage

Burkitt lymphoma: vacuoles + deep blue cytoplasm

t(\_\_\_;\_\_\_) → _____ fusion is present in the majority of Burkitt lymphoma cases

t(8;14) → MYC-IgH | (this leads to the Warburg effect)

All cases of African/endemic Burkitt lymphoma are from a _____ and primarily affect the \_\_\_\_\_.

* latent EBV infection * mandible or small intestine (very aggressive, mass can appear w/in weeks; fastest growing human tumor)

**Sporadic** Burkitt lymphoma is a common childhood cancer that is NOT associated with ______ and is commonly located in the \_\_\_\_\_.

* EBV * distal ileum and cecum (African/endemic burkitt is assoc. w/EBV)

EBV & HTLV-1 are associated with which malignancy?

Peripheral T cell Lymphoma | (mature T cells)

CD3+, CD4+ w/diffusely effaced LN & B-symptoms is diagnostic of \_\_\_\_\_\_\_

nodal cell lymphoma (note: it is CD8(-))

Non-Hodgkins Lymphoma Pathology Flashcards

(61 cards)