Patho week 4

Question 1

Enlargement of lymph node

Answer 1

Lymphadenitis

Question 2

Regions affected in acute non specific lymphadenitis

Answer 2

Cervical: infections of teeth or tonsils
Axillary or inguinal: infections in extremities
Mesenteric: acute appendicitis

Question 3

How are the nodes in acute non specific lymphadenitis

Answer 3

Swollen, gray-red and engorged

Question 4

Characteristics of chronic non specific lymphadenitis

Answer 4

Lymph nodes are nontender
In inguinal and axillary nodes

Question 5

Immune response of follicular and paracortical hyperplasia

Answer 5

Follicular: humoral immune respones (macrophages)
Paracortical: T-cell immune response (immunoblasts)

Question 6

Characteristics of reticular hyperplasia

Answer 6

Increase in number an size of endothelial cells lining lymphatic sinusoids

Question 7

Most common indolent form NHL

Answer 7

Follicular lymphoma

Question 8

Translocation of follicular lymphoma

Answer 8

t(14:18) → overexpression BCL2

Question 9

Predominant cell in follicular lymphoma

Answer 9

Centrocytes → small cells with irregular cleaved nuclear contours and scant cytoplasm

Question 10

Immunophenotype of follicular lymphoma

Answer 10

Express CD19, CD20, CD10, surface Ig, BCL6
Do not express CD5
BCL2 expressed in 90% cases

Question 11

Mutation in diffuse large cell lymphoma

Answer 11

Somatic hypermutation that results in overexpression of BCL6

Question 12

Waldeyer ring is commonly involved in this lymphoma

Answer 12

Diffuse large cell lymphoma

Question 13

Morphology of diffuse large cell lymphoma

Answer 13

Large cell size and diffuse pattern of growth

Question 14

Immunophenotype of diffuse large cell lymhpoma

Answer 14

Express CD19 and CD20
Variable expression of CD10 and BCL6

Question 15

One of the fastest-growing human tumors that predominates in children and young adults

Answer 15

Burkitt lymphoma

Question 16

Morphologic characteristic of Burkitt lymphoma

Answer 16

Starry sky

Question 17

Mutation in Burkitt lymphoma

Answer 17

Translocations MYC gene (chromosome 8)

Question 18

Immunophenotype of Burkitt lymphoma

Answer 18

Express IgM, CD19, CD20, CD10, BCL6
Does not express BCL2

Question 19

Main characteristic of Hodgkin lymphoma

Answer 19

Reed-Sternberg cells

Question 20

Classification of Hodgkin lymphoma

Answer 20

Classical: nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte depletion
Nodular lymphocyte predominance

Question 21

Characteristics of nodular sclerosis in HL

Answer 21

Most common
Good prognosis
Lacunar cells with mixed infiltrate
Deposit of collagen bands

Question 22

Characteristics of mixed cellularity in HL

Answer 22

Mix of inflammatory cells
70% EBV+ and RS
Common older males
Good prognosis

Question 23

Characteristics of lymphocyte-rich in HL

Answer 23

Uncommon
Reactive lymphocytes in background with RS
Very good/excellent prognosis

Question 24

Characteristics of lymphocyte depletion in HL

Answer 24

Least common
Abundant RS and paucity of lymphocytes
Older adults
Bad prognosis

Question 25

Characteristics of nodular lymphocyte predominance in HL

Answer 25

Good prognosis No RS cells Small lymphocytes and macrophages CD20 and BCL6

Question 26

Origin of Reed-Sternberg cells

Answer 26

Originate from germinal center

Question 27

What does classical HL activate

Answer 27

NF-kB

Question 28

Clinical features in multiple myeloma

Answer 28

Calcium elevation Renal failure Anemia Bone lesions

Question 29

Epidemiology of multiple myeloma

Answer 29

Men and Africans 65-70 years old

Question 30

Pathogenesis of multiple myeloma

Answer 30

IGH locus rearrangement in 14q32 and cyclin D1a and D3

Question 31

IL that ensures proliferation and survival of multiple myeloma

Answer 31

IL-6

Question 32

Morphology of multiple myeloma

Answer 32

Destructive plasma cell tumors (plasmacytomas) involving axial skeleton

Question 33

Bones more commonly affected in multiple myeloma

Answer 33

Vertebral column, ribs, skull, pelvis, femur, clavicle, scapula

Question 34

Macroscopic morphology of bone lesions in multiple myeloma

Answer 34

Soft, gelatinous, red tumor masses

Question 35

Cytologic variants in multiple myeloma

Answer 35

Plasmablasts: single prominent nucleolus Multinucleated/bizarre cells Flame cells: fiery red cytoplasm Mott cells: grapelike cytoplasmic droplets Russell bodies: cytoplasmic inclusions Dutcher bodies: nuclear inclusions

Question 36

Immunophenotype of multiple myeloma

Answer 36

CD138+, syndecan-1, CD56+

Question 37

Main complication of multiple myeloma

Answer 37

Renal failure → Bence Jones proteinuria

Question 38

Prognosis of multiple myeloma

Answer 38

Good prongosis: Cyclin D1 translocation Bad prognosis:13q or 17p deletions, t(4:14)

Question 39

Most common mutation in Langerhans cell histiocytosis

Answer 39

Valine-to-glutamate substitution at residue 600 in BRAF

Question 40

Pathogenesis of Langerhans cell histiocytosis

Answer 40

Expresses both CCR6 and CCR7 (rather than just CCR6) → allows neoplastic cells to migrate into tissues and express chemokines

Question 41

Chemokines released in Langerhans cell histiocytosis

Answer 41

CCL20 in skin and bone CCL19 and CCL21 in lymphoid organs

Question 42

Morphology of Langerhans cell histiocytosis

Answer 42

Langerhan cells: many, vacuolated cytoplasm and vesicular nuclei containing linear grooves or folds Birbeck granules in cytoplasm: has langerin

Question 43

Characteristics of multifocal multisystem Langerhans cell histiocytosis

Answer 43

Letterer-Siwe disease <2 years old Development cutaneous lesions resembling seborrheic eruption in trunk and scalp

Question 44

Characteristics of unifocal and multifocal unisystem Langerhans cell histiocytosis

Answer 44

Eosinophilic granuloma Proliferations of Langerhans cells admixed with eosinophils, lymphocytes, plasma cells and neutrophils Arises within medullary cavities of bones (calvaria, ribs, femur)

Question 45

Difference between unifocal and multifocal unisystem Langerhans cell histiocytosis

Answer 45

Unifocal: older children and adults Multifocal: children

Question 46

Hand-Schüller-Christian triad

Answer 46

Calvarial bone defects, diabetes insipidus and exophthalmos

Question 47

Who is affected by pulmonary Langerhans cell histiocytosis

Answer 47

Adult smokers