Pathology of Lymphomas Flashcards Preview

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Flashcards in Pathology of Lymphomas Deck (47):
1

Anaplastic large cell lymphoma is always what kind of cell?

T-cell bro!

2

b-cell or t-cell lymphoma more common?

B-cell is more common - accounts for over 90% of lymphoid neoplasms worldwide

3

lymphomas that arise from germinal center?

follilular
burkitt
large cell

4

lymphomas that arise from mantle zone?

naive b-cell mantle cell lymphoma

5

lymphomas that arise from marginal zone?

memory b cell
CLL/SLL
marginal zone lymphoma

6

follicular lymphoma
-common age?
-clinically at diagonsis?

-middle age is common
-widespread disease at Dx
-peripheral and central lymphadenopathy
-splenomegaly
-BM- 40-70%
-PB 10% (PB usually not involved)

7

follicular lymphoma germinal center made up of what cells?

centroblasts & centrocytes

8

follicular lymphoma low grade has what cell type?

mostly centrocytes

9

follicular lymphoma high grade has what cell type?

greater than 15 centroblasts/hpf

10

centrocyte appearance vs centroblast?

-centrocytes are more condensed (condensed = mature)

-blasts are looser looking = immature

11

***follicular lymphoma positive immunephenotype? negative staining?

+ =CD19, CD20, ***CD10***, and ***bcl-2***

- = CD5 and CD3

12

Mantle cell lymphoma
-age group?
-sex predominance?
-general presentation?
-lymphocytosis how often?
-organs usually affects?
-any other organs sometimes?

**-50-60s yr
**-male predominance
**-generalized lymphadenopathy, BM involvement, and liver involvement
-lymphocytosis in 30%
*-splenomegaly in 50% and liver common
-small bowel involvement - lymphomatoid polyposis

13

***mantle cell lymphoma - immunophenotypes + and -?

+ = CD19, CD20, **CD5**, & **cyclinD**

- = CD23 and CD3

14

Burkitt lymphoma
-3 types?

-endemic BL (african)
-sporadic BL (non african, non endemic)
-immunodef BL

15

Endemic BL etiology:

-equatorial Africa
-most common childhood malignancy
-4-7 yo, EBV+ in majority

16

sporadic BL etiology:

-throughout the world
-children and young adults
-30-50% of all childhood lymphomas
-med age of adult 30 yo

17

All BL patients are at risk for:

CNS involvement

18

Endemic BL common sites:

-50% in jaws or facial bones
-ovaries, kidneys and breasts

19

Sporadic BL common sites:

-majority: abdominal masses, ileo-cecal region
-also: ovaries, kidneys and breast
RARELY JAW

20

Immunodeficient-associated BL common sites?

nodal localization and BM

21

BL - morphology:

-DIFFUSE MONOMORPHIC INFILTRATE of intermediate sized round to slightly irregular lymphoid cells with multiple peripherally placed nucleoi
-high mitotic rate
-TINGIBLE BODY MACROPHAGES PRESENT (STARY SKY)

22

***STARRY SKY APPEARANCE?

BL!

23

***BL - immunophenotype:
+ and -?

+ = CD10, CD19, CD20
- = blc-2

24

BL - prognosis:

-very aggressive disease
-responds well to therapy

25

Adult T-cell leukemia/lymphoma
-what kind of cell?
-caused by what?
-where most common?
-age group?

-Mature T-cell only CD4!
-caused by HTLV-1
-Central africa, caribbean, southwestern japan
-long latency
-OCCURS ONLY IN ADULTS

26

Adult t-cell leukemia/lymphoma - presentation?

-not very specific:
--large LN
--large spleen & liver
****--hypercalcemia****
--skin lesions

27

Case has japanese patient and some hypercalcemia disease may be?

Adult t-cell leukemia/lymphoma

28

Type of cell in adult t-cell leukemia/lymphoma?

CD4 T-cell

29

adult t-cell leukemia/lymphoma - appearance of cells?

-appearance varies
-immature are smooth even chromatin with high nucleus to cytpolasm ratio
-more mature chromatin, multilobated nuclei-flower cells or cloverleaf cells

30

Flower cells or clover leafs cells?

adult t-cell leukemia/lymphoma
not specific but need to rule out other potential Dx

31

adult t-cell leukemia/lymphoma - prognosis?

-very aggressve and most die within 1 year w/ treatment

32

new therapy for adult t-cell leukemia/lymphoma?

anti-CD52 antibody - alemtuzumab

33

which adult t-cell leukemia/lymphoma is more indolent?

when skin is primarily involved

34

Mycosis fungoides/Sezary syndrome-
presentation?
what cell type?
survival?

One disease with two clinical manifestations
-SKIN IS ALWAYS INVOLVED***
-malignant lymphocytes are CD4***
-indolent disease - 8to9 yrs survival-ish

35

Mycosis fungoides/Sezary syndrome- appearance for pathology?

malignant cells have cerebriform nuclei- **highly folded nuclear membrane**

36

Mycosis fungoides/Sezary syndrome-
-disease progression?

-skin lesions startwith *premycotic (patch) phase* which has few neoplastic lymphoid cells
-PLAQUE PHASE-increased neoplastic lymphoid cells in epidermis
-TUMOR PHASE - tumor masses, predominantly in dermis

Progresses to involved LN and BMT-

37

Sezary syndrome-presentation:

2 simulataneous manifestations:
-leukemia
-generalized exfoliative eryhroderma

38

t-lymphoblastic leukemia/lymphoma -
-whats important?
-general presentation?

-immature t-cell lymphomas
-medical emergency - patients are short of breath (SOB)
-85% presents as a mass in ant mediastium and cervial LN
-15% as leukemia - similar to B-ALL

39

T-cell ALL clinical presentation?

-abrupt stormy onset - within days to a few weeks of symptoms
-depression of normal marrow: fatigue due to anemia, infection, bleeding, 2ndary to thrombocytopenia
-***MEDIASTINAL MASS***, lymphadenopathy, splenomegally, hepatomegaly due to neoplastic infiltration
-CNS; headache, vomit, nerve palsies due to meningeal spread

40

T-cell ALL - morphology:

monotonous population of blasts similar to B-ALL
-may have more clumped chromatin
sheets of blasts in lymph node, soft tissue or bone marrow

41

****T-cell ALL - immunophenotype markers:

-Positive for: CD34, TdT, CD1a (IMMATURE MARKERS)
-CYTOPLASMIC CD3 + (neg for surface CD3)

42

T-cell ALL - prognosis:

-most T-ALL are higher risk - immature
-more factors;
---under age 2
---presentation in adolescence or adulthood
---presence of philadelphia chromosome 9,22 or translocation involving MLL gene on ch11
---WBC>100K

43

anaplastic large t-cell lymphoma (ALCL):
-etiology:

-immature t-cell lymphoma
-10-20% of childhood lymphomas-- also seen in adults
-involved LN and extranodal sites, mediastinal disease is less frequent then HL
-aggressive

44

ALCL - immunophenotype +/- & prognosis

***-ALK-1 positive = better prognosis
***-ALK-1 negative = poor prognosis in adults

45

***distinct cell in ALCL?

HALLMARK CELLS - abundant cytoplasm and kidney shaped nuclei

46

ALCL - immunophenotype

-ALK+/-, *****CD30+****

-EMA+, CD2, CD5, CD4 = positive 70%
-CD3 negative in 75%
-CD15 engative

47

CD30 positive?

ALCL