Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Heme/Lymph Exam > Pathology of Non-Hodgkins Lymphomas > Flashcards

Pathology of Non-Hodgkins Lymphomas Flashcards

(57 cards)

Start Studying
1
Q

B cell lymphoblastic leukemia/lymphoma (B-LBL or B-ALL) - clinical features

A

*children > adults
*abrupt stormy onset; days-weeks of first symtpoms
*predominantly leukemic:
-peripheral blood/bone marrow involvement
-sx related to marrow dysfunction: fatigue, infections, bruising
-bone pain: marrow/subperiosteum infiltration
*extramedullary involvement frequent:
-CNS: headache, vomiting, and nerve palsies resulting from meningeal spread
-organomegaly: lymph nodes, spleen, liver, gonads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

B cell lymphoblastic leukemia/lymphoma (B-LBL or B-ALL) - clinical course

A

*typically aggressive
*prognosis depends on cytogenetics
*80% cure rate in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

B cell lymphoblastic leukemia/lymphoma (B-LBL or B-ALL) - morphology

A

*primitive lymphoblasts replace tissue (Tdt+)
-no auer rods
-sites: peripheral blood/bone marrow; nodes and extranodal sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

B cell lymphoblastic leukemia/lymphoma (B-LBL or B-ALL) - phenotype

A

*IMMATURE B cells:
-Tdt, CD34 (markers of maturity)
-CD19, CD10 (markers of B lineage)
-negative for CD20, Sig kappa/lambda
-Ki-67 proliferation > 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

B cell lymphoblastic leukemia/lymphoma (B-LBL or B-ALL) - genotype

A

t(9;22) - BCR/ABL = favorable
t(4;11) AF4/MLL = unfavorable

hyperdiploidy > 50 = favorable
hypodiploidy < 44 = unfavorable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T cell lymphoblastic leukemia/lymphoma (T-LBL or T-ALL) - clinical features

A

*adolescents
*predominantly lymphomatous:
-mediastinal mass: compression of large vessels and airways; pleural effusions
-CNS: headache, vomiting, and nerve palsies resulting from meningeal spread
-organomegaly: lymph nodes, spleen, liver, gonads
*peripheral blood/bone marrow frequent:
-symptoms related to marrow dysfunction: fatigue, infections, bruising
-bone pain: marrow/subperiosteum infiltration

note - aggressive clinical course; good prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T cell lymphoblastic leukemia/lymphoma (T-LBL or T-ALL) - morphology

A

*primitive lymphoblasts replace tissue
*no auer rods
*sites:
-anterior mediastinum/nodes
-peripheral blood/bone marrow
*thymus replaced by lymphoblasts

note - morphologically indistinguishable from B-ALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T cell lymphoblastic leukemia/lymphoma (T-LBL or T-ALL) - phenotype

A

*IMMATURE T cells
-Tdt, CD34
-CD7, CD3
-CD4/8 CO-EXPRESSION (b/c immature)
-Ki-67 proliferation > 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T cell lymphoblastic leukemia/lymphoma (T-LBL or T-ALL) - genotype

A

*TCR genes rearranged
*30% cases translocations TCR loci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - clinical features

A

*90% of chronic lymphoid leukemias
*adults > 40 years; M>F
*USUALLY ASYMPTOMATIC
*lymphadenopathy +/- organomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - peripheral blood

A

*absolute lymphocytosis > 5K
*small mature cells (scant cytoplasm, condensed, clumped “soccer ball” chromatin)
*“SMUDGE CELLS” (arrows on image)
*prolymphocytes < 55%
*anemia
*thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - indolent course

A

*prognosis generally very good:
-asymptomatic pt: median survival > 10 years, even without treatment
-symptomatic patients are treated

note - “Richter transformation” = aggressive tumor progression, low median survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - bone marrow

A

*diffuse interstitial lymphoid infiltrate or nodular lymphoid infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - lymph nodes

A

*diffuse effacement:
-monotonous round small lymphocytes
-clumpy “soccer ball” chromatin
*“pseudofollicular” proliferation centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - phenotype

A

*MATURE B cells
-CD19, CD20, sIg kappa/lambda
-CD5+ (IMPORTANT - this is a T cell marker)
*Ki-67 proliferation < 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - genotype

A

*IGH, IGL genes clonally rearranged
*karyotypic/genetic abnormalities prognostic:
-TP53 mutations = worse prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

follicular lymphoma - clinical features

A

*most common indolent NHL in US (25-30% of NHL; adults)
*often ASYMPTOMATIC
*“waxing/waning” lymph nodes - painless, generalized lymphadenopathy
*usually higher stage:
-multiple lymph node sites (III,IV)
-bone marrow involved
-may be extranodal: spleen, liver, GI, skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

follicular lymphoma - clinical course

A

*indolent, INCURABLE course
*prognosis generally good:
-“gentle” chemo
-median survival 7-9 years
*up to 30% progress to a more aggressive tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

follicular lymphoma - morphology

A

*nodular growth pattern:
-effacing node
-“back-to-back” follicles
-extracapsular extension

*mixed cell composition:
-small “rasinoid” centrocytes with cleaved nuclei
-larger centroblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

follicular lymphoma - phenotype

A

*MATURE B cells:
-CD19, CD20, sIg kappa/lambda
-CD10 (germinal center marker)
-BCL2 protein!!
-Ki-67% proliferation < 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

follicular lymphoma - genotype

A

*IGH, IGL genes clonally rearranged
*t(14;18) BCL2/IgH genotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

diffuse large B-cell lymphoma - clinical features

A

*most common lymphoma in US
*all ages, more common in adults > 50 years
*RAPIDLY ENLARGING, SYMPTOMATIC MASS:
-nodal
-extranodal common
*may be de novo or secondary to other B-NHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

diffuse large B-cell lymphoma - clinical course

Study These Flashcards
A

*aggressive, CURABLE course
*different distinct molecular subtypes have differing clinical outcomes
*intensive combination chemo & anti-CD20 immunotherapy

23
Q

diffuse large B-cell lymphoma - morphology

Study These Flashcards
A

*diffuse, destructive growth
*LARGE LYMPHOID CELLS:
-pleomorphism
-irregular nuclear contours
-may have prominent nucleoli
*mitoses and necrosis common

24
diffuse large B-cell lymphoma - phenotype
*MATURE B cells: -CD19, CD20, sIg kappa/lambda -other variable expressions (CD5, CD10, BCL2, etc) -Ki-67 proliferation 50-100% *MAY BE EBV ASSOCIATED
25
diffuse large B-cell lymphoma - genotype
*IgH, IgL genes clonally rearranged *non specific chromosomal or genetic abnormalities
26
anaplastic large cell lymphoma - clinical features
*children and young adults *rapidly enlarging, symptomatic mass -nodal, extranodal common (skin, bone, soft tissue, liver, lung) *may be advanced stage with B-symptoms (but it is a T cell lymphoma)
27
anaplastic large cell lymphoma - clinical course
*aggressive, curable course *>80% survival
28
anaplastic large cell lymphoma - morphology
*complete to partial nodal effacement *sinusoidal infiltrate *large pleomorphic cells: -"Hallmark" cells = reniform nuclei -multi-nucleated "wreath" cells -"donut" cells -Reed-Sternberg cells
29
anaplastic large cell lymphoma - phenotype
*MATURE T cells *T-cell or "null" phenotype: +/- CD3, CD4 +CD30 +/- ALK-1 protein
30
anaplastic large cell lymphoma - genotype
*TCR genes clonally rearranged ***t(2;5) → ALK/NPM fusion protein** *genotype is important for distinguishing from Hodgkin's Lymphoma: anaplastic large cell lymphoma has a 2;5 TRANSLOCATION; Hodgkin's does NOT -AND Hodgkin's is B-cell; anaplastic is T-cell
31
Classic Hodgkin Lymphoma (CHL) - clinical features
*bimodal age distribution: young adults (2nd and 3rd decade); elderly (>60 years) *PAINLESS LYMPHADENOPATHY: mediastinal, cervical, para-aortic *typically low stage I/II *may have B-symptoms *may be EBV associated
32
Classic Hodgkin Lymphoma (CHL) - clinical course
*indolent, CURABLE course *tumor stage most important prognostic factor -stages I/IIA cure > 90%
33
Classic Hodgkin Lymphoma (CHL) - morphology
*REED-STERNBERG CELLS -multi/bi/mono-nuclear 1-10% of tumor cell population *inflammatory background: -eosinophils, neutrophils -lymphocytes, plasma cells *collagen fibrous bands (+/- nodular growth pattern) *lymph node capsular fibrosis
34
Classic Hodgkin Lymphoma (CHL) - phenotype
*"broken" mature B cells *"null" lineage phenotype (negative: CD19, CD20, sIg kappa/lambda) ***positive for CD30, CD15 (Reed Sternberg cells)** *+/- EBV
34
Classic Hodgkin Lymphoma (CHL) - genotype
*IgH, IgL genes clonally rearranged *no specific chromosomal/genetic abnormalities
35
plasma cell myeloma (multiple myeloma) - clinical features
*bone marrow involvement (bone fractures, pain): -radiographically: multiple PUNCHED-OUT, LYTIC BONE LESIONS (spine, ribs, and skull especially) *immunoglobulin protein secretion: -MONOCLONAL SERUM GAMMOPATHY -Bence Jones proteins found in the urine: ~monoclonal immunoglobulin kappa/lambda light chains
36
plasma cell myeloma (multiple myeloma) - peripheral blood
*normochromic, normocytic anemia *ROULEAUX FORMATION - correlates with magnitude of gammopathy *occasional plasma cells *leukopenia *thrombocytopenia
37
plasma cell myeloma (multiple myeloma) - bone marrow
*plasmacytosis with atypia (hypercellular marrow with replacement by plasma cells - see image): -patchy, interstitial, focal, or diffuse -multinucleation -nucleoli -cytoplasmic or nuclear inclusions > 10% plasma cells for multiple myeloma (<10% for MGUS)
38
plasma cell myeloma (multiple myeloma) - phenotype
*unique "post-mature" B cells in bone marrow: -CD38, CD138, cytoplasmic Ig kappa/lambda -CD56 -negative for BD19, CD20, sIg kappa/lambda
39
plasma cell myeloma (multiple myeloma) - genotype
*IGH, IGL genes clonally rearranged *IGH TRANSLOCATIONS [ex. t(11;14)]
40
Burkitt Lymphoma - morphology
*"starry sky" histiocytes with apoptotic debris on biopsy of tumor and/or bone marrow *effacing (destroying) underlying tissue architectures
41
Burkitt Lymphoma - phenotype
*MATURE B-cells: -CD19, CD20, sIg kappa/lambda -CD10 *Ki-67 proliferation ~100% *may be EBV-associated note - negative for CD34, TdT
42
Burkitt Lymphoma - genotype
*MYC (8q24) REARRANGEMENT: t(8;14) MYC/IGH rearrangement !!!!
43
Burkitt Lymphoma - prognosis
*potentially curable with intensive chemo *treatment begins ASAP due to rapid doubling time or tumor *include CNS prophylaxis
44
hairy cell leukemia (HCL) - clinical features
*rare distinctive B-cell non-Hodgkin Lymphoma *PANCYTOPENIA (weakness/fatigue, easy bruising, recurrent opportunistic infections) *SPLENOMEGALY
45
hairy cell leukemia (HCL) - clinical course
*indolent, CURABLE course *sensitive to alpha-interferon, purine analogs 2-cda *BRAF inhibitors
46
hairy cell leukemia (HCL) - peripheral blood
*lymphocytosis: -large, round, oval, reniform nuclei -moderate/abundant pale cytoplasm with "hairy" or "villous" projections *cytopenias: anemia, neutropenia, monocytopenia, thrombocytopenia
47
hairy cell leukemia (HCL) - bone marrow
*lymphocytic infiltrate: -"fried egg" cells (round cells with pale cytoplasm and distinct cell borders) *"dry tap": -increased reticulin fibrosis -inaspirable
48
hairy cell leukemia (HCL) - phenotype
*MATURE B cells -CD19, CD20, sIg kappa/lambda -HCL markers: CD11c, **Cd103**, CD25
49
hairy cell leukemia (HCL) - genotype
BRAF MUTATIONS !!!
50
mycosis fungoides - clinical featuers
*rare, mainly affects adults/elderly *CUTANEOUS INVOLVEMENT: -widespread distribution +/- ulceration -plaques/patches/papules -tumors note - it is a T cell lymphoma of the skin
51
mycosis fungoides - clinical course
*indolent, INCURABLE course: *long natural history: -slow dissemination & long-term survival -median survival 8-9 years *prognosis depends on clinical stage: small may transform to more aggressive subtype
52
mycosis fungoides - morphology
*dermal infiltration of medium-sized "cerebriform" cells *epidermotropism with Pautrier microabscess
53
Sezary Syndrome - clinical features
*systemic generalized disease *LEUKEMIC FORM OF MYCOSIS FUNGOIDES (peripheral blood with sparing of bone marrow) *generalized exfoliative erythroderma (pruritis, alopecia, etc)
54
Sezary Syndrome - morphology
*peripheral blood: -atypical lymphocytosis -circulating Sezary cells and variants *skin/other tissues: -skin: histology similar to mycosis fungoides -lymph nodes: paracortical expansion with atypical cerebriform cells
55
Sezary Syndrome - phenotype
*MATURE T cells: -CD3, CD4, also CD2, CD5 -loss of pan T-cell antigen: CD7 -CCR4, CCR10

Heme/Lymph Exam (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions