Plasma Cell Disorder and Hodgkin Lymphoma

Question 1

Most Plasma Cell Neoplasms originate as bone marrow tumors and are detectable by measuring ______ in the serum or urine

Answer 1

monoclonal protein (M protein)

Question 2

What does CRAB stand for?

Answer 2

hyperCalcemia, Renal insufficiency, Anemia, Bone lesions

Question 3

When CRAB accompanies 20% nucleated cells in bone marrow, what is the diagnosis?

Answer 3

Plasma Cell Myeloma.

CRAB is the most important criteria for PCM

Question 4

Bone marrow is normally 3%, in PCM it can be ____

Answer 4

about 30-40%

Question 5

elevated creatinine is related to ____

Answer 5

kidney disfunction

Question 6

in PCM which immunoglobulins are you looking to be elevated?

Answer 6

IgM and IgA. Other types of PCM include light chain only, and nonsecretory also IgD, IgE but these are rare.

Question 7

In testing for PCM what does it mean if in a serum protein immunofixation test there are very high levels of one type of heavy chain and one type of light chain?

Answer 7

This is positive for PCM. The abnormal plasma cells all arise from one progenitor, have same ABs.

Question 8

Which chain appears on urine test?

Answer 8

only the light chain.

Question 9

What is rouleaux formation?

Answer 9

occurs in PCM. Its when RBCs stack on top of each other because of all the antibodies. ABs are + charged and RBCs are - charged. Occurs with high m protein serum levels

Question 10

What do you use SPEP and SPI for?

Answer 10

SPEP to see which AB is high, SPI to see which AB (will show a band as opposed to a smear).

Question 11

True or False: If you see the nucleolus in a plasma cell it is neoplastic.

Answer 11

true

Question 12

Hematologic tumor is systemic or local?

Answer 12

systemic, can metastasize everwhere

Question 13

What is MGUS?

Answer 13

presence of monoclonal antibody in the serum or urine with no evidence of a plasma cell myeloma.

Question 14

T or F- MGUS is a precursor to PCM?

Answer 14

T

Question 15

What is Solitary plasmacytoma?

Answer 15

just the singular version of PCM (which is also called multiple myeloma). a single plasmacytoma of bone which is a localized tumor of bone.

Question 16

T or F? Solitary plasmacytoma of bone involves the bone marrow?

Answer 16

F. If it does then it is PCM.

Question 17

Diagnostic criteria for Solitary plasmacytoma of bone

Answer 17

No CRAB. absent or low serum M protein, single bone lesion

Question 18

Diagnostic criteria for MGUS?

Answer 18

M-spike but no CRAB or other multiple myeloma features.

Question 19

What is extraosseous plasmacytoma and where do they typically occur?

Answer 19

localized plasma cell tumors that arise in tissues outside of the bone marrow. 75% occur in the upper respiratory tract.

Question 20

CHL (Classic Hogkin Lymphoma) and NLPHL (nodular lymphocyte-predominant Hodgkin’s lymphoma) are both lymphomas involving what?

Answer 20

B cells

Question 21

CHL and NLPHL both originate where?

Answer 21

B cells in the germinal center

Question 22

What are the four types of CHL?

Answer 22

1. Nodular sclerosis most common 70% of all cases
2. Lymphocyte-rich (best prognosis)
3. Lymphocyte depleted (most aggressive)
4. Mixed cellularity (associated with Eosinophils)

Question 23

What are RS cells?

Answer 23

Reed sternberg cells. Found in CHL.

• They are large B cells
• multiple lobulated nuclei
• nucleolus is large and pink-big cytoplasm
• “owl eye” nuclei

Question 24

What markers do RS cells have? What do they lack that is significant?

Answer 24

Have CD30 and CD 15

Lack common leukocyte antigen CD45

Question 25

What is the morphology of Nodular sclerosis?

Answer 25

- Classic Presentation is an enlarging cervical or mediastinal lymph node in a young adult, usually female. - Lymph node is divided by bands of sclerosis ***most important*** - RS cells are present in lacunar cells.

Question 26

What is mixed cellularity CHL?

Answer 26

- Second most frequent subtype, 20-30% - Lack of broad bands of collagen seen in nodular sclerosis CHL*** probably most important.*** - Frequent in children and older patients - B symptoms Epstein-Barr virus (EBV) infection in ~75% of cases

Question 27

What is lymphocyte rich CHL?

Answer 27

Not much on this one... - Classic RS cells are present though rare ***most important*** - lacks the broad bands of collagen seen in NSHL patients -B cell symptoms

Question 28

When do you typically see lymphocyte depleted CHL?

Answer 28

in older patients and those with HIV

Question 29

Typical characteristics of lymphocyte depleted CHL?

Answer 29

numerous RS cells many of which will look cancerous. The RS cells are abundant and can form clusters.

Question 30

What is a typical radiographic finding of plasma cell myeloma?

Answer 30

Bone "punch outs" where osteoclasts have thinned the bone out significantly.

Question 31

What is a smoldering myeloma?

Answer 31

Well its like a fire that has gone out... the coals still smolder but they are inactive as far as firemaking goes. Smolderimg myeloma is inactive myeloma. It is AKA indolent myeloma

Question 32

Where are the typical locations of plasma cell myelomas and plasmacytomas?

Answer 32

``` PCM= marrow Plasmacytoma= bone and extraosseous ```