Presentations - Ch. 13

Question 1

Enlarged, painful lymph nodes that may be fluctuant, overlying skin is red

Answer 1

Acute nonspecific lymphadenitits - bacterial infection

Question 2

Enlarged, nontender inguinal and/or axillary lymph nodes that grow slowly over time, organized collections of immune cells in nonlymphoid organs (tertiary lymphoid organs)

Answer 2

Chronic nonspecific lymphadenitits - chronic H. pylori gastritis or RA B-cell follicles in synovium

Question 3

Child, abrupt onset, fatigue, fever, bleeding, bone pain, lymphadenopathy, organomegaly, meningitis symptoms (stiff neck, vomiting, etc.)

Explain symptoms

Answer 3

B-ALL (leukemia)

Fatigue = anemia
Fever = neutropenic infections
Bleeding = thrombocytopenia
Bone pain = marrow expansion
Organomegaly and neuro symptoms = neoplastic infiltration

Question 4

Adolescent male, thymic mass, superior vena cava syndrome, Horner’s syndrome

Answer 4

T-ALL (lymphoma)

Question 5

Adolescent/young adult, masses in the mandible and abdominal viscera

Answer 5

Endemic (EBV-associated) Burkitt lymphoma

Question 6

Older adult, rapidly growing masses within LN, liver, spleen, Waldeyer ring (throat) and/or extranodal sites (GI, skin, bone, brain)

Answer 6

DLBCL

Question 7

Adult, chronic inflammatory disease, extranodal mass, indolent

Answer 7

Extranodal marginal zone lymphoma

Question 8

Middle age, generalized painless lymphadenopathy, marrow involvement, indolent, expanded white pulp follicles in spleen

Answer 8

Follicular lymphoma

Question 9

Middle aged white male, pancytopenia, massive splenomegaly, atypical Mycobacterium infections

Answer 9

Hairy cell leukemia

Question 10

Older male, disseminated disease, moderately aggressive

Answer 10

Mantle cell lymphoma

Question 11

Older adult, lytic bone lesions, pathologic fractures, hypercalcemia, renal failure, neurologic manifestations, recurrent bacterial infections

Answer 11

Multiple myeloma

Question 12

Isolated plasma cell mass in bone, extraosseous lesions in lungs, oronasopharynx, or nasal sinuses

Answer 12

Solitary plasmacytoma

Question 13

Older adult, asymptomatic at diagnosis, then nonspecific symptoms (easily fatigued, weight loss), generalized lymphadenopathy, hepatosplenomegaly, periportal lymphocytic infiltrate in liver

Answer 13

CLL/SLL

Question 14

Adult, rapidly progressive, skin lesions, generalized lymphadenopathy, hepatosplenomegaly, lymphocytosis, hypercalcemia

What else can accompany this?

Answer 14

Adult T cell leukemia/lymphoma - Endemic to Japan, West Africa, Caribbean

Progressive demyelinating disease

Question 15

Older adult, generalized lymphadenopathy, eosinophilia, pruritis, fever, weight loss

Answer 15

Peripheral T-cell lymphoma, unspecified

Question 16

Children/young adult, LN and soft tissue disease

Answer 16

Anaplastic large-cell lymphoma

Question 17

Adult, destructive extranodal mass (esp. sinonasal, testis, or skin), ischemic necrosis, EBV

Answer 17

Extranodal NK/T-cell lymphoma

Question 18

Adult, changing cutaneous patches, plaques, nodules, or generalized redness

Answer 18

Mycosis fungoides/Sezary syndrome

Question 19

Adult, lymphocytosis, splenomegaly, neutropenia and anemia, maybe autoimmune (rheumatologic) disease

Answer 19

Large granular lymphocytic leukemia

Question 20

Small monoclonal Ig spike

Answer 20

CLL/SLL

Question 21

Hypogammaglobulinemia, multiple bacterial infections

Answer 21

CLL/SLL

Question 22

10% to 15% of CLL/SLL patients may develop ___ or ___ due to autoantibodies

Answer 22

Hemolytic anemia or thrombocytopenia

Question 23

HIV+, EBV+ neoplastic B cells, rapidly growing mass(es)

Answer 23

Immunodeficiency-associated large B-cell lymphoma (DLBCL subtype)

Question 24

HIV+, KSHV/HHV-8, malignant pleural or ascitic effusion, cells w/ clonal IgH rearrangements, no B or T cell surface markers

Answer 24

Primary effusion lymphoma (DLBCL subtype)

Question 25

Children/young male, mass in ileocecum or peritoneum

Answer 25

Sporadic (American) Burkitt Lymphoma

Question 26

Older adult, asymptomatic, moderately large monoclonal Ig population in the blood (but less than 3 gm/dL)

Answer 26

Monoclonal gammopathy of undetermined significance (MGUS)

Question 27

Asymptomatic, monoclonal Ig population in blood greater than 3 gm/dL, plasma cells are 10% to 30% of marrow cellularity

Answer 27

Smoldering myeloma (between MGUS and MM)

Question 28

50s or 60s, many plasma cells in bone marrow, monoclonal IgM in blood, hyperviscosity

Answer 28

Lymphoplasmacytic lymphoma

Question 29

Nonspecific symptoms, lymphadenopathy, hepatosplenomegaly, anemia, maybe autoimmune hemolysis via cold agglutinins

Answer 29

Lymphoplasmacytic lymphoma

Question 30

Visual impairment, neurologic problems, bleeding, symptoms in cold temperatures

Answer 30

Hyperviscosity syndrome - due to excess IgM secretion

Question 31

Salivary gland disease or thyroid gland disease or chronic gastritis

Answer 31

Marginal zone lymphoma - MALToma type

Question 32

Rheumatoid arthritis, splenomegaly, neutropenia

Answer 32

Felty syndrome - due to Large granular lymphocytic leukemia

Question 33

Young adult male or older male, painless lymphadenopathy, cutaneous anergy, systemic symptoms, advanced tumor stage

Answer 33

Mixed-Cellularity HL

Question 34

Young adult, mediastinal mass, early tumor stage, lacunar cells

Answer 34

Nodular sclerosis HL

Question 35

Older adult or HIV+ or poor country, systemic symptoms, late tumor stage, poor prognosis

Answer 35

Lymphocyte depletion HL

Question 36

Young male, cervical or axillary lymphadenopathy, excellent prognosis

Answer 36

Lymphocyte predominance HL

Question 37

Older adult, anemia, thrombocytopenia, neutropenia, much hemorrhaging, fever, fatigue, recurrent opportunistic infections (Pseudomonas, fungi, commensals)

Answer 37

AML

Question 38

Older adult, maybe asymptomatic, maybe weakness, infections, hemorrhages

Answer 38

MDS

Question 39

Middle age, slow onset, anemia and thrombocytopenia symptoms, dragging sensation in abdomen or LUQ pain, later myeloid blasts in the blood and marrow

Answer 39

CML

Question 40

Late middle age adult, slow onset, plethora, cyanosis, headache, dizziness, HTN, GI symptoms, intense pruritis, peptic ulceration, hyperuricemia Major risk for what?

Answer 40

Polycythemia vera DVT, stroke, MI, bowel infarction, or minor hemorrhages

Question 41

Older adult, elevated platelet count, thrombosis (DVT, venous thromboses, MI), hemorrhage

Answer 41

Essential thrombocytopenia

Question 42

Throbbing and burning of hands and feet

Answer 42

Erythromelalgia - due to small arteriole occlusion in PCV or ET

Question 43

Older adult, progressive anemia and splenomegaly, fullness in LUQ, nonspecific symptoms

Answer 43

Primary myelofibrosis - ealry

Question 44

Under 2 yo, cutaneous lesions over front and back of trunk and scalp, hepatosplenomegaly, lymphadenopathy, pulmonary lesions, bone lesions

Answer 44

Multifocal multisystem Langerhans cell histiocytosis (L-S disease)

Question 45

Child or older adult, eosinophilic infiltration of skull, ribs, or femur that may extend into soft tissue, diabetes insipidus

Answer 45

Histiocytosis X (Eosinophilic granuloma Langerhans cell histiocytosis)

Question 46

Skull bone defects, diabetes insipidus, eyeball protrusion

Answer 46

Hand-Schuller-Christian triad -- Eosinophilic granuloma

Question 47

Adult, smoker, pulmonary lesion of macrophages

Answer 47

Pulmonary Langerhans cell histiocytosis