WBC path

Question 1

lymphoma vs leukemia

Answer 1

• Lymphoma = lymphoid neoplasms arising as DISCRETE MASSES
• Leukemia = lymphoid or myeloid neoplasms with INVOLVMENT OF BlOOD AND BONE MARROW

Question 2

Staging of lymphoma

Answer 2

Stage

1. Single lymph node REGION or extralymphatic site
2. two or more lymph node REGIONS or extralymphatic site on same side of diaphragm
3. LN regions or extralymphatic site (IIIE) on both sides of the diaphragm
4. Disseminated or diffuse involvement of one or mroe extralymphatic sites

FOR ALL STAGES

1. A = asymptomatic
2. B = fever, night sweats or > 10% weight loss

Question 3

Clinical presenation of cancer

Answer 3

• PAINLESS, non-tender, lymphadenopathy
• fatigue
• malaise
• night sweats
• fever
• weight loss

Question 4

Follicular lymphoma

Answer 4

• Clinical
  
  • common in middle age
  • Widespread disease at diagnosis
    
    • peripheral and central lymphadenopathy
    • splenomegaly
    • Bone marrow (40-70%) involvement
• lymphoma composed of follicule germinal center cells: centroblasts and centrocytes
  
  • low grade (good) = mostly centrocytes
  • high grade (bad) = greater than 15 centroblasts/hpf
• immunophenotype
  
  • positive = CD19, CD20, CD10, Bcl-2 (B cells markers)
    
    • Bcl-2 is specific to follicular lymphoma (ANTI-apoptotic protein)
  • Negative = CD5, CD3

Question 5

Mantle cell lymphoma

Answer 5

• 5th to 6th decade in MALES
• CLINICAL
  
  • generalized lymphadenopathy, bone marrow involvement, liver involvement
  • Splenomegaly in about HALF, liver is commonly affected
• IMMUNOPHENOTYPE
  
  • Positive = CD19, CD20, Cyclin D1, CD5
    
    • CD5!!!!!! Cyclin D1!!!!!!!! –> specific markers
  • Negative = CD23, CD3

Question 6

Endemic Burkitt lymphoma

Answer 6

• Equitorial africa, most common childhood malignancy
• 4-7 yo, EBV+ in majority
• Clinical
  
  • 50% include Jaws and facial bones
  • involvement of ovaries, kdineys and breast
• RISK OF CNS INVOLVMENT
• IMMUNOPHENOTYPE
  
  • positive = CD10, CD 19 and CD20
  • negative = bcl-2

Question 7

Sporadic Burkitt lymphoma

Answer 7

• non-african, non-endemic)
• throughout the world, children/young adults
• 30-50% of all childhood lymphomas
• median age of adult is 30 yo
• CLINICAL
  
  • Majority = abdomianl masses, ileo-cecal region
  • Involvment of ovaries, kidneys and breast are frequent
  • RARELY INVOLVE JAWS
• RISK FOR CNS INVOLVEMENT
• IMMUNOPHENOTYPE
• positive = CD10, CD 19 and CD20
• negative = bcl-2

Question 8

immunodefiiency burkitt lymphoma

Answer 8

• HIV infection, often is initial manifestation of AIDS
• NODAL LOCALIZATION and involvment of BONE MARROW is frequent
• CNS INVOLVMENT
• IMMUNOPHENOTYPE
  • positive = CD10, CD 19 and CD20
  • negative = bcl-2

Question 9

describe morphology of Burkitts morphology

Answer 9

• DIFFUSE MONOMORPHIC INFILTRATE of intermediate sized round to slightly irregular lymphoid cells with multiple peripehrally placed nucleoli
• TINGIBLE BODY MACROPHAGES PRESENT (“starry-sky pattern”)
  
  • Tingible = stainable
  • tingible body macrophages is predominantly found in germinal cents, containing many phagocytized apoptoic cells in various states of degradation, referred to as tingible bodies