Question | Answer |
reasons for reactive proliferation (lymphocytosis) | chronic infection with M. tuberculosis or B. pertussis, viral infections or stress from CVA, MVC or other traumas |
pathogenetic/etiological factors of lymphocytic neoplasias | radiation/chemo, gene arrangements involving proto-oncogene translocations, oncogenic viral infection (HTLV-1 or EBV), genomic instability syndromes, chronic infection and immune dysregulation (H. pylori MALT lymphoma) |
nl B cell markers | CD19, 20, 22, 79a (like CD3 for T cells), kappa and lambda Ig light chains |
nl T cell markers | remember SINGLE DIGITS: CD2, 3, 4, 5, 7, 8 |
CD45 | leukocyte common antigen, expressed on all nl hematolymphoid opulations |
Virchow's node aka sentinel or signal node | L supraclavicular node that receives drainage from thoracic duct, if it's swollen this indicates an abd ca |
markers of immaturity in lymphoid populations (thus seen most only in immature neoplasms) | CD34 and TdT also CD1a in T cells |
important markers for making distinction btwn classical Hodgkin's lymphoma and nodular lymphocyte predominant Hodgkin lymphoma | CD30 & 15, CD45, CD20, CD3 |
important NK cell markers | CD2, CD7, CD8, CD16, CD5 |
markers useful in subcategorizing B-lineage lymphomas | CD10 (expressed by immature B cells [aka hematogones] or mature germinal center B cells) and T-cell marker CD5 |
marker of cell proliferation, determines the percentage of neoplastic cells actively growing | Ki-67 or Mib-1 |
terms used to describe neoplasms of immature lymphocytes | acute, blastic, central or precursor |
terms used to describe neoplasms of mature lymphocytes | chronic or peripheral |
immunoblast | transformed, reactive and mature lymphocyte |
B-ALL/LBL (B-cell acute lymphoblastic leukemia or just lymphoblastic lymphoma) cells typically express what markers? | CD19 (earliest recognizable B cell marker), CD79a (like CD3 co-receptor for T cells), CD22 (inhibits B cell signaling) and at times CD20 (starting at late pro-B cell stage). normally don't express Ig light chains, (+) CD10 at times (immature B cells) |
distribution of types of cells in ALL | 85% B cell and 15% T cell blasts, also associated marrow suppression |
T-ALL/LBL (T-cell acute lymphoblastic leukemia or just lymphoblastic lymphoma) cells typically express what markers? | CD1a, 2, 3, 4, 5, 7, 8. since these are blasts, they can also express nonspecific lymphoid immature markers TdT and CD34 |
morphology of ALL/LBL cells | very large and round nuclei, high N/C ratio with more cytoplasm than a nl lymphocyte would have, usually able to see nucleoli |
common clinical features of ALL/LBL (usually in young children not older adults) | cytopenias due to lymphoblasts filling up marrow and suppressing growth of other lineages (this rapid growth causes bone pain), LAD, organomegaly, fatigue/weakness, petechiae or other hemorrhages, infections. anterior mediastinal masses, IVC syndrome? |
lymphoma definition and its 2 broad categories | tumor of genetically altered lymphocytes that show evidence of maturation; non-Hodgkins and Hodgkins lymphomas |
"grading system" for NHL | indolent - comprised of small cells that grow slowly but are disseminated at time of dx /// aggressive - large cells that proliferate quickly but are usually localized |
types of indolent NHLs | Chronic Lymphocytic Leukemia/Small
Lymphocytic Lymphoma (CLL/SLL), follicular lymphoma and extranodal marginal zone B-cell lymphoma of MALT |
types of aggressive NHLs | Burkitt lymphoma and diffuse large B-cell lymphoma |
characteristics of follicular lymphoma | pts present with advanced dz, painless and progressive LAD. various proportions of centrocytes and centroblasts that express CD10, nodular with disorganized, crowded follicles; involves t(14;18) moving Ig heavy chain to bcl-2 anti-apoptotic locus |
centroblasts vs centrocytes | blasts: without nuclear grove, round; // cytes: with nuclear groove, "cleaved" cells -- REMEMBER: cyte, cleaved |
pathogenetic mechanism behind extranodal marginal zone B cell lymphoma of MALT | thought to be due to chronic immune stimulation causing MALT like organization of B cells that acquire mutations in various sites like thyroid, salivary glands, skin, stomach, etc. |
characteristics of extranodal marginal zone B cell lymphoma of MALT | CD10 and CD5 negative, one of the few curable indolent lymphomas, lymphoepithelial lesions - infiltrative cell into glands, |
translocations involved with extranodal marginal zone B cell lymphoma of MALT | t(14:18) IGH and MALT1 genes, t(11:18) AP12 and MALT1 genes |
characteristics of
CLL/SLL | indolent, but diffuse leukemia composed of cells which are indistinguishable morphologically from normal mature lymphocytes, CD5+, pts present with anemia, thrombocytopenia, LAD and possibly hepatosplenomegaly |
characteristics of diffuse large B cell lymphoma (DLBCL) | diffuse infiltration of large lymphoid cells, pts present with rapidly growing mass of extranodal or LN tissue, only CD10+ in 25-50% of cases. 20% of cases have bcl-2 translocation, 30% with bcl-6 translocation |
characteristics of Burkitt lymphoma | often associated with HIV or EBV infection , diffusely infiltrates tissues and leaves "starry sky" appearance (lots of histiocytes in neoplastic lymphocyte background), CD10 and 38+, Ki-67 usually 100%, involves myc translocation of chr 8 with Ig chain |
morphologic salient features of Burkitt lymphoma | scattered histiocytes with abundant cytoplasm set in a background of uniformly medium-sized lymphoma cells with round nuclei, peripheral small nucleoli, deeply basophilic cytoplasm, lipid-containing vacuoles, numerous mitotic bodies |
classical Hodgkin lymphoma | relatively few large neoplastic cells, arises in LN of neck or medastinum, half of pts have B sx, spreads in an orderly fashion as one would expect lymph flow to travel, commonly cured |
histological appearance of CHL | Reed-Sternberg cells, very few large neoplastic cells (Hodgkin cells), immunophenotype is unclear but usually B-cell origin, diffuse or nodular infiltrate |
typical CD marker profile for CHL | CD15+ and 30+ // CD 45-, 20-, 3- |
Nodular Lymphocyte Predominant Hodgkin Lymphoma | indolent dz that usually presents with just one enlarged LN in the neck, axilla or inguinal region; (+) are CD45 and 20, (-) are CD3, 15, 30 |
plasma cell myeloma | near or terminally differentiated plasma cells are hyperproliferative within the bone marrow, make tons of Ig, hyperimmunoglobulinemia is what causes sx |
various types of morphologic forms of neoplastic cells seen with Hodgkin lymphoma | popcorn cells with bizarre nuclei, Reed-Sternberg cells with bi or multi-lobulated nuclei, monolobate nuclei are Hodgkin cells which are usually very sparse |