Goljan Pathology Chapter 13

Front 1

Where in the lymph nodes are B-cells found?

Back 1

Germinal follicles

Front 2

Where in the body are T-cells found (2)?

Back 2

1) Paracortex of lymph nodes
2) Thymus

Front 3

Where in the body are histiocytes found (2)?

Back 3

1) Subcapsular sinus of lymph nodes
2) Skin

Front 4

What is another name for histiocytes?

Back 4

Langerhans cells

Front 5

At what age range is lymphadenopathy usually benign? Malignant?

Back 5

Benign <30 y/o
Malignant >30 y/o

Front 6

What does painful lymphadenopathy usually indicate (2)?

Back 6

1) Infection
2) Autoimmune disease

Front 7

What does painless lymphadenopathy usually indicate (2)?

Back 7

1) Metastasis
2) Primary malignant lymphoma

Front 8

White asterisk: what region?
Solid arrow: what region?
Dotted arrow: what region?

Back 8

White asterisk: germinal follicle
Solid arrow: paracortex
Dotted arrow: subcapsular sinus

Front 9

Metastasis to left supraclavicular lymph node. From where (2)?

Back 9

1) Stomach
2) Pancreatic carcinoma

Front 10

Metastasis to hilar lymph nodes. From where (1)?

Back 10

1) Lung cancer

Front 11

Metastasis to para-aortic lymph node. From where (1)?

Back 11

1) Testicular cancer

Front 12

Follicular hyperplasia. Histologic appearance?

Back 12

Prominent germinal follicles

Front 13

Dermatopathic lymphadenitis such as in psoriasis. Histological appearance.

Back 13

Melanin pigmentation

Front 14

Cat-scratch disease. Cause?

Back 14

Bartonella henselae

Front 15

Toxoplasmosis. Cause? Clinical features?

Back 15

Toxoplasma gondii
Mononucleosis-like syndrome with painful cervical lymphadenopathy

Front 16

Tularemia. Cause? Reservoir? Clinical feature?

Back 16

Francisella tularensis
Rabbits (zoonosis)
Ulceroglandular lesions

Front 17

Sinus histiocytosis in axillary lymph nodes of breast cancer patient. Good or bad?

Back 17

Good

Front 18

Non-Hodkin's lymphoma. Cell of origin?

Back 18

B-cell (>80%)

Front 19

What extranodal sites may non-Hodgkin's lymphoma arise from (3)?

Back 19

1) Stomach
2) CNS
3) Peyer's patch

Front 20

Are non-Hodgkin's lymphoma common in children and adults?

Back 20

Most common malignant lymphoma in adults and children (~60%).

Front 21

What types of non-Hodgkin's lymphoma may EBV cause (2)?

Back 21

1) Burkitt's lymphoma
2) CNS lymphoma

Front 22

What type of non-Hodgkin's lymphoma may H. pylori cause (1)?

Back 22

Malignant lymphoma of stomach

Front 23

Which autoimmune disorders are associated with non-Hodgkin lymphoma (2)?

Back 23

1) Sjogren's syndrome
2) Hashimoto's thyroiditis

Front 24

Mycosis fungoides. What cell type is involved? What tissue is involved?

Back 24

CD4 Th cells
Skin

Front 25

Lymph node section. What pattern is present? Diagnosis?

Back 25

Starry sky pattern with reactive histiocytes.
Burkitt's lymphoma

Front 26

Diagnosis?

Back 26

Follicular lymphoma

Front 27

Sézary syndrome. What?

Back 27

Mycosis fungoides in leukemic phase.

Front 28

Nodular sclerosing Hodgkin Lymphoma. More common in men or women?

Back 28

Women

Front 29

What type of Hodgkin Lymphoma is EBV associated with?

Back 29

Mixed cellularity type.

Front 30

What is the classic neoplastic cell of Hodgkin Lymphoma? Immunophenotype?

Back 30

Reed-sternberg cell. CD15+, CD30+

Front 31

What is required for diagnosis of Hodgkin Lymphoma?

Back 31

Reed-sternberg cell

Front 32

What uncommon fever variant is associated with Hodgkin Lymphoma? Characteristics?

Back 32

Pel-Ebstein fever. Recurring bouts of fever followed by remissions.

Front 33

What is more important for the prognosis of Hodgkin Lymphoma, stage or type?

Back 33

Stage

Front 34

What lymph nodes are involved in nodular sclerosing Hodgkin Lymphoma (2).

Back 34

1) Mediastinal nodes
2) Either cervical or supraclavicular nodes

Front 35

What secondary malignancies are patients with Hodgkin Lymphoma at increased risk for?

Back 35

Acute myelogenous leukemia (AML) or non-Hodgkin lymphoma (NHL)

Front 36

Diagnosis. (include type)

Back 36

Mixed-cellularity Hodgkin Lymphoma.
Notes: Reed-Sternberg cells, eosinophils, plasma cells

Front 37

Diagnosis? (include type)

Back 37

Nodular-sclerosing Hodgkin's lymphoma

Front 38

Langerhans histiocytes. Distinguishing immunophenotype? Pathognomonic intracellular structure?

Back 38

CD1+
Birbeck granules

Front 39

Malignant histiocytosis. What tissues commonly involved (2)?

Back 39

1) Skin
2) Lytic bone lesions

Front 40

Hand-Schuller-Christian disease is a type of malignant histiocytosis. What is the classic triad?

Back 40

1) Lytic skull lesions
2) Diabetes insipidus
3) Exophthalmos

Front 41

Eosinophilic granuloma. What? Clinical finding (1)?

Back 41

Benign histiocytosis
Unifocal lytic lesions in bone

Front 42

Mast cell disease. Clinical signs and symptoms (3)?

Back 42

1) Pruritis
2) Swelling
3) Hyperpigmentation

Front 43

What cell is this? Why?

Back 43

Histiocyte
Birbeck granules

Front 44

Urticaria pigmentosum. Clinical findings (2)?

Back 44

1) Dermatographism
2) Regressed lesions remain hyperpigmented

Front 45

Histology of Urticaria Pigmentosum?

Back 45

Mast cells containing metachromatic granules that stain positive with toluidine blue and Giemsa stain.

Front 46

Plasma cell dyscrasia. Finding on serum protein electrophoresis?

Back 46

Monoclonal spike, usually IgG.

Front 47

Bence Jones protein. What?

Back 47

Light chains (κ or λ) in urine.

Front 48

Biopsy revealed Giemsa positive cells. Diagnosis?

Back 48

Urticaria Pigmentosum

Front 49

What age group does multiple myeloma typically involve?

Back 49

>40 y/o

Front 50

What is the typical cellular progression of multiple myeloma?

Back 50

Normal plasma cell → monoclonal gammopathy of undetermined significance (MGUS) → myeloma

Front 51

Multiple myeloma. Classical bone findings (3)?

Back 51

1) Lytic lesions
2) Pathologic fractures
3) Hypercalcemia

Front 52

Multiple myeloma. Classical renal findings include proteinaceous casts composed of what (2)?

Back 52

1) Bence Jones protein
2) Intratubular multinucleated giant cell reaction

Front 53

Multiple myeloma. Common causes of death (2)?

Back 53

1) Renal failure
2) Sepsis

Front 54

What is the most common monoclonal glomerulopathy?

Back 54

MGUS

Front 55

What cell type is present in the red pulp of the spleen (1)?

Back 55

Macrophages

Front 56

What cell types are present in the white pulp of the spleen (2)?

Back 56

1) B-cells
2) T-cells

Front 57

What is the most common cause of splenomegaly in developing countries?

Back 57

Malaria

Front 58

Gaucher's disease. What is deficient and what is elevated?

Back 58

↓ glucocerebrosidase
↑ glucocerebroside

Front 59

Niemann-Pick. What is deficient and what is elevated?

Back 59

↓ sphingomyelinase
↑ sphingomyelin

Front 60

Massive splenomegaly. Common complications (4)?

Back 60

1) LUQ pain
2) Splenic infarctions
3) Friction rub
4) Left-sided pleural effusion

Front 61

Splenomegaly in cirrhosis. Morphology?

Back 61

Thickened "sugar-coated" spleen

Front 62

Hypersplenism. Causes what?

Back 62

Destruction of hematopoietic cells causing peripheral blood cytopenia.

Front 63

Splenic dysfunction. Increased risk for what?

Back 63

Streptococcus pneumoniae sepsis

Front 64

Mechanisms for septicemia seen in splenic dysfunction (3)?

Back 64

1) ↓ IgM
2) ↓ tuftsin (increases macrophage phagocytic receptors)
3) ↓ splenic macrophages

Front 65

This patient presented with proteinaceous tubular casts and lytic bone lesions. What malignant cell types are shown in this slide?

Back 65

Plasma cells.

Front 66

This patient presented with splenomegaly. This is a bone marrow biopsy. What is the diagnosis?

Back 66

Gaucher's disease
Notes: macrophage with fibrillary appearnae of cytoplasm

Front 67

This patient presented with splenomegaly and a bone marrow biopsy was taken. What is the diagnosis?

Back 67

Niemann-Pick Disease
Notes: Soap bubble appearance of macrophage cytoplasm.