Pathology - S2B2 - Wbc/lymph 5

Front 1

Define Lymphoblastic Lymphoma

Back 1

Neoplasm of precursor T cells

Front 2

Neoplasm of precursor T cells that affects Adolescent Males and presents with an Anterior Mediastinal mass

Back 2

Lymphoblastic Lymphoma

Front 3

How does Lymphoblastic Lymphoma present usually?

Back 3

Anterior Mediastinal Mass in Adolescent Males
- can present with pulmonary symptoms related to the mass
-compress the trachea and major bronchi and lead to airway obstruction

Front 4

Mimics B cell ALL morphologically

Back 4

Lymphoblastic Lymphoma

Front 5

Define Burkitt Lymphoma

Back 5

highly aggressive neoplasm of MATURE B cells

Front 6

Describe the pathogenesis of Burkitt Lymphoma

Back 6

1. Viral infection (HIV or EBV)
2. C-myc proto-oncogene overexpression
3. t(8;14) translocation

Front 7

Describe the pathology of Burkitt Lymphoma

Back 7

1. Diffuse infiltrate of Intermediate size Lymphocytes = effaces the lymph node architecture
2. High mitotis activity
3. Tumor cell apoptosis
4. Starry sky pattern

Front 8

Describe the Endemic type of Burkitt Lymphoma

Back 8

1. Africa or New Guinea
2. Children are affected
3. Mandible involvement
4. associated with EBV

Front 9

Describe the Sporadic type of Burkitt Lymphoma

Back 9

1. USA
2. Children or young adults
3. Abdominal mass
4. associated with HIV

Front 10

Neoplasm of CD4+ cells that is endemic to Japan and Caribbean

Back 10

Adult T cell Leukemia/Lymphoma

Front 11

What does the pathogenesis of Adult T cell Leukemia/Lymphoma involve?

Back 11

HTLV-1 infection

Front 12

List the clinical symptoms of Adult T cell Leukemia/Lymphoma (3)

Back 12

1. Skin lesions
2. HYPERCALCEMIA
3. Enlargement of the Spleen, Lymph Nodes, and Liver

Front 13

Adult T cell Leukemia/Lymphoma

Back 13

Hyperlobated "4-leaf clover" lymphocytes in the peripheral blood

Front 14

What is the prognosis of Adult T cell Leukemia/Lymphoma?

Back 14

median survival < 1 year

Front 15

Define Mycosis Fungoides/Sezary Syndrome

Back 15

Skin neoplasm of CD4+ T cells

Front 16

Skin neoplasm of CD4+ T cells that produces skin plaques, then nodules, then tumors

Back 16

Mycosis Fungoides

Front 17

Skin neoplasm of CD4+ T cells that presents with Diffuse Erythroderma (redness)

Back 17

Sezary Syndrome

Front 18

What is the prognosis of Mycosis Fungoides / Sezary Syndrome?

Back 18

median survival > 5 years

Front 19

What is the treatment for Mycosis Fungoides / Sezary Syndrome?

Back 19

Chemotherapy

Light Therapy = kills lymphocytes --> palliates disease

Front 20

Describe the histology of Mycosis Fungoides / Sezary Syndrome

Back 20

Epidermotropic lymphocytes
- Pautrier microabscesses of the skin
- Cerebriform nucleus (nuclear membrane folding) of lymphocytes

Front 21

List the 3 general features of Hodgkin Disease

Back 21

1. B cell neoplasm

2. Neoplastic cell is Reed-Sternberg Cell

3. CONTIGUOUS spread = goes from one node to adjacent lymph node

Front 22

Describe Nodular Sclerosis Hodgkins Disease (5)

Back 22

1. Most common HD = 70%
2. affects YOUNG FEMALES
3. Anterior Mediastinal mass
4. Lymphoid nodules surrounded by fibrotic bands
5. Lacunar Cells (RS variant)

Front 23

Describe Mixed Cellularity HD

Back 23

1. affects Males
2. comprises 25% of HD's
3. Diffuse Polymorphous infiltrate = lymphocytes, eosinophils, plasma cells, histiocytes

Front 24

Describe Lymphocyte Predominant HD

Back 24

1. Least common = 5%
2. Males most affected
3. Nodules of small mature Lymphocytes = Popcorn cells (RS variant)
4. associated with "good prognosis"

Front 25

List the clinical features of Hodgkin Disease

Back 25

1. Localized lymphadenopathy (especially Axillary & Cervical)
2. B symptoms
-fever, night sweats, weight loss
3. Pruritis
4. Alcohol induced lymph node pain

Front 26

Describe Stage I HD

Back 26

Single Lymph Node group

Front 27

Describe Stage II HD

Back 27

2 or more lymph node groups on the same side of the Diaphragm

Front 28

Describe Stage III HD

Back 28

Lymph Node regions on both sides of Diaphragm

Front 29

Describe Stage IV HD

Back 29

Disseminated disease

Front 30

Describe the treatment for the Stages of HD

Back 30

Stage 1 & 2 can have Radiation alone

Stage 3 & 4 need radiation and Chemo combo

Front 31

What is the survival rate for Stage I and II HD?

Back 31

90% 5 year survival

Front 32

What is the survival rate for Stage IV HD?

Back 32

60-70% 5 year survival

Front 33

What are the complications of HD?

Back 33

Secondary Malignancy
1. Carcinoma = lung, breast, stomach
2. Hematologic = AML, MDS
3. Sarcoma, Melanoma

**due to radiation and chemotherapy

Front 34

Burkitt Lymphoma
-Starry-sky appearance
-large cells with clear cytoplasm = macrophages engulfing apoptotic cells

Back 34

What disease?

Front 35

Mycosis Fungoides/Sezary Syndrome

Pautrier Microabscess

Back 35

What disease?
What is this called?

Front 36

Reed-Sternberg Cell = owl-eye binucleated cell

Hodgkin Disease

Back 36

What is the arrow pointing at?

What disease?

Front 37

What is the survival rate for Stage I and II HD?

Back 37

90% 5 year survival

Front 38

What is the survival rate for Stage IV HD?

Back 38

60-70% 5 year survival

Front 39

What are the complications of HD?

Back 39

Secondary Malignancy
1. Carcinoma = lung, breast, stomach
2. Hematologic = AML, MDS
3. Sarcoma, Melanoma

**due to radiation and chemotherapy

Front 40

-Nodular Sclerosis HD
-Lymphoid nodules surrounded by fibrotic bands
-Females

Back 40

What specific disease?
How do you know?
What gender?

Front 41

Reed-Sternberg cell

Hodgkin Disease

Back 41

What is this showing?
What disease?

Front 42

Lacunar cells

Nodular Sclerosis

Back 42

What are these cells called?

What disease?

Front 43

Popcorn Cell = large mononuclear cells with high irregularly folding nucleus

Lymphocyte predominance HD

Back 43

What are these cells called?

What disease?

Front 44

Mycosis Fungoides / Sezary Syndrome
-Cerebriform nucleus = nuclear membrane folding

**The cells with the nuclear cleft are malignant CD4 T helper cells, or Sezary cells. They stain positive for PAS (not demonstrated in this slide) and have PAS positive chunks of material located around the nucleus ("ring around the collar" analogous to ringed sideroblasts in sideroblastic anemias").

Back 44

What disease are these cells found in?

Front 45

B. Hodgkin Disease

Back 45

-

Front 46

D. Spleen

**Hairy Cell Leukemia results in massive Splenomegaly

Mandible = Endemic Burkitts
Skin = ATLL or Mycosis Fungoides/Sezary Syndrome
Stomach = MALToma or Burkitt

Back 46

-

Front 47

A 22-year-old man presents with a painless lump in his neck. Upon further questioning he has had a low-grade fever, drenching night sweats, 14 lb. weight loss over the past 6 wks, and his skin is itchy. He also states that after a night of drinking he has pain in the lump in his neck

Back 47

Hodgkin Lymphoma
-PAINLESS LYMPHADENOPATHY
-Pruritis
-Splenomegaly
-Low grade fever, night sweats, weight loss

Front 48

T cell cancer associated with Hypercalcemia

Back 48

Adult T cell Leukemia/Lymphoma