Pathoma - Lymphadenopathy, Lymphoma - Fundamentals Of Pathology

Front 1

LAD refers to __________.

Back 1

enlarged lymph nodes

Front 2

Painful LAD is seen with _______________.

Back 2

acute infection

Front 3

Painless LAD is seen with ______________.

Back 3

chronic inflammation, metastatic carcinoma, lymphoma

Front 4

What region of the lymph node would expand in rheumatoid arthritis?

Back 4

Follicles

Front 5

What region of the lymph node would expand in early HIV?

Back 5

In HIV we see generalized lymphadenopathy and the region is the follicles (HIV infects CD4+ cells, however, cells of the follicle, the follicular dendritic cells are also CD4+)

Front 6

What region of the lymph node would expand in viral infections?

Back 6

Paracortex

Front 7

What region of the lymph node would expand in sinus histiocytosis?

Back 7

This is classically seen in lymph nodes draining tissue with cancer (reactive).

Front 8

Histiocytes live deep in the ________ of lymph nodes.

Back 8

medulla

Sinus histiocytes would be present in the encircled areas.

Front 9

Lymphoma is what?

Back 9

Neoplastic proliferation of lymphoid cells that form a mass.

Front 10

Where do lymphomas arise?

Back 10

May arise in lymph nodes, but may arise in extranodal tissues

Front 11

Lymphomas are divided into [...]

Back 11

NHL (60%)
HL (40%)

Front 12

What cell type make up the vast majority of NHLs?

Back 12

B-cell type

Front 13

What key lymphomas arise from small cell neoplastic B-cells?

Back 13

Small cells indicate more mature cells. More mature cells would tend to make structures similar to normal tissue.

Follicle, Mantle, Margin

Front 14

Follicular lymphoma what?

Back 14

Neoplastic proliferation of small B cells (CD20+) that make follicle-like nodules.

Front 15

Follicular lymphoma presents as [...]

Back 15

Clinically presents in late adulthood with painless LAD

Front 16

What could this be?

Back 16

Follicular lymphoma.

Front 17

Follicular lymphoma is driven by what?

Back 17

A translocation: t(14;18).

BCL2 (18) translocates to the immunoglobulin heavy chain locus (14)

Front 18

Immunoglobulin heavy chain is located on chromosome ____.

Back 18

14

Front 19

Follicular lymphoma is due to _______________ (overproliferation/absence of apoptosis).

Back 19

absence of apoptosis

Front 20

Patients with follicular lymphoma are relatively ___________.

Back 20

asymptomatic

Front 21

Treatment in follicular lymphoma?

Back 21

Treatment is reserved for those who are symptomatic.

Low-dose chemotherapy (CTX) or rituximab (anti-CD20).

Front 22

Complication of follicular lymphoma?

Back 22

(1) Can progress to diffuse large B-cell lymphoma which presents as an enlarging lymph node.

Front 23

How do you distinguish follicular hyperplasia from follicular lymphoma?

Back 23

(1) In follicular lymphoma, architecture is disrupted.
(2) Lack of tingible body macrophages in germinal centers.
- Normally in response to infection, B-cells undergo hypermutation and many of them die by apoptosis, only to be eaten by macrophages.
(3) Expression of Bcl2 in follicles
(4) Monoclonality

Front 24

What is mantle cell lymphoma?

Back 24

Neoplastic small B cells (CD20+) that expand the mantle zone.

Front 25

How does mantle cell lymphoma present?

Back 25

Clinically presents in late adulthood with painless LAD.

Front 26

Mantle cell lymphoma is driven by what?

Back 26

t(11;14)

Cyclin D1 on 11 is translocated to IgH locus on 14. Overexpression of cyclin D1 promotes progression through G1/S checkpoint.

Front 27

What is a marginal cell lymphoma?

Back 27

Neoplastic small B-cells (CD20+) that expand marginal zone.

Front 28

This type of lymphoma is associated with chronic inflammatory states.

Back 28

Marginal cell lymphoma

Front 29

What chronic inflammatory states may lead to marginal zone lymphoma?

Back 29

Marginal zone is formed by post-germinal center B-cells (they enter, get activated, that's when margins are produced).

Hashimoto's thyroiditis
Sjogren syndrome
H. pylori gastritis

Front 30

What is a MALToma? Where is it classically seen?

Back 30

Marginal zone lymphoma of mucosal sites (e.g., stomach). Seen with chronic H. pylori gastritis.

Front 31

This lymphoma may regress if the inciting agent is removed.

Back 31

Gastric MALToma (if H.pylori is eradicated)

Front 32

What is Burkitts lymphoma?

Back 32

Neoplastic proliferation of intermediate-sized B-cells (CD20+). It is associated with EBV.

Front 33

Burkitt's lymphoma classically presents as?

Back 33

Extranodal mass in a child or young adult.

Front 34

What forms of Burkitt's lymphoma is there?

Back 34

(1) African form that usually involves the jaw
(2) Sporadic form that usually involves the abdomen

Front 35

Burkitt's lymphoma is driven by what?

Back 35

Translocations of c-myc. t(8;14) is the most common.

Front 36

What would you see on histology of Burkitt's lymphoma?

Back 36

High c-myc drives a very high proliferation of cells.

We see high mitotic rate and starry sky appearance.

Tumor cells are blue (the sky). They are turning over so quickly that they are dying. Tingible body macrophages eating them forms the star.

Front 37

What is DLBCL?

Back 37

Diffuse Large B-Cell Lymphoma

Neoplastic large B-cells (CD20+) that grow diffusely in sheets.

Front 38

What is the MC form of NHL?

Back 38

DLBCL

Front 39

DLBCL is clinically _____________ (indolent/aggressive).

Back 39

aggressive. It doesn't look like anything.

Front 40

DLBCL can arise how?

Back 40

Sporadically or from transformation of follicular lymphoma.

Front 41

DLBCL presents how?

Back 41

Presents in late adulthood as an enlarging LN or extranodal mass.

Front 42

In Hodkin's lymphoma you don't have a big mass of malignant cells, instead you have?

Back 42

Rare neoplastic cells called Reed sternberg cells that produce cytokines that draw in other inflammatory cells, which then results in the production of a mass.

Front 43

Key hallmark of Hodkin's lymphoma. What are its markers?

Back 43

Reed-Sternberg cell. CD15+, CD30+.

Front 44

Describe the Reed-sternberg cell.

Back 44

Large B cell with multilobed nuclei and prominent nucleoli.

Front 45

What is the result of reed sternberg cells that secrete cytokines?

Back 45

(1) Occasionally results in 'B' symptoms (which are fevers, chills, night sweats)
(2) Attract reactive lymphocytes, plasma cells, macrophages, and eosinophils
(3) May lead to fibrosis

Front 46

What forms the basis of classification of Hodkin's lymphoma?

Back 46

Reactive inflammatory cells that are present

Front 47

The MC form of Hodkin lymphoma is?

Back 47

Nodular sclerosis subtype (70%)

Front 48

What subtypes of Hodkin's lymphoma are there?

Back 48

(1) Nodular sclerosis
(2) Lymphocyte-rich
(3) Mixed cellularity
(4) Lymphocyte-depleted

Front 49

Describe the classical presentation of nodular sclerosing subtype of Hodkin's lymphoma.

Back 49

Classic presentation is enlarging cervical neck or mediastinal lymph node in a young adult, usually female.

Front 50

A biopsy is performed in a female young adult with Hodkin's lymphoma. What do you see?

Back 50

Lymph node divided by bands of fibrosis. RS cells are present in lake-like spaces (lacunar cells)

Front 51

What important consideration is there regarding lymphocyte-rich variant of Hodkin's lymphoma?

Back 51

Best prognosis

Front 52

What important consideration is there regarding mixed cellularity variant of Hodkin's lymphoma?

Back 52

Abundant eosinophils (IL-5)

Front 53

What important consideration is there regarding lymphocyte-depleted variant of Hodkin's lymphoma?

Back 53

Worst prognosis.

Front 54

The lymphocyte-depleted variant of Hodkin's lymphoma is seen in ________ and _________.

Back 54

elderly; HIV+ individuals