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30 Cards in this Set

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T-cell neoplasm/Marrow
T-Acute Lymphoblastic Leukemia
T cell neoplasm of Thymus
T- Lymphoblastic Lymphoma
T cell neoplasm of Lymph Node
Peripheral T-Cell Lymphoma
T cell neoplasm of skin
Mycosis Fungoides
how to prove T cell clonality
Molecular tests (SB and PCR) are currently the only way to prove T-cell clonality
T-Lymphoblastic Lymphoma: Morphology/Histology
Medium sized lymphoblasts; High N:C ratio, finely stippled chromatin and inconspicuous nuclei; Infiltrate through tissue in single file pattern; May have “starry-sky” appearance
T-Lymphoblastic Lymphoma: Immunophenotype
Have an “immature” phenotype: TdT+, CD3+, CD7+; Often CD4 and CD8 dual positive
T-Lymphoblastic Lymphoma Geneticsn
~1/3 have a translocation involving the alpha and delta T-cell receptor loci on chromosome 14, or the beta and gamma loci on chromosome 7; Partner genes are numerous--MYC (Chromosome 8), TAL1 (Chromosome 1) Lead to dysregulation of transcription of the partner gene
Immunophenotype of MF tumor cellsn
Mature T-cells; CD3+, CD5+, CD7+ and usually CD4+ (Some will “drop” a marker Usually CD7)
Sézary Syndrome
Subtype of MF; Triad of Findings; 1 Erythroderma; 2 Circulating tumor cells; 3 Lymphadenopathy
Sézary Prep
Atypical Lymphocytes with convoluted or “cerebriform” nuclei; Usually 15% of circulating lymphocytes
Peripheral T-cell Lymphoma, Unspecified (PTCL)
A node-based disease in adults; Peripheral adenopathy; Generalized disease; May see circulating tumor cells; Constitutional symptoms; Paraneoplastic syndromes; Poor prognosis; Account for ~1/2 of PTCLs in Western countries.
PTCL Histologic Features
Diffuse effacement of lymph node architecture; Pleomorphic infiltrate; May have: 1 Prominent reactive component; 2 Prominent angiogenesis; Erythrophagocytosis
PTCL Immunologic and Molecular Features
Immunophenotype: mature T-cell Usually CD4+; May have an aberrant phenotype; Clonal rearrangement of the T-cell receptor locus by PCR or Southern Blot
Anaplastic Large Cell Lymphoma (ALCL)
Specific type of peripheral T-cell lymphoma; Most common PTCL in children and young adults; Peripheral adenopathy most common; Good prognosis with appropriate therapy
Anaplastic Large Cell Lymphoma ALCL: Pathology, genetics
Pleomorphic large cell infiltrate involving lymph node sinuses Immunophenotype: T-cell markers +,CD30+, and many EMA+; Characteristic chromosomal translocation t(2;5)(p23;q35) present in many cases of systemic ALCL, portends a better prognosis
Histologic Features of Hodgkins Lymphoma
Low magnification: total effacement by a mass or a mass compressing the remaining normal lymphoid tissue; High magnification: Reed-Sternberg cells, or variant R-S cells; Appropriate reactive background
Reed Sternberg Cells
The neoplastic cell in Hodgkin’s lymphoma; Cell of origin not clear for many years, but now ~98% believed to be B-cells. Several appearances, the most common is the “diagnostic” or “classic” RS cell. Other variants: “lacunar” cells (NSHL) and “popcorn” or “L&H” variants (NLPHL)
Classification of Hodgkin’s Lymphoma
I. Classical HL: Nodular Sclerosis; Mixed Cellularity; Lymphocyte Rich; Lymphocyte Depleted. II Nodular Lymphocyte Predominant HL
Classical versus Nodular Lymphocyte Predominant HL: Presenting features, behavior, prognosis
Classical HL: Usually localized LAD, w/ B symptoms; relapses less frequent and less responsive, good prognosis. NLPHL: asymptomatic localized LAD, frequent relapses.responsive; excellent prognosis
Classical HL versus NLPHL growth pattern
classical: lump, interfollicular or replaces node. NLPHL: compression of adjacent node, PTGC
Classical HL vs NLPHL reactive background
Classical Small lymphocytes, histiocytes, eosinophils, plasma cells. NLPHL: small lymphocytes histiocytes, plasma cells
RS cell morphology in classical HL vs NLPHL
Classical: lacunar, mononuclear; NLPHL: L and H or popcorn
RS cell immunophenotye in classical HL vs NLPHL
Classical: LCA-, CD15+, CD30+, CD20 +/-. EMA+. NLPHL: LCA+ CD15-, CD30- CD20+ EMA+
Nodular Sclerosing Hodgkin's Lymphoma (NSHL)
Most common type of HL; Young adults; Females = males; Cervical lymphadenopathy +/-mediastinal mass; Prognosis good with limited stage disease
Mixed Cellularity Hodgkin’s Lymphoma (MCHL)
Second most common type of HL; Young adults, males >females; B-symptoms and generalized lymphadenopathy; Prognosis similar to NSHL; Most commonly related to EBV infection
Lymphocyte Rich Classical Hodgkin’s Lymphoma
Uncommon type of HL; Effects adults, males > females; Peripheral lymph node involvement, generally with low stage at presentation; Lack B-symptoms; Good prognosis, if they remain relapse-free
Lymphocyte Depleted Hodgkin’s Lymphoma (LDHL)
Relatively uncommon; Usually present with widely disseminated disease; Constitutional symptoms; Historically Elderly males > females; Poor prognosis
Nodular Lymphocyte Predominance Hodgkin’s Lymphoma (NLPHL)
Relatively uncommon;Young males > females; Cervical or axillary lymphadenopathy; Good prognosis with limited stage; “Histologically unstable”
Postulated Molecular abnormalities in Classical HL
Crippling genetic mutations prohibiting Ig transcription: mutation within the Ig gene, mutated promoter Blocked apoptosis: NF-KB constitutively activated Some cases show evidence of EBV infection