lymphomas

CD19/20, CD23, and CD5

CLL/SLL

chronic lymphocytic lymphoma/leukemia

small lymphocytic lymphoma (small cell lymphoma)

associated with chronic inflammatory disorders of autoimmune or infectious etiology (think Helicobacter pylori gastritis)

extranodal include mucosa-associated lymphoid tumors (MALTomas)

marginal zone lymphoma

t(8;14)

Burkitt lymphoma

translocations of MYC gene on chromosome 8 that lead to increased MYC protein levels

Burkitt lymphoma

Starry sky pattern

express IgM, CD19, CD20, CD10, and BCL-6

Burkitt lymphoma

mass involving the mandible

endemic (african) burkitt lymphoma

mass involving the ileocecum and peritoneum

sporadic burkitt lymphoma

high levels of IgM lead to symptoms due to hyperviscocity of the blood

Waldenstrom macroglobulinemia

high levels of M protein cause rouleaux formation of RBCs (red cells stick to one another “stack of coins”)

multiple myeloma

monoclonal Igs usually first detected as abnormal "protein “spikes” in serum or urine electrophoresis

most common is IgG

bone marrow: increased plasma cells (usually >30% of the cellularity)

multiple myeloma

flame cells, mott cells, russel bodies, dutcher bodies

multiple myeloma

heptaosplenomegaly, lymphadenopathy, hypogammaglobinemia

seen in older adults

Richter syndrome: the transformtaion to more aggressive tumors like diffuse large B cell lymphoma

CLL/SLL

chronic lymphocytic lymphoma/leukemia

small lymphocytic lymphoma (small cell lymphoma)

nodular growth pattern

t(14;18)

follicular lymphoma

BCL-2, CD19, CD20, CD10

spleen: paratrabecular

follicular lymphoma

most common form of nonhodgkin lymphoma

large cells

CD19, CD20, BCL-6

aggressive and can be associated with HIV

Diffuse large B-cell lymphoma

increased calcium (hypercalcemia) renal dysfunction, anemia, and bone lesions (CRAB)

multiple myeloma

lytic lesions- especially in skull and vertebral column

can see x-rays with bones that look like holes have been “punched out”

hypercalcemia

multiple myeloma

increased M protein (monoclonal Ig)

plasma cell dysrasia

Bence-jones proteinuria (kidney dysfunction)

multiple myeloma

CD5, CD20, CD23-, cyclin D1

mantle cell lymphoma

CD5 and CD23 positive vs CD5+ but CD23-

CD23: Chronic lymphocytic lymphoma/ small cell lymphoma

CD23- : mantle cell lymphoma

t(11;14)

mantle cell lymphoma

CD4+ T cells infected by retrovirus HTVL-1

adult T cell lymphoma/leukemia

kypercalcemia

tumor cells show cloverleaf/flower

adult T cell lymphoma/leukemia

In general: Reed-sternberg cell and variants

Hodgkin lymphoma

Which type of hodgkin lymphoma?

collagen bands, lacunar variants of the Reed-sternberg cells (R-S cells)

nodular sclerosing hodgkin lymphoma

Which type of hodgkin lymphoma?

Reed-sternberg cells are mononuclear and diagnostic

R-S cells infected with EBV 70% of cases

mixed cellularity Hodgkin lymphoma

Which type of hodgkin lymphoma?

mononuclear variants of reed-sternberg cells, EBV assocaited with 40% of cases, good prognosis

lymphocyte rich hodgkin lymphoma

Which type of hodgkin lymphoma?

diagnostic R-S cells, EBV associated with 90%, HIV, less favorable prognosis

lymphocyte depletion Hodgkin lymphoma

Which type of hodgkin lymphoma?

no EBV association, excellent prognosis, males, popcorn reed-sternberg cells with multilobed nuclei

nodular lymphocyte predominance hodgkin lymphoma

Hodgkin lymphoma:

CD20+, CD15-, CD30-

vs

PAX5, CD15, and CD30 but negative for CD45

CD15 and CD30 positive: the classic 4: nodular sclerosing, mixed cellularity, lymphocyte rich, lymphocyte depletion

CD15 and CD30 negative: the non-classical: nodular lymphocyte predominance

peripheral blood shows smudge cells

chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL)

histo: cerebriform appearance due to marked infolding of nuclear membrane

diffferent manefestations of a tumor od CD4+ helper T cells that involves skin

mycosis fungoides

mycosis fungoides variant with generalized exfoliative erythroderma

Sezary syndrome

Some cells containing horseshoe shaped nuclei and voluminous cytoplasm (hallmark cells)

anaplastic large-cell lymphoma

explain ALK positive versus ALK negative anaplastic large cell lymphoma

ALK+: children and young adults, involves soft tissues, very good prognosis

ALK-: occurs in older adults, worse prognosis

Waldeyer ring, oropharyngeal lymphoid tissue including tonsils and adenoids commonly involved

diffuse large B-cell lymphoma