Mature Lymphoid Neoplasms

What is a lymphoproliferative disorder?

Any condition in which lymphocytes (B cells, T cells, or NK cells) grow and multiply excessively, ranging from benign/reactive expansions to malignant cancers like lymphomas and leukemias

Let me list all the disorders in this chapter

• Chronic Lymphocytic Leukemia

• B cell Prolymphocytic Leukemia

• Hairy Cell Leukemia

• Plasma Cell Disorders

• Lymphoma

Which cell more more common in Chronic Lymphocytic Leukemia (CLL)?

B cell more than T cell

What is the problem in CLL?

The lymphocytes in CLL are unable to fight infection very wel. So the lymphs increase in the blood and bm, so there is less room for healthy WBCs, RBCs, and platelets

Symptoms of CLL

• weight loss

• lymphadenopathy

• anemia symptoms

• thrombocytopenia

• splenomegaly

• hepatomegaly

What are the CBC findings of CLL?

• Leukocytosis

• Lymphocytosis

• Smudge cells

Why are smudge cells found in CLL?

The neoplastic lymphocytes are more fragile than normal ones

The bone marrow of CLL is…

hypercellular with a predominance of lymphocytes

What marker characterizes B cell CLL?

CD5

What is B cell prolymphocytic leukemia?

An aggressive leukemia dominated by large promyelocytes with strong surface markers. Much higher WBC than CLL: >300 × 10^9/L

What is Hairy Cell Leukemia (HCL)?

The malignancy of B cells. They do not work normally. They increase in number in the blood and bm, so less room for WBC, RBC, and platelets

What are the hallmark features of HCL?

• pancytopenia

• dry tap aspiration

• hairy cells

• normocytic, normochromic anemia

Why does the aspirate need to be a dry tap in HCL?

Due to the bm being so hypercellular. Need a biopsy to confirm presence of hairy lymphs

What cytochemical stain differentiates hairy cell leukemia?

a positive TRAP stain

What are the two plasma cell disorders in the chapter?

Multiple Myeloma and Waldenstrom’s Macroglobulinemia

What cytokine is responsible for the stimulation in bone marrow resulting in excess plasma cells in Multiple Myeloma (MM)?

IL 6

What is the most common antibody class that is overproduced?

IgG (with IgA also being kinda common)

What characterizes MM?

XS plasma cells = XS antibodies = XS proteins

Therefore in MM, there is excess protein in…

urine, serum, and body

The xs antibodies/proteins in MM cause the blood to be thick. What is another name for this?

Hyperviscosity

In some cases of MM, the body will try to excrete the xs antibodies in the urine. What protein will the antibodies appear as when tested?

Bence-Jones protein

What arrangement are the RBCs in on the pb?

Rouleaux due to the increased viscosity

There is bone pain in MM and on xrays, the bones appear to have “punched out lesions”. What causes this?

IL-6 because it is an activator of bone dissolvement

What are laboratory findings of MM?

• leukocytosis

• anemia

• Rouleaux

• Increased ESR due to rouleaux

• hypercellular bone marrow with Mott cells and Flame cells

How do mott cells appear?

Plasma cells filled with globules which contain immunoglobulin

What spikes from the xs antibody produced in MM on Serum protein Electrophoresis (SPE)?

the monoclonal (M) spike

What is the difference between MM and Waldenstrom’s Macroglobulinemia?

The xs antibody is IgM NOT IgG. BUT OTHERWISE EVERYTHING IS THE SAME. ALSO NO BONE PAIN

What is lymphoma?

A group of cancers (malignant neoplasms) that originate in the lymphatic system

How is the diagnosis of lymphoma confirmed?

Lymph node biopsy

What are symptoms of lymphoma?

• painless swelling of lymph nodes

• fatigue

• recurrent high fever

What cells found in lymph nodes characterize Hodgkin’s lymphoma?

Reed-Sternberg cells

• extremely large abnormal lymphs that are bi-nucleus