CLL and Non-Hodgkin Lymphoma Flashcards Preview

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Flashcards in CLL and Non-Hodgkin Lymphoma Deck (45)
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What are the layers of a follicle beginning in the middle and moving outwards?

Germinal center, mantle zone, marginal zone


What types of cells are found in the Medullary cord of the Medulla of a lymph node?

plasma cells and lymphocytes

These are the darker areas of the medulla


What types of cells are found in the medullary sinus of the medulla of a lymph node?


These are the lighter areas of the medulla.


The dark zones of a germinal center contain mostly _______ while the light zones of a germinal center contain ____, ______, ______, and ______

centroblasts (immature B cells)
mixed centrocytes (Mature B cells), T cells, dendritic cells, and histiocytes


The medulla is in what part of the lymph node?



CD20 is a marker that highlights _____ and _____ B cells (location).

mantle zone
germinal center


What are the important B cell markers for immature B cells (germinal center/ mantle zone)?

CD19, CD20, CD22 (CD20 is the most important)


What are important cell markers that are positive in paracortical T cells?

CD3, CD4, CD5, CD8 (CD3 is the most important).


Naive B cells undergo activation in the ____ (in the spleen) or the _______ (in the thymus) by antigen primed dendritic cells.

PALS (periarteriolar lymphoid sheath)
paracortical region


Some activated B cells become plasma cells that secrete IgM. Where do others go to become IgG secreting plasma cells?

back into the lymphoid follicles (the germinal center).


What hematologic malignancies arise from problems in:
Immature B-cells?

Acute lymphoblastic leukemia or lymphoma (B-ALL/LBL)


What hematologic malignancies arise from problems in:
a mantle cell?

mantle cell lymphoma


What hematologic malignancies arise from problems in:
Germinal center B-cells?

Follicular lymphoma
Burkitts lymphoma
Hodgkin lymphoma


What hematologic malignancies arise from problems in:
pre- or post-germ center B cells?

Chronic lymphocytic leukemia/Small Lymphocytic Lymphoma (CLL/SLL)


What hematologic malignancies arise from problems in:
plasma cells?

plasma cell myeloma


A soccer ball appearance is a morphologic feature of cells associated with what hematologic malignancy?



CD10 and BCL6 are both expressed in normal ______.

Normal germinal B cells


What are pseudofollicles?

They are proliferation centers--pale areas containing transformed larger cells. It is seen in SLL where the lymph node is so packed full of cells that normal lymph node histology is indeterminable.


In CLL/SLL which markers would we expect to be positive and which would we expect to be negative?

positive: CD5, CD23, CD19 (CD5 is a T cell marker so this is abnormal, and CD23 is just a weird one, CD19 is normal B cell marker)
negative: CD10 (this is because CD10 is a germinal center B-cell marker. CLL/SLL is with pre- and post-germinal center cells)


T or F: under regular conditions the follicles should be variable in size?


They should also be far apart (not touching), and only in the cortex. FL reverses all these observations.


What happens to the location of follicles in follicular lymphoma?

They spread all over the lymph node (they are not just in the cortex as they should be).
Also they to touch each other. In normal lymph node they should be far apart


In FL follicles are positive for _____. Normally they would be negative.

BCL2 gene


What does BCL2 do?

It turns off apoptosis. Want this to be turned off in the follicles of normal cells because want to allow for selection of lymphocytes. In Follicular lymphoma this is gene is on (due to the 14-18 translocation, this gene gets placed under the influence of a new promoter)


What are some of the important morphologic features of FL? Can you see tingible-body macrophages?

cannot identify mantle-zone or dark and light zone within germinal center.
Do not see tingible body macrophages


What sort of cytogenetic finding is characteristic of FL?



In FL B-cells are positive for which markers?

CD19, CD20 (B cell markers)
CD10, BCL6 (germinal center B-cell markers)
They are also BCL2 positive (the apoptosis gene)
They are negative for CD5 and CD23 (this is how you can know that it isn't CLL/SLL)


How do you tell the difference between reactive follicular hyperplasia (normal immune response) and Follicular lymphoma?

FL has strange morphologic features of the follicles that does not exist in hyperplasia:
-tightly packed (sometimes touching)
-monomorphic follicles (no variation in morphology- i.e. lost light zone, dark zone)
-absent or obscured mantle zones
-no tingible body macrophages
also, reactive follicles would not be positive for the BCL2 gene which is turned on in FL.


over expression of cyclin D is a component of which hematologic malignancy?

Mantle Cell Lymphoma


How does MCL compare with B cell lymphomas in aggressiveness?

B-cell lymphomas are indolent whereas MCL is fairly aggressive.


MCL patients often present with Stage ___ or ___ lymphadenopathy and _____ involvement.