Hematology Chapter 21 The Lymphomas

In Ann Arbor Classification, Stage 3 indicates the presence of lymph nodes on both sides of the diaphragm. This means that the cancer has spread to lymph nodes located above and below the diaphragm, which is a muscle that separates the chest from the abdomen. The presence of lymph nodes on both sides suggests a more advanced stage of cancer compared to Stage 1 or Stage 2, where lymph nodes are affected only on one side.

Oncogenes are genes that have the potential to cause cancer when they are abnormally activated. These genes can be mutated or translocated, leading to their abnormal function. When growth regulating genes are translocated and start functioning abnormally, they are referred to as oncogenes. Therefore, the statement "growth regulating genes that function abnormally when translocated are called oncogenes" is true.

Lymphomas are a type of cancer that develop from immune system cells. The genetic code that regulates the growth and reproduction of these cells can become damaged, leading to the development of lymphomas. This damage can occur through various mechanisms such as translocations, deletions, and mutations. Therefore, the statement that lymphomas develop due to damage of the genetic code that regulates the growth and reproduction of immune system cells is true.

Lymphocyte Rich Hodgkin Lymphoma is the correct answer. This type of lymphoma is characterized by the presence of large numbers of lymphocytes and small numbers of Reed-Sternberg cells. Reed-Sternberg cells are abnormal cells that are typically found in Hodgkin lymphoma. In Lymphocyte Rich Hodgkin Lymphoma, the abundance of lymphocytes helps to distinguish it from other subtypes of Hodgkin lymphoma, such as Lymphocyte Depletion Hodgkin Lymphoma, which is characterized by a scarcity of lymphocytes.

In the Ann Arbor classification (Cotswold modification), the designation "B" in stage 4 indicates the presence of systemic symptoms. This means that in addition to the cancer being present in multiple nodal sites, the patient also experiences symptoms such as fever, night sweats, or unexplained weight loss. These symptoms indicate a more advanced stage of the disease and may require more aggressive treatment.

The given correct answer is Follicular B-cell Lymphoma. This is because the unique translocation t(14:18) of the BCL2 oncogene is a characteristic genetic abnormality found in follicular B-cell lymphoma. Additionally, the mention of a shrunken mantle zone helps to distinguish it from a benign secondary reactive lymph node. Mantle cell lymphoma does not typically have the t(14:18) translocation and does not show a shrunken mantle zone, making it less likely to be the correct answer.

The given description of large non-cleaved cells with a diameter of 20-40 u, modest amount of cytoplasm, round to oval nuclei, and small distinct nucleoli is most likely describing centroblasts. Centroblasts are immature B-cells found in the germinal centers of lymphoid follicles, and they have these characteristics. Centrocytes, on the other hand, are smaller and have more condensed chromatin with indistinct nucleoli. Therefore, centroblasts are the more appropriate answer based on the given description.

The primary follicles are indeed composed of small B cells. When these B cells are stimulated by antigens, they transform into secondary follicles. The secondary follicles contain a germinal center surrounded by a crescent of B cells called the mantle zone. Therefore, the statement is true.

Lacunar cells are accurately described as being separated from surrounding cells by a pale area, and they are large in size. The nucleoli in lacunar cells are small to medium in size.

Stage I of the Ann Arbor Classification for Hodgkin Lymphoma involves only one lymph node region. This means that the cancer is localized to a single group of lymph nodes. The classification system helps to determine the extent and spread of the cancer, with higher stages indicating more widespread disease. In Stage I, the cancer is limited to a single region, making it easier to treat and potentially increasing the chances of successful treatment outcomes.

The correct answer is proliferating B cells. Germinal centers are specialized structures found within secondary lymphoid organs where B cells undergo intense proliferation and differentiation. Centroblasts are large, rapidly dividing B cells that are found within the germinal center. They play a crucial role in the process of somatic hypermutation and affinity maturation, ultimately leading to the production of high-affinity antibodies. Therefore, centroblasts are a type of proliferating B cells within the germinal center.

Nodular Sclerosis Hodgkin Lymphoma is the correct answer because it is associated with female predominance, anterior mediastinal mass, and adenopathy. It is usually asymptomatic at first presentation. Nodular Lymphocyte Predominant Hodgkin Lymphoma, on the other hand, does not typically present with an anterior mediastinal mass and is not associated with female predominance.

Follicular B-Cell Lymphoma is characterized by a unique translocation of the BCL2 oncogene, specifically the t(14:18) translocation. This translocation involves a rearrangement of genetic material between chromosomes 14 and 18, resulting in the overexpression of the BCL2 gene. The overexpression of BCL2 prevents programmed cell death (apoptosis), leading to the accumulation of abnormal B cells and the development of lymphoma.

Classic Hodgkin Lymphoma-Nodular Sclerosis Hodgkin Lymphoma features Lacunar cells.

Burkitt Lymphoma is the correct answer for this question. The description provided matches the characteristics of Burkitt Lymphoma, which was first described in 1958 and is endemic to Africa. It is commonly found in pediatric patients and those with weakened immune systems, particularly AIDS patients. The lymphoma cells are monoclonal, medium-sized, and have round nuclei with small nucleoli. They also exhibit high proliferation and apoptosis. Burkitt Lymphoma is categorized by specific chromosomal translocations (t(2:8) or t(8:22)). It is more common in men, with facial bones being the most affected site in the endemic form and the intestine in the nonendemic form. If left untreated, Burkitt Lymphoma can be aggressive and fatal, but it is curable.

Patients with autoimmune diseases have an increased risk of developing marginal zone lymphoma (MZL). MZL is a type of non-Hodgkin's lymphoma that arises from the marginal zone of the lymphoid tissue. Autoimmune diseases occur when the immune system mistakenly attacks healthy cells and tissues in the body. The chronic inflammation and immune dysregulation associated with autoimmune diseases can contribute to the development of MZL. Therefore, it is true that MZL is often seen in patients with autoimmune disease.

Intravascular Large B-cell lymphoma is the correct answer because the given description matches the characteristics of this rare, aggressive lymphoma. The neoplastic cells are confined to the lumina of blood vessels, causing vascular obstruction. This type of lymphoma is known for its poor response to therapy.

No, it usually presents with non-painful lymph node swelling

Primary Effusion Lymphoma (PEL) is described by malignant cells that are confined to body cavity spaces such as pleural, pericardial, and peritoneal with no detectable tumor masses. These cells are positive for human herpes virus type 8, sometimes EBV, and express an aberrant phenotype. PEL is most commonly seen in HIV positive patients.

Stage II of the Ann Arbor Classification involves 2 or more lymph node regions on one side. This means that there are multiple lymph node regions affected, but they are all on the same side of the body. This classification helps to determine the extent and spread of lymphoma in the body, with Stage II indicating involvement of lymph nodes on one side of the diaphragm.

Lymphocyte Depletion Hodgkin Lymphoma is the correct answer because the given information states that lymphocytes are sparse, which means there are very few lymphocytes present. In contrast, Reed-Sternberg cells are numerous, indicating an abundance of these abnormal cells. Additionally, the presence of infrequent plasma cells, histiocytes, and eosinophils further supports the diagnosis of Lymphocyte Depletion Hodgkin Lymphoma, as these cell types are not commonly seen in this type of lymphoma.

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Hodgkin Lymphoma is more common in ages 15-35 and also over 50. This means that individuals between the ages of 15 and 35 are more likely to develop Hodgkin Lymphoma compared to other age groups. Additionally, individuals over the age of 50 also have an increased risk of developing this type of lymphoma.

Non-Hodgkin lymphoma is more common in older adults. This is because the risk of developing this type of cancer increases with age. As people get older, their immune system weakens, making them more susceptible to developing lymphoma. Additionally, older adults may have been exposed to certain risk factors over a longer period of time, such as certain infections or exposure to certain chemicals, which can increase their chances of developing non-Hodgkin lymphoma.

In the Ann Arbor classification (Cotswold modification), the designation "A" signifies the absence of systemic symptoms in stage 4 of the classification. This means that despite the presence of extra nodal sites, the patient does not experience any symptoms related to the lymphoma. The "A" designation is used to indicate that the lymphoma is asymptomatic in stage 4.

Nodular Lymphocyte Predominant Hodgkin Lymphoma is the correct answer because it is characterized by a predominance of males and younger individuals. It typically presents with localized involvement of one node group. The prognosis for this type of lymphoma is generally good, with a good long-term survival rate. However, there is a risk of late relapses.

The term "Ann Arbor Hodgkin Lymphoma III1" refers to a specific staging system used to classify the extent of Hodgkin lymphoma. In this system, stage III1 indicates involvement of lymph nodes both above and below the diaphragm, with or without the presence of splenic, hilar, celiac, and portal nodes. This means that the cancer has spread to multiple lymph node regions in the abdomen and chest. The answer choice "with or without splenic, hilar, celiac, portal nodes" accurately reflects this classification.

Mantle Cell Lymphoma is a subtype of mature B-Cell Lymphomas. This means that it arises from B-cells that have fully developed and differentiated into mature cells. Precursor B-Cell Lymphomas, on the other hand, refer to lymphomas that originate from B-cells that are still in the early stages of development and have not fully matured. Therefore, the correct answer is mature.

Mantle Cell Lymphoma is the correct answer because it is a mature B-cell lymphoma that involves the BCL-1 gene. This gene is responsible for the overexpression of the protein Cyclin D1, which is a characteristic feature of Mantle Cell Lymphoma. Follicular B-Cell Lymphoma is not associated with the overexpression of Cyclin D1 and does not involve the BCL-1 gene, making it an incorrect answer.

The correct answer is lacunar cells. Lacunar cells are a type of histiocyte that can be observed in formalin-fixed tissue sections of sclerosis. These cells are characterized by their clear cytoplasm and eccentrically located nuclei. They are often seen in conditions such as Langerhans cell histiocytosis and Rosai-Dorfman disease.

T-cell lymphomas account for approximately 10-15% of NHLs. This means that out of all cases of NHL, only a small percentage can be attributed to T-cell lymphomas. The majority of NHL cases are derived from B-cell lymphocytes.

The given description of "cleaved cells" that are small to medium in size, have scan cytoplasm, irregular nuclei, and indistinct nucleoli matches with the characteristics of Centrocytes. Centrocytes are mature B-cells that are found in the germinal centers of lymph nodes and are involved in the production of antibodies. They have irregular nuclei and their cytoplasm appears to be scanned due to the presence of cell processes.

B-cell lymphomas account for the majority (85-90%) of NHLs. This means that the lymphomas can originate from B-cells, which are a type of lymphocyte that plays a crucial role in the immune response. B-cell lymphomas can arise from various lymph node cells and can manifest in different forms, such as diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma. These lymphomas are characterized by the abnormal growth and accumulation of B-cells, leading to the development of tumors in lymph nodes and other lymphoid tissues.

The correct answer is centroblasts. The WHO Classification grades for Follicular B-cell Lymphoma, a subtype of Mature B-cell Lymphoma, based on the severity of the disease, is determined by counting the number of centroblasts. Centroblasts are large, rapidly dividing cells that are characteristic of aggressive lymphomas. The higher the number of centroblasts, the more severe the lymphoma is considered to be.

The Revised European American Classification of Lymphoid Neoplasms is the most widely used classification system for Non-Hodgkin Lymphoma. This system provides a standardized way to categorize and classify different types of lymphoid neoplasms, making it easier for healthcare professionals to diagnose and treat patients with this type of cancer. It is widely accepted and used in clinical practice and research, making it the preferred classification system for Non-Hodgkin Lymphoma.

The mature subtype of B-cell lymphomas accounts for greater than 90% of lymphoid neoplasms. This means that the majority of B-cell lymphomas belong to the mature subtype rather than the precursor subtype.

Most MCL (Mantle Cell Lymphoma) demonstrate a unique translocation called t(11:14). This translocation involves a rearrangement of genetic material between chromosomes 11 and 14. This translocation leads to the overexpression of cyclin D1, a protein that promotes cell cycle progression. The overexpression of cyclin D1 plays a crucial role in the development and progression of MCL.

Germinal Center contains centrocytes, which are a type of resting B cells. These B cells have undergone activation and differentiation in response to an antigen, but they are not actively dividing or proliferating. Instead, they are in a quiescent state, waiting for further stimulation or signals to either differentiate into plasma cells and produce antibodies or undergo apoptosis.

A Reed-Sternberg cell is characterized by its large size, abundant acidophilic cytoplasm, multinucleated or multi-lobed nucleus, and gigantic inclusion-like nucleoli. These cells are typically found in Hodgkin's lymphoma, a type of cancer that affects the lymphatic system. The size of a Reed-Sternberg cell can vary, but it can be as large as 45 micrometers.

The given description matches the characteristics of Lymphoplasmacytic B-Cell Lymphoma. This type of lymphoma is characterized by cells exhibiting plasmacytoid features, being negative for CD5, CD10, and CD23, and 50% of cases demonstrating t(9:14) involving IgH and PAX5. It is also associated with Waldenstroms macroglobulinemia and monoclonal gammopathy of IgM type. Lymphoplasmacytic B-Cell Lymphoma primarily affects older adults and usually involves lymph nodes, spleen, and bone marrow.

Follicular B Cell Lymphoma can be distinguished from a benign secondary reactive lymph node by the shrunken mantle zone. This indicates that the follicular lymphoma has caused a reduction in the size of the mantle zone, which is not typically seen in benign reactive lymph nodes. This characteristic can help in the diagnosis and differentiation of follicular B Cell Lymphoma from other types of lymphomas or benign conditions.

Hodgkin Lymphoma accounts for approximately 15% of new lymphoma cases in the U.S. This means that out of all the new cases of lymphoma diagnosed in the country, 15% of them are specifically Hodgkin Lymphoma. This statistic highlights the relative prevalence of Hodgkin Lymphoma compared to other types of lymphoma, indicating that it is a significant subtype of the disease.

The description provided matches the characteristics of Small Lymphocytic Lymphoma. This type of B-Cell Lymphoma is characterized by a diffuse growth pattern, with small uniform lymphocytes that have scant cytoplasm, round nucleus, clumped chromatin, and may have small nucleoli. The presence of prolymphocytes is also mentioned. The lymphoma is positive for CD5, CD23, and CD43, but negative for CD10. Additionally, around 80% of cases exhibit cytogenic abnormalities, specifically trisomy 12. Small Lymphocytic Lymphoma primarily affects older adults, is considered incurable with standard therapy, and fludarabine treatment has shown more success.

The given description matches the characteristics of Diffuse Large-Cell Lymphoma (DLBCL). DLBCL is characterized by being CD5, CD10, and CD23 negative. Approximately 50% of DLBCL cases demonstrate t(9:14) involving IgH and PAX5. It is also associated with Waldenstroms macroglobulinemia, and monoclonal gammopathy is IgM type. DLBCL can affect older adults and usually involves lymph nodes, spleen, and bone marrow. Gene expression shows two cell types, germinal center B-like (centroblastic) and activated B-like (immunoblastic). The disease can affect a broad age range and may present as nodal or extranodal. If left untreated, DLBCL can be aggressive, but it responds well to multi-agent therapy.

The correct answer is Brown. Immunocytochemical techniques involve the use of antibodies that bind to specific proteins and produce a visible color reaction. In this case, the protein of interest is Cyclin D1, which is overexpressed in Mantle Cell Lymphoma due to the translocation t(11:14) involving the BCL-1 gene. The staining technique used to detect Cyclin D1 in the nuclei of MCL cells would likely produce a brown color, indicating the presence of the protein.

In Nodular Lymphocyte-Predominant Hodgkin Lymphoma, Reed-Sternberg cells are absent. Reed-Sternberg cells are large, abnormal cells typically found in classical Hodgkin lymphoma. Eosinophils and plasma cells are also not commonly seen in Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Eosinophils are a type of white blood cell involved in allergic reactions and plasma cells are responsible for producing antibodies. Histiocytes are a type of immune cell that can be found in the lymph nodes and are typically present in Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Popcorn cells are not a recognized term in relation to lymphoma and therefore cannot be considered a valid answer.