FirstRanker.com / Lymphoma
Leukemia - PB, B. T.
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Lymphoma-Lymphnodes, Organs
When tumor load ↑ changeable.
WHO Classification
HL
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Nodal (LN).
Step-wise.
Rare.
m/c involved Lymphnode Cervical.
Hodgkin's Lymphoma:
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EBV mostly a/w HL (not always)
EBV → B cells
Reed-Sternberg/cells-
NHL
extranodal(organs)
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Random.
Very Common
mirrors like nuclei
pink/eosinophilic/nucleoli
alone It's not characteristic of Hodgkin's lymphoma
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1) → also present in Infectious mononucleosis
Rowney cells-activated CD8 T cells
2) NHL → Diffuse Large B cell lymphoma
Immunoblastic 1° CNSly. 1° effusion lymphoma
m/c-a/w
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For Histological diagnosis:
Reed Stein Berg cells +/- mixed inflammatory background
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Neoplastic + non-neoplastic Background
Hodgkins
Classical
RS cells Lymphocyte predominant
CD 15+ 30+
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with different Immuno phenotyping
CD30 > CD15.
(90-100%) (70%)
1) Nodular Sclerosis
Collagen Band
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Lacunar RS
2) mixed Cellularity
mc-India
mononuclear RS
EBV m/c associated/HIV
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3) Lymphocyte poor
mummified RS, Hodgkin type cells
4) Lymphocyte Rich
mononuclear RS
CD 15-30-
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germinal centre of lymphnodes
CD-20+
CD-45+
BCL-6+
Popcorn cells
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Lymphocyte, Histiocyte Rich
RS.
atypical
Histiocytes.
multilobulated
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polypoid nuclei.
EBV/not associated
Nodular Sclerosis lymphocyt predominant HL
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Firstranker's choice
i) NHL
ii) Kaposi Sarcoma
HIV → AIDS
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decreasing order
iii) Cervical invasive Carcinoma
NHL: DLBCL: m/c - Immunoblastic then Hodgkins lymphoma
1° CNS lymphoma (20%)
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m/c brain tumor in HIV - PCNS lymphoma
Acute Leukemia
- PS/ BMT aspirate/bx/cytogenetics
Blast-cells->20% WHO.
Lymphoblast
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agranular cytoplasm
No nucleoli
Myeloblast
granular cytoplasm
prominent nucleoli
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PAS +ve
MPO +ve
Both PAS +ve.
Lymphoblast Erythadblast
Block positive.
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Diffuse PAS positivity.
Sudan Black B +ve
Monocytes (MPO, SBB.)
NSE (+ve)
MT3, MT4, MT5
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Erythadblast-PAS +ve
→ Based on pattern of staining
Firstranker's choice
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Auer Rods → abnormal granules
ALL- m/c Cancer of childhood
- all is Common in ALL compared to AML
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CNS
mediastinum
Testis
Bad Prognosis
B cell (80%) T-cell (15-20%)
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Adolescents
2-5 years
→ BMT involvement
mediastinal mass.
anaemia.
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NOTCH positive!
FPT PAX-5
CD-10+
CALLA +ve
CD1-8
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CD28
Good prognosis
CD-19+-24+ +ve
Even when Blast count is <20% is
of Translocation, t(8:21) t(15,17) inv 16.
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Irrespective of Blast - AML
Firstranker's choice
2-10 years
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-white
-female
Cytogenetics
Hyperdiploidy
(ch>50)
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Trisomy, -4,7,10
+(9,12)
+(12,21)
CALLA +ve.
B-ALL
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(early pre-B-ALL)
ANTL:
Bad
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- Black
-male
CNS, mediastinal, Testicular
Hypodiploidy [ch<50]
t(9,22) BCR-ABL.
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+(8,14)
+(1,19)
T-ALL.
Precursor B-ALL.
mature B-ALL.
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Recurrent genetic abnormalities
a) t (8,21) -MT2 good
b) t (15,17) -MT3 good
ANTL
irrespective of Blast count.
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c) t (16,16) inv 16. -M4 Hypereosinophilia.
d) t (U:11) Variable -11-. Bad prognosis
(any chromosome no).
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Firstranker's choice
associated with
bad prognosis.
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cytogenetics-
Monosomy - 5
Monosomy - 7 - Pediatrics/m/c)
Deletion - 5 - Adult (m/c) Overall
Deletion - 7
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3) AML Treatment Related - Worse Prognosis
4) Not otherwise specified
MPO+
NT0 undifferentiated
Auer Rods NT1 - AML without maturation
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most
definite
myeloid
AML with maturation
NT2
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NT3 - Acute Promyelocytic leukemia [Auer Rods-max]
NT4 - Acute myelomonocytic MPO+ NSE+
NT5 - Acute monocytic - NSE+ MPO-ve
Auer-ve
NT6 - Acute erythroblastic - CD 71/glycophorin A
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NT7 - Acute megakaryocytic - ↑ Synthesis
of fibrogenic cytokines
BM fibrosis
plt/RBC/WBC- ↓
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Firstranker's choice
NTS & NT4 (monocyte infiltration)
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Chloroma - MT2
Myeloblastoma; m/c site-Orbital Tissue, skin infiltration.
[Granulocytic Sarcoma]
→Pabasiovalls (atypical monocytes)
PB/Blast → skin/ & Blast cells
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BMT Tissue
→predictor for future myeloid Ca
Myelodysplastic Syndrome-
Myeloid stem-cells, maturation defect.
erythroblasts
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Myeloid lineage
Megakaryocytes
Largest cell
Nuclei injured &
Syncytium like
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Fe protoporphyrin. Neutrophils
Heme.
Fe deposits
around nucleus
in mitochondria
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Ringed Sideroblasts
MDS,
Lead poisoning
Sideroblastic anaemia.
Pseudo-Pelger Huet anomaly
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Dohle bodies
Pavon Ball megakaryocytes
Pelger Huet
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Firstranker's choice
Chronic Leukemia
Bone marrow biopsy → only prognosis
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never diagnostic.
CLL
SLL
boyes
massive splenomegaly
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LN enlargement
peripheral / small lymph node organ.
P's/PB: ↑ Lymphocyte count
Absolute lymphocyte count >5000/mm3
IOC → Flowcytometry
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B cell > T cell
Immunophenotyping CD5+ CD23+ / Diagnostic
Mantle cell lymphoma- CD5+; CD 23-ve
B cell type mantle zone- marker-CD5+
Bad Prognosis- i) Expression of ZAP-70
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ii) No Somatic Hypermutation.
m/c Cytogenetic change.
iii) Trisomy 12.
iv) Richter's Transformation
@CLL-del 13q-good
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multiple myeloma pug
(one lymphoma to other)
SLL → DLBL) Worst prog
Bad Prognosis
Western world-Follicular ii) m/c NHL in
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lymphoma India would
Firstranker's choice
acute calls Barbet coller
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Chronic Myeloproliferative Disorder.
1) CML Philadelphia
2) PV
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End Result Rumanymyelos
3) Essential Thrombocytosis all myeloid stem cell proliferation
4) Progressive myelofibrosis Risto abnormal tyrosine.
JAK-2 kinase activation
due to IT IT
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Essential thrombocytosis-mild/no splenomegaly.
Chronic Myeloid Leukemia:
Age- bed, adult, elderly
Peak age 50-70 yus
representation - massive splenomegaly
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Nalymphnode enlargement
K/c/o CML with sudden & painful LN enlargement!!
Blast Crisis.
PS: Neutrophil ↑ immature >mature.
Platelet ↑
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Basophilia. Presumption.
eosinophils. ↑.
Confirm - Cytogenetics
BCR < FISH
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Firstranker's choice
ISH- BCR-ABL
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+(9:22)
Philadelphia chromosome
longtalong aim Translocation
Philadelphia chromosome 22 long aim
Ph-chromosome - megakaryocyte - dx of cml
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→ any myeloid lineage
3 years
6mo.
i) Chronic phase ii] Accelerated iii] Blast Crisis
phase →Blast> 20%
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B. MT Biopsy <10%
Blast 10-19%
extramedullary
cytogenetics
Basophil >20%
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Chloroma
Blast cells
Thrombocytosis
confirm
Thrombocytopenia
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Large group of
Blast cells in
Not Responding to PR.
BM Bx
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Firstranker's choice
1) Mantle
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→ B cell >60 years
→m/c-Cervical LN enlargement
CD5+ CD-23-ve.
cytogenetics
t(11:14)
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cyclin D1 (BCL)
3) Burkitt lymphoma:
2) Follicular
→B cell type
20-30 years
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LN Biopsy
1) Centrocytes (Smaller)
- Buttock cells.
2) Centroblasts.
cytogenetics t(14:18)
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cyclin D2 (BCL 2)
Takkue B cell lymphoma.
CD34-ve; Ig ⊕
→ Highest proliferative Index among all Human cancers
i) poor prognosis (Brain Tissue involvement)
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ii) m/c association with tumor lysis Syndrome
Bcl 2 -ve. Germinal Centre BCL-6+ve.
LN Biopsy- Small Round Blue cell tumor
i) wilms
ii) Neuroblastoma
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iii) Ewings
iv) Lymphoma
Firstranker's choice
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tholic
to high Fami
Dead-tumor-cells
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Small Round cells
Macrophage engulf with
(foamy macrophages)
Starry Sky appearance
t (3:14) m/c type of Cytogenetics
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t (8,22)
t (2,8)
Hairy Cell Leukemia
→B cell lymphoma
→60/m.
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-massive splenomegaly
Cytoplasmic Hair like projections (in phase contrast):
TRAP+ve
(Halo contrast around cells)
A. BMT aspirate-Dry Tap.
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BMT Biopsy-
Tumor cell pattern
Honey Comb pattern:
Fried egg appearance
(perinuclear Halo)
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Text Specific Best inv:
CD-11C
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CD-25
CD 103
Annexin A1+
↑ Risk - Atypical mycobacterial infection
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790/-BRAF mutation
Multiple myeloma
plasma cell disorder
↑IL-6
abnormal plasmablast
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(no perinuclear Hoff)
Reinuclear Hall
Hoff
due to golgi body
Light chain Ig.
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monoclonal protein-M protein.
Ig G (m/c)
A
NT
D (Rare)
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E (very Rare)
Bence Jones protein
50° clot
100c° Liquid
Myeloma kidney - Primary type of Amyloidosis
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AL type
Firstranker's choice
of dece
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infection → Renallay
m/c Cause of Renal failure in MNT-Light chain deposition.
↑ Abnormal Ig synthesis
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Russell Bodies
Cytoplasm
Cells Mott's cells
Bluish cluster of grape like Ig
Dutcher Bodies
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Nucleus
Flame Cells
Fiery Red cytoplasm due to Ig
Diagnosis: 1) BMT Biopsy - Plasma cell >10%
2) NT-protein ↑-Both Serum & Urine
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3] Incidence of end organ damage
c-calcemia
R -Renal damage
A- Anemia
B-Bone lytic lesion
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Prognosis B2-microglobulin ↑ Tumor load - Best
↑ Sa LDH
Bad prog
↑ C-R.P.
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Firstranker's choice
Pin-Di
Langerhan's Cell Histiocytosis:
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→2-10 years.
m/c chavethisthe -involving all bones of body,
simultaneously
→Seborrheic dermatitis like lesion - Scalp.
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Gonadal Involvement-Absent / Rare.
1) Letterer-Siwe -multisystem,
multifocal, multicentric
2) Eosinophilic granuloma-Scalp defects-multifocal
3) Hand-Schuller christian
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unisystem
Calvarial defect.
Diabetes insipidus
Exophthalmos
Cytogenetics - Immunophenotyping - CD1a (Best),
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S-100, VHLA-DR,
CD-207 (langerin protein)
m/E: Langerhans cells + eosinophilia
elongated cells with coffee bean nucleus
Cytoplasmic granules (EM) → Birbeck granules.
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Tennis racket
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