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Week 11: Lymphoproliferative Disorders Multiple myelomaMultiple myeloma Plasma cellPlasma cell Monoclonal Monoclonal
gammopathygammopathy Bence-Jones proteinBence-Jones protein Protein ELPProtein ELP Hairy cell leukemiaHairy cell leukemia TRAPTRAP
LymphomaLymphoma Hodgkin’s diseaseHodgkin’s disease Reed-Sternberg cellReed-Sternberg cell Mycosis fungoidesMycosis fungoides Sezary cellSezary cell
Multiple Myeloma
Plasma cell leukemiaPlasma cell leukemia Monoclonal gammopathy ELP pattern with Monoclonal gammopathy ELP pattern with
sharp sharp region spike region spike High ESR, rouleaux, Bence-Jones protein, High ESR, rouleaux, Bence-Jones protein,
Platelet dysfunctionPlatelet dysfunction Osteolytic (punched out) bone lesionsOsteolytic (punched out) bone lesions
Myeloma cells in peritoneal fluid
Rouleaux
Other Plasma Cell Disorders
Waldenstrom’s macroglobulinemiaWaldenstrom’s macroglobulinemia IgMIgM Soft tissue involvementSoft tissue involvement CD 20 (B cell) but no CD 21 (mature B) CD 20 (B cell) but no CD 21 (mature B)
or PC 1 (plasma cell)or PC 1 (plasma cell) Heavy chain diseaseHeavy chain disease
Plasmacytoid lymphocytePlasmacytoid lymphocyte
Unusual plasma cells
Osteoblasts
Hairy Cell Leukemia
Leukemic reticuloendotheliosisLeukemic reticuloendotheliosis Probably B cell originProbably B cell origin CD 19, 20, 22, 24 (B cell), 25, 11c CD 19, 20, 22, 24 (B cell), 25, 11c
(granulocyte), sIg, some CD 5 (pan-T)(granulocyte), sIg, some CD 5 (pan-T) Tartrate resistant acid phosphatase (TRAP)Tartrate resistant acid phosphatase (TRAP)
Hairy CellLeukemia
LRE: Ruptured Spleen
Acid Phosphatase
Naphthol AS-BI phosphate ACP in acid pH > Free naphthol AS-BI + FastGarnet GBC
Magnesium > Maroon deposits
Tartrate Resistant ACP: TRAP + Tartrate
Non-Hodgkin’s Lymphoma Lymphocytes with clefted nucleiLymphocytes with clefted nuclei Sezary cells in mycosis fungoides have many cleftsSezary cells in mycosis fungoides have many clefts Rappaport classification based on morphology and Rappaport classification based on morphology and
differentiationdifferentiation Lukes-Collin classification with cell types identifiedLukes-Collin classification with cell types identified International Working Formulation with tumor International Working Formulation with tumor
aggressiveness and histologyaggressiveness and histology Revised European/American Lymphoma (REAL) Revised European/American Lymphoma (REAL)
classification is most recentclassification is most recent
Lymphoma Cells
Bone Marrow: Focal Involvement
WHO Classification of Acute Lymphoproliferative Syndromes
Precursor B Lymphoblastic Precursor B Lymphoblastic Leukemia/Lymphoma (ALL/LBL) -- ALL Leukemia/Lymphoma (ALL/LBL) -- ALL in children (80-85% of childhood ALL); in children (80-85% of childhood ALL); LBL in young adults and rare; FAB L1 or LBL in young adults and rare; FAB L1 or L2 blast morphologyL2 blast morphology
Precursor T ALL/LBL -- 15% of childhood Precursor T ALL/LBL -- 15% of childhood ALL and 25% of adult ALLALL and 25% of adult ALL
Burkitt Leukemia/Lymphoma (FAB L3)Burkitt Leukemia/Lymphoma (FAB L3)
Mycosis Fungoides: T-cell Lymphoma of skin
Skin Biopsy
Skin Imprint
Sezary Syndrome
PAS Positive: Sezary Syndrome
Hodgkin’s Lymphoma
Reed-Sternberg cell (RS): lobated nuclei, Reed-Sternberg cell (RS): lobated nuclei, mutinucleate variants, lacunar cells, mutinucleate variants, lacunar cells, lymphocytic-histiocytic cell (LH)lymphocytic-histiocytic cell (LH)
RS: has CD 15 (granulo/mono) and CD 30 (B RS: has CD 15 (granulo/mono) and CD 30 (B cell)cell)
Lymphocyte predominant type CD 20 (B cell)Lymphocyte predominant type CD 20 (B cell) Clinical staging I through IV according to Clinical staging I through IV according to
number and location of tumorsnumber and location of tumors
Reed-Sternberg Cell