Podcast
Questions and Answers
What is the usual procedure for handling a lymph node biopsy after removal?
What is the usual procedure for handling a lymph node biopsy after removal?
- Refrigeration at 4°C
- Immediate placement in formalin (correct)
- Leaving the specimen open to air
- Immediate submersion in isotonic solution
During pathology lab working hours, how should a lymph node biopsy be handled?
During pathology lab working hours, how should a lymph node biopsy be handled?
- Store the lymph node in the refrigerator
- Submerge the lymph node in formalin
- Store the lymph node at -80°C
- Submerge the lymph node in an isotonic solution (correct)
Why is it important to move a lymph node biopsy quickly to the pathology lab when evaluating nucleic acids?
Why is it important to move a lymph node biopsy quickly to the pathology lab when evaluating nucleic acids?
- To enhance tissue morphology
- To increase the antigenicity of the tissue
- To prevent DNA degradation
- To prevent mRNA degradation (correct)
How long can tissue be left in formalin before it affects immunohistochemistry?
How long can tissue be left in formalin before it affects immunohistochemistry?
Why is it important to avoid cutting a lymph node before sampling?
Why is it important to avoid cutting a lymph node before sampling?
What is the maximum time frame within which a lymph node specimen must be transported to the pathology lab?
What is the maximum time frame within which a lymph node specimen must be transported to the pathology lab?
What is the best course of action when a lymphadenectomy is performed on a Friday afternoon after the pathology lab is closed?
What is the best course of action when a lymphadenectomy is performed on a Friday afternoon after the pathology lab is closed?
What happens to a lymph node if it is not placed in formalin after a lymphadenectomy?
What happens to a lymph node if it is not placed in formalin after a lymphadenectomy?
What is one half of an unfixed lymph node used for upon arrival at a pathology lab?
What is one half of an unfixed lymph node used for upon arrival at a pathology lab?
At what temperature is a portion of a lymph node stored for certain studies?
At what temperature is a portion of a lymph node stored for certain studies?
What is flow cytometry used for in hematopathology?
What is flow cytometry used for in hematopathology?
What are the main layers that lymph nodes consist of?
What are the main layers that lymph nodes consist of?
Where is the efferent lymphatic vessel located within the lymph node?
Where is the efferent lymphatic vessel located within the lymph node?
Which area is predominantly a zone of B-cells?
Which area is predominantly a zone of B-cells?
What is the ultimate outcome of B-cell development?
What is the ultimate outcome of B-cell development?
Where does somatic hypermutation occur?
Where does somatic hypermutation occur?
What surrounds the germinal center?
What surrounds the germinal center?
In which location would IgA producing plasma cells contribute to the mucosal barrier?
In which location would IgA producing plasma cells contribute to the mucosal barrier?
What is the purpose of examining the cells within our Hilar lymph nodes in the Lungs?
What is the purpose of examining the cells within our Hilar lymph nodes in the Lungs?
What is a characteristic morphology specifically recognized in Hodgkin lymphoma?
What is a characteristic morphology specifically recognized in Hodgkin lymphoma?
Which of the following is a subtype of Hodgkin lymphoma?
Which of the following is a subtype of Hodgkin lymphoma?
What is the prognostic significance of nodular sclerosis in Hodgkin lymphoma?
What is the prognostic significance of nodular sclerosis in Hodgkin lymphoma?
What is the classical microenvironment of lymphocytes in Hodgkin lymphomas characterized by?
What is the classical microenvironment of lymphocytes in Hodgkin lymphomas characterized by?
What cells do CD4-positive T cells recognize?
What cells do CD4-positive T cells recognize?
Reed-Sternberg cells must be positive for which marker?
Reed-Sternberg cells must be positive for which marker?
What is the term for neoplastic cells found in lymphocytic predominance Hodgkin lymphoma?
What is the term for neoplastic cells found in lymphocytic predominance Hodgkin lymphoma?
What is a key feature of popcorn cells in lymphocytic predominance Hodgkin lymphoma?
What is a key feature of popcorn cells in lymphocytic predominance Hodgkin lymphoma?
In classical Hodgkin lymphoma, what type of cells are predominant in the microenvironment?
In classical Hodgkin lymphoma, what type of cells are predominant in the microenvironment?
What markers do popcorn cells express?
What markers do popcorn cells express?
If material becomes birefringent when analyzed under polarized light, what does this indicate?
If material becomes birefringent when analyzed under polarized light, what does this indicate?
What is the role of Interleukin-13 in Reed-Sternberg cells?
What is the role of Interleukin-13 in Reed-Sternberg cells?
Which of the following best describes the classical microenvironment?
Which of the following best describes the classical microenvironment?
In Hodgkin Lymphoma, what does CD30 identify?
In Hodgkin Lymphoma, what does CD30 identify?
Which of the following is true regarding CD45 in Reed-Sternberg cells?
Which of the following is true regarding CD45 in Reed-Sternberg cells?
In the context of lymphomas, what do lymphomas represent?
In the context of lymphomas, what do lymphomas represent?
In the diagnosis of follicular lymphoma, what markers are used after cells are confirmed to be Bcl-2 positive and belong to follicles?
In the diagnosis of follicular lymphoma, what markers are used after cells are confirmed to be Bcl-2 positive and belong to follicles?
What does BCL-2 positivity, when identified by IHC, suggest about germinal center cells?
What does BCL-2 positivity, when identified by IHC, suggest about germinal center cells?
If B cells are BCL-2 negative in a lymph node containing two follicles, what does this indicate?
If B cells are BCL-2 negative in a lymph node containing two follicles, what does this indicate?
What genetic test is used in cases where IHC is negative for BCL-2 but follicular lymphoma is still suspected?
What genetic test is used in cases where IHC is negative for BCL-2 but follicular lymphoma is still suspected?
If IHC staining for BCL-2 shows that many cells are positive, what does this indicate?
If IHC staining for BCL-2 shows that many cells are positive, what does this indicate?
What additional test is needed if a case is Myc positive by IHC?
What additional test is needed if a case is Myc positive by IHC?
What is indicated if there is Myc rearrangement without Bcl-2 and Bcl-6?
What is indicated if there is Myc rearrangement without Bcl-2 and Bcl-6?
What is the most frequent type of lymphoma?
What is the most frequent type of lymphoma?
What clinical features are described as most important in peripheral T cell lymphomas?
What clinical features are described as most important in peripheral T cell lymphomas?
In T-cell lymphomas, what is the term for the loss of normal T-cell markers?
In T-cell lymphomas, what is the term for the loss of normal T-cell markers?
What are common symptoms for patients diagnosed with peripheral T-cell lymphoma?
What are common symptoms for patients diagnosed with peripheral T-cell lymphoma?
In diffuse large B-cell lymphoma (DLBCL), which cases are mainly nodal?
In diffuse large B-cell lymphoma (DLBCL), which cases are mainly nodal?
What does the 'R' stand for in the R-CHOP treatment that patients are mainly treated with?
What does the 'R' stand for in the R-CHOP treatment that patients are mainly treated with?
What does MUM1 mark as a marker?
What does MUM1 mark as a marker?
Where is the primary site of action in patients presenting with lymphomatous polyposis?
Where is the primary site of action in patients presenting with lymphomatous polyposis?
What genetic abnormality is associated with resistance to anti-Helicobacter therapy?
What genetic abnormality is associated with resistance to anti-Helicobacter therapy?
Where are MALT lymphomas commonly located?
Where are MALT lymphomas commonly located?
What is the MOST common translocation associated with MALT lymphomas?
What is the MOST common translocation associated with MALT lymphomas?
What does primary gastric lymphoma often involve, besides the gastric wall?
What does primary gastric lymphoma often involve, besides the gastric wall?
What feature is commonly associated with mediastinal large B-cell lymphoma?
What feature is commonly associated with mediastinal large B-cell lymphoma?
Which lymphomas does the translocation t(14;18) often appear?
Which lymphomas does the translocation t(14;18) often appear?
Which of the following is a common symptom of small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL)?
Which of the following is a common symptom of small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL)?
What is a distinctive diagnostic feature of small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) regarding peripheral blood involvement?
What is a distinctive diagnostic feature of small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) regarding peripheral blood involvement?
In the context of small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL), what is the role of bone marrow biopsy?
In the context of small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL), what is the role of bone marrow biopsy?
In small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL), what do proliferation centers in lymph node biopsies represent?
In small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL), what do proliferation centers in lymph node biopsies represent?
Which marker is NOT typically associated with small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL)?
Which marker is NOT typically associated with small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia (CLL)?
Small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) displays what type of expression of CD5 compared to normal B cells?
Small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) displays what type of expression of CD5 compared to normal B cells?
If local pathologists are concerned about increased proliferation rate, which factor should be considered?
If local pathologists are concerned about increased proliferation rate, which factor should be considered?
Mantle cell lymphoma is characterized what specific translocation?
Mantle cell lymphoma is characterized what specific translocation?
Mantle cell lymphoma is positive what marker?
Mantle cell lymphoma is positive what marker?
If there is no bacterium association, what other virus causes MALT lymphoma in salivary glands?
If there is no bacterium association, what other virus causes MALT lymphoma in salivary glands?
What ocular adnexal lymphoma were patients testing positive for?
What ocular adnexal lymphoma were patients testing positive for?
Which type of molecule do CD4 T cells recognize on H. pylori?
Which type of molecule do CD4 T cells recognize on H. pylori?
Before attempting a biopsy, what medication should you avoid administration?
Before attempting a biopsy, what medication should you avoid administration?
Which of the following lymphoid organs is covered by squamous epithelium?
Which of the following lymphoid organs is covered by squamous epithelium?
In a germinal center, where are the cells predominantly homogenous?
In a germinal center, where are the cells predominantly homogenous?
What two areas can a germinal center be divided into?
What two areas can a germinal center be divided into?
What is the function of tangible body macrophages in germinal centers?
What is the function of tangible body macrophages in germinal centers?
What is the MOST common chromosomal translocation in follicular lymphoma?
What is the MOST common chromosomal translocation in follicular lymphoma?
What is the role of the BCL2 protein in lymphoma development?
What is the role of the BCL2 protein in lymphoma development?
In the context of follicular lymphoma, is the proliferation rate in germinal centers high or low?
In the context of follicular lymphoma, is the proliferation rate in germinal centers high or low?
In what age group do tonsils sent for evaluation most commonly come from?
In what age group do tonsils sent for evaluation most commonly come from?
In the spleen, which of the following structures does the capsule produce?
In the spleen, which of the following structures does the capsule produce?
What is typically seen in the spleen that helps distinguish it from other tissues?
What is typically seen in the spleen that helps distinguish it from other tissues?
What is the response when reactive follicles are present in lymph adenoid tonsils?
What is the response when reactive follicles are present in lymph adenoid tonsils?
In microscopic analysis, what size would small lymphocytes in a tissue sample be described as, relative to endothelial cells?
In microscopic analysis, what size would small lymphocytes in a tissue sample be described as, relative to endothelial cells?
What is used to stain B or T cells?
What is used to stain B or T cells?
Which of the following is indicated by increased proliferation in reactive germinal centers?
Which of the following is indicated by increased proliferation in reactive germinal centers?
Which cells should stain positive but weakly when using PAX5?
Which cells should stain positive but weakly when using PAX5?
What is the first consideration when examining a CD20 stained slide in the case presented?
What is the first consideration when examining a CD20 stained slide in the case presented?
In the specimen shown, what is indicated by co-expression of CD3 and CD5?
In the specimen shown, what is indicated by co-expression of CD3 and CD5?
What stains follicular dendritic cells physiologically?
What stains follicular dendritic cells physiologically?
What is considered a classic immunophenotype for CLL?
What is considered a classic immunophenotype for CLL?
What feature helps distinguish small lymphocytes?
What feature helps distinguish small lymphocytes?
What is a key characteristic of plasma cells?
What is a key characteristic of plasma cells?
In the context of the slides shown, what is a typical characteristic of T-cell lymphomas related to follicular structures?
In the context of the slides shown, what is a typical characteristic of T-cell lymphomas related to follicular structures?
A marker used to identify T cells is?
A marker used to identify T cells is?
What term from the text applies to the composition of the T-cell lymphomas microenvironment?
What term from the text applies to the composition of the T-cell lymphomas microenvironment?
What feature would suggest that a cell is NOT a centroblast?
What feature would suggest that a cell is NOT a centroblast?
Which marker may be positive in T-cell lymphomas not arising from TFH?
Which marker may be positive in T-cell lymphomas not arising from TFH?
Which antibodies are used to rule out bonafide in morphology?
Which antibodies are used to rule out bonafide in morphology?
What should be identified to claim this is the spleen?
What should be identified to claim this is the spleen?
The thymus undergoes some sort of atrophy, what should you expect to see?
The thymus undergoes some sort of atrophy, what should you expect to see?
What condition is qualified by co-expression of CD20, CD5, and CD23?
What condition is qualified by co-expression of CD20, CD5, and CD23?
If a patient expresses positivity for both CD4 and CD8 in peripheral T-cell lymphoma, what does the professor say is true?
If a patient expresses positivity for both CD4 and CD8 in peripheral T-cell lymphoma, what does the professor say is true?
If you think that this could be an anaplastic large cell lymphoma, what does the professor say?
If you think that this could be an anaplastic large cell lymphoma, what does the professor say?
What is a characteristic of T cells in a lymphoma, as indicated in one of the slides?
What is a characteristic of T cells in a lymphoma, as indicated in one of the slides?
What is the physiological ratio between CD4 and CD8?
What is the physiological ratio between CD4 and CD8?
What is the significance of CD30?
What is the significance of CD30?
What should also be performed during analysis because some cases can be negative?
What should also be performed during analysis because some cases can be negative?
In this case what does CD5 stain?
In this case what does CD5 stain?
In CLL, what proliferative rate that is normally expected?
In CLL, what proliferative rate that is normally expected?
If there are positive element in this B-cells chemoattractant, what does it mean?
If there are positive element in this B-cells chemoattractant, what does it mean?
Lack to define it in a classic reactive secondary
Lack to define it in a classic reactive secondary
In the specimen, what observation suggests it is NOT the spleen?
In the specimen, what observation suggests it is NOT the spleen?
What is the composition of the white pulp in the spleen?
What is the composition of the white pulp in the spleen?
What is found in the marginal zone of the spleen?
What is found in the marginal zone of the spleen?
What is the primary role of the marginal zone in the spleen?
What is the primary role of the marginal zone in the spleen?
Which structures account for most of the red pulp?
Which structures account for most of the red pulp?
What are the sinusoids in the red pulp filled with?
What are the sinusoids in the red pulp filled with?
What is a key feature of the endothelial sinuses in the red pulp?
What is a key feature of the endothelial sinuses in the red pulp?
What causes the flattening of cells in epithelial splenic cysts?
What causes the flattening of cells in epithelial splenic cysts?
What is typically found outside of the capsule in a spleen affected by perisplenitis?
What is typically found outside of the capsule in a spleen affected by perisplenitis?
In the context of intestinal specimens, which layer is the muscularis propria?
In the context of intestinal specimens, which layer is the muscularis propria?
What intestinal structure differentiates the duodenum from the jejunum?
What intestinal structure differentiates the duodenum from the jejunum?
What is a key difference between a villus and a pseudovillus?
What is a key difference between a villus and a pseudovillus?
In a normal small intestinal specimen, what are the expected characteristics of the muscularis propria?
In a normal small intestinal specimen, what are the expected characteristics of the muscularis propria?
What type of cells are commonly found in the unknown population outside the follicles in the bowel?
What type of cells are commonly found in the unknown population outside the follicles in the bowel?
What is the nature of the dot in a 'nuclear pseudo inclusion'?
What is the nature of the dot in a 'nuclear pseudo inclusion'?
What feature differentiates a viral inclusion from a nuclear pseudo inclusion?
What feature differentiates a viral inclusion from a nuclear pseudo inclusion?
What is the typical appearance of the plasma cell nucleus?
What is the typical appearance of the plasma cell nucleus?
What cell surface marker is characteristically NOT expressed by plasma cells?
What cell surface marker is characteristically NOT expressed by plasma cells?
What is the best method to assess clonality in a plasma cell population?
What is the best method to assess clonality in a plasma cell population?
What Kappa/Lambda ratio indicates a polyclonal antibodies population?
What Kappa/Lambda ratio indicates a polyclonal antibodies population?
In a soft tissue biopsy of the subcutis, what tissue type is expected?
In a soft tissue biopsy of the subcutis, what tissue type is expected?
What adjective best describes the nuclei of the cells in the soft tissue biopsy specimen?
What adjective best describes the nuclei of the cells in the soft tissue biopsy specimen?
Which of the following properties do cells with a dispersed chromatin and lack of nucleoli resemble?
Which of the following properties do cells with a dispersed chromatin and lack of nucleoli resemble?
Which of the following best describes the growth area in one of the cases presented?
Which of the following best describes the growth area in one of the cases presented?
Which of the following properties can be expected of cells?
Which of the following properties can be expected of cells?
In Case 1, what is the primary cell morphology observed?
In Case 1, what is the primary cell morphology observed?
In Case 1, what is CD20 expression in the subcutaneous tissue?
In Case 1, what is CD20 expression in the subcutaneous tissue?
Why was Cyclin D1 testing performed in Case 1?
Why was Cyclin D1 testing performed in Case 1?
What is a key characteristic of the blastoid variant of mantle cell lymphoma?
What is a key characteristic of the blastoid variant of mantle cell lymphoma?
In cases of suspected mantle cell lymphoma, what test should be applied for correct differential diagnosis?
In cases of suspected mantle cell lymphoma, what test should be applied for correct differential diagnosis?
What is considered the gold standard method for assessing p53 mutation in mantle cell lymphoma?
What is considered the gold standard method for assessing p53 mutation in mantle cell lymphoma?
For what purpose is p53 mutational analysis primarily used in the context of mantle cell lymphoma?
For what purpose is p53 mutational analysis primarily used in the context of mantle cell lymphoma?
What is the typical cellular composition of the pale areas observed in the lymph node in Case 2?
What is the typical cellular composition of the pale areas observed in the lymph node in Case 2?
What is a 'proliferation center' in the context of the cases discussed?
What is a 'proliferation center' in the context of the cases discussed?
In Case 2, what disease is suspected based on the presence of a peripheral proliferation center?
In Case 2, what disease is suspected based on the presence of a peripheral proliferation center?
To confirm the diagnosis in Case 2, which markers are needed?
To confirm the diagnosis in Case 2, which markers are needed?
Which marker is characteristically expressed in normal B cells?
Which marker is characteristically expressed in normal B cells?
What lymphoma is suggested when the cells stain for CD5?
What lymphoma is suggested when the cells stain for CD5?
In which cells is Cyclin D1 expression seen without being detected by immunohistochemistry?
In which cells is Cyclin D1 expression seen without being detected by immunohistochemistry?
Where do cells show higher Cyclin D1 levels?
Where do cells show higher Cyclin D1 levels?
What is the expected proliferation index in indolent lymphoma?
What is the expected proliferation index in indolent lymphoma?
What is 'Richter Syndrome'?
What is 'Richter Syndrome'?
What is indicated by a nodular growth pattern composed of medium-sized and somewhat larger cells in a consultation case?
What is indicated by a nodular growth pattern composed of medium-sized and somewhat larger cells in a consultation case?
In the context of immunohistochemistry, what cells are in the nodules are centered in?
In the context of immunohistochemistry, what cells are in the nodules are centered in?
What is a typical composition for the outline the nuclei of centroblasts?
What is a typical composition for the outline the nuclei of centroblasts?
If neoplastic cells are present outside of the germinal center in reactive lymphadenopathy which cell is restricted to the areas?
If neoplastic cells are present outside of the germinal center in reactive lymphadenopathy which cell is restricted to the areas?
What is said to make morphologically with the follicles, mixed or minimally follicular?
What is said to make morphologically with the follicles, mixed or minimally follicular?
Which markers shows that follicles really belong to a germinal center?
Which markers shows that follicles really belong to a germinal center?
What is the proliferation rate of geminal centers in a reactive state?
What is the proliferation rate of geminal centers in a reactive state?
What cells do T follicular helper cells balance?
What cells do T follicular helper cells balance?
What is a significant risk associated with performing a bone marrow procedure at the sternum?
What is a significant risk associated with performing a bone marrow procedure at the sternum?
What type of bone is present at the level of the posterior iliac crest, which is important to consider during a bone marrow biopsy?
What type of bone is present at the level of the posterior iliac crest, which is important to consider during a bone marrow biopsy?
What is the purpose of making twisting motions with the Jamshidi needle during a bone marrow biopsy?
What is the purpose of making twisting motions with the Jamshidi needle during a bone marrow biopsy?
What is the most common major complication associated with bone marrow biopsies today?
What is the most common major complication associated with bone marrow biopsies today?
What term describes an unsuccessful bone marrow aspiration due to the inability to extract any material?
What term describes an unsuccessful bone marrow aspiration due to the inability to extract any material?
What condition might be suspected if a bone marrow aspiration results in an inability to suck marrow due to the overproduction of bone marrow with blasts sticking together?
What condition might be suspected if a bone marrow aspiration results in an inability to suck marrow due to the overproduction of bone marrow with blasts sticking together?
What is a method to obtain preliminary cytological information from a core biopsy before it is placed in fixative?
What is a method to obtain preliminary cytological information from a core biopsy before it is placed in fixative?
What is the most important indication for performing a bone marrow biopsy?
What is the most important indication for performing a bone marrow biopsy?
Which of the following is a normal component of bone marrow?
Which of the following is a normal component of bone marrow?
What is a general rule for the expected normal content of adipose tissue in bone marrow based on?
What is a general rule for the expected normal content of adipose tissue in bone marrow based on?
What is the most immature myeloid precursor found in the bone marrow?
What is the most immature myeloid precursor found in the bone marrow?
In normal bone marrow, where do megakaryocytes reside?
In normal bone marrow, where do megakaryocytes reside?
What staining method is used to highlight cytological features of erythrocytes?
What staining method is used to highlight cytological features of erythrocytes?
What bone marrow finding is very frequent at the staging level for Follicular Lymphomas?
What bone marrow finding is very frequent at the staging level for Follicular Lymphomas?
How can I determine if cells are plasma cells?
How can I determine if cells are plasma cells?
Flashcards
Lymph node biopsy protocol
Lymph node biopsy protocol
The usual protocol involves excision followed by prompt placement in formalin to prevent autolysis before sending to the pathology lab.
Lymph node biopsy during lab hours
Lymph node biopsy during lab hours
Submerge in isotonic solution. Do NOT use formalin. Aim to prevent autolysis, so speed is critical.
Lymph node biopsy outside lab hours
Lymph node biopsy outside lab hours
Place in formalin at room temperature to prevent autolysis. Avoid refrigeration.
Importance of lymph node capsule
Importance of lymph node capsule
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Cytogenetic Study vs. FISH
Cytogenetic Study vs. FISH
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Gene Expression Profiling (GEP)
Gene Expression Profiling (GEP)
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Why Lymph Nodes Enlarge
Why Lymph Nodes Enlarge
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Lymph Node Hilum
Lymph Node Hilum
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Outcome of B-cell development
Outcome of B-cell development
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B-Cell Maturation
B-Cell Maturation
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Lymph Node Zones (Inside Out)
Lymph Node Zones (Inside Out)
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Tingible Body Macrophages (TBMs)
Tingible Body Macrophages (TBMs)
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Reactive germinal center proliferation index
Reactive germinal center proliferation index
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CD20 Marker
CD20 Marker
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Follicular Dendritic Cells (FDCs)
Follicular Dendritic Cells (FDCs)
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MALT Formation
MALT Formation
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Lymphocyte Entry (HEVs)
Lymphocyte Entry (HEVs)
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Granulomas
Granulomas
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Kikuchi Disease
Kikuchi Disease
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Hodgkin Lymphoma
Hodgkin Lymphoma
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Hodgkin lymphoma subtypes
Hodgkin lymphoma subtypes
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Nodular sclerosis prognosis
Nodular sclerosis prognosis
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Birefringence in nodular sclerosis
Birefringence in nodular sclerosis
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Differential diagnosis in HL
Differential diagnosis in HL
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Reed-Sternberg cell immunophenotype
Reed-Sternberg cell immunophenotype
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Classical Hodgkin lymphoma microenvironment
Classical Hodgkin lymphoma microenvironment
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CD30 in Hodgkin lymphoma
CD30 in Hodgkin lymphoma
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CD45 negativity in Hodgkin Lymphoma
CD45 negativity in Hodgkin Lymphoma
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Lymphocytic predominance Hodgkin lymphoma
Lymphocytic predominance Hodgkin lymphoma
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CD30 receptor in Reed-Sternberg cells
CD30 receptor in Reed-Sternberg cells
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CFLIP function in Reed-Sternberg cells
CFLIP function in Reed-Sternberg cells
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Interaction of Reed-Sternberg cells
Interaction of Reed-Sternberg cells
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Laser capture microdissection (LCM)
Laser capture microdissection (LCM)
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Hodgkin Lymphoma spread
Hodgkin Lymphoma spread
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Lymphoma vs. Leukemia
Lymphoma vs. Leukemia
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Lymphomas' Development
Lymphomas' Development
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Bcl-2 assessment
Bcl-2 assessment
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Reactive Follicle Bcl-2
Reactive Follicle Bcl-2
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Exploiting Bcl-2 with IHC
Exploiting Bcl-2 with IHC
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Bcl-2 with CD10 and Bcl-6 testing
Bcl-2 with CD10 and Bcl-6 testing
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Bcl-2 positivity
Bcl-2 positivity
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Bcl-2 IHC Diagnostic Purpose
Bcl-2 IHC Diagnostic Purpose
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Bcl-2 positive cases
Bcl-2 positive cases
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Neoplastic follicle Bcl-2
Neoplastic follicle Bcl-2
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t(14;18)(q32;q21) translocation
t(14;18)(q32;q21) translocation
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Primary DLBCL Presentation
Primary DLBCL Presentation
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Distinguishing Lymphomas
Distinguishing Lymphomas
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DLBCL Immunophenotype
DLBCL Immunophenotype
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DLBCL Categories
DLBCL Categories
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HANS algorithm
HANS algorithm
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Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia
Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia
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Leukemic Involvement in SLL/CLL
Leukemic Involvement in SLL/CLL
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Proliferation Centers in CLL
Proliferation Centers in CLL
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CLL Immunophenotype
CLL Immunophenotype
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17p Deletion in CLL
17p Deletion in CLL
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Mantle Cell Lymphoma
Mantle Cell Lymphoma
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Mantle Cell Lymphoma Immunophenotype
Mantle Cell Lymphoma Immunophenotype
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Lymphomatous Polyposis
Lymphomatous Polyposis
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Punnet Cells
Punnet Cells
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t(11;14) in Mantle Cell Lymphoma
t(11;14) in Mantle Cell Lymphoma
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Cyclin D1 in Mantle Cell Lymphoma
Cyclin D1 in Mantle Cell Lymphoma
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t(11;18) translocation in MALT lymphomas
t(11;18) translocation in MALT lymphomas
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Extranodal Lymphoma
Extranodal Lymphoma
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Marginal Zone Lymphomas
Marginal Zone Lymphomas
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MALT Lymphoma Development
MALT Lymphoma Development
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Gastric MALT Lymphomas Treament
Gastric MALT Lymphomas Treament
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Marginal Zone Lymphoma Immunophenotype
Marginal Zone Lymphoma Immunophenotype
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Treating Primary Central Nervous System Lymphoma
Treating Primary Central Nervous System Lymphoma
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doxycycline
doxycycline
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Steroid treatment
Steroid treatment
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Reactive Follicular Metaplasia
Reactive Follicular Metaplasia
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Squamous Epithelium
Squamous Epithelium
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Tonsil
Tonsil
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Central Zone
Central Zone
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Mantle Zone
Mantle Zone
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Dark Zone
Dark Zone
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Light Zone
Light Zone
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Tingible Body Macrophages
Tingible Body Macrophages
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Polarization
Polarization
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Chromosomes 14 and 18
Chromosomes 14 and 18
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BCL2
BCL2
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Highly Over-Reactive
Highly Over-Reactive
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Dense Cells
Dense Cells
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Richter Transformation
Richter Transformation
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Lymph Node Capsule
Lymph Node Capsule
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Lymph Node Features
Lymph Node Features
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Lymph Node Cell Description
Lymph Node Cell Description
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Eosinophil Identification
Eosinophil Identification
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Histiocyte Characteristics
Histiocyte Characteristics
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High Endothelial Venule (HEV)
High Endothelial Venule (HEV)
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Plasma Cell
Plasma Cell
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CD5
CD5
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BCA-1
BCA-1
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PD1
PD1
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Classic CLL Immunophenotype
Classic CLL Immunophenotype
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CD30
CD30
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Paraimmunoblast
Paraimmunoblast
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CLL/SLL Qualification
CLL/SLL Qualification
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CD5 confirmation marker
CD5 confirmation marker
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TFH T-cell lymphoma
TFH T-cell lymphoma
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B cell component angioimmunoblastic
B cell component angioimmunoblastic
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Lymphocytes
Lymphocytes
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TFH tumor
TFH tumor
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Thickened Capsule
Thickened Capsule
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Septa
Septa
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Hemosiderin
Hemosiderin
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Apoptotic Debris
Apoptotic Debris
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Erythrocyte Digestion
Erythrocyte Digestion
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Marginal Zone of Spleen
Marginal Zone of Spleen
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Red Pulp
Red Pulp
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Sinusoids with Erythrocytes
Sinusoids with Erythrocytes
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Parenchyma
Parenchyma
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Fenestrated Endothelium
Fenestrated Endothelium
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Perisplenitis
Perisplenitis
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Splenic Cyst
Splenic Cyst
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Epithelium
Epithelium
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Submucosa
Submucosa
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Serosa
Serosa
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Villi
Villi
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Brunner Glands
Brunner Glands
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Goblet Cell
Goblet Cell
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Resection Margin
Resection Margin
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Muscularis Propria Interruption
Muscularis Propria Interruption
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Nuclear Pseudo Inclusion
Nuclear Pseudo Inclusion
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Salt and Pepper Chromatin
Salt and Pepper Chromatin
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Golgi Apparatus
Golgi Apparatus
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IPSID
IPSID
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Monomorphic Appearance
Monomorphic Appearance
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High-Grade B Cell Lymphomas
High-Grade B Cell Lymphomas
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CD3 Testing
CD3 Testing
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Avoid CD5 Testing
Avoid CD5 Testing
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Cyclin D1
Cyclin D1
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Aggressive Lymphoma Indicator
Aggressive Lymphoma Indicator
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Blastoid Appearance Differential
Blastoid Appearance Differential
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Mantle Cell Transformation
Mantle Cell Transformation
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Mutational Analysis
Mutational Analysis
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Mutational Analysis Method
Mutational Analysis Method
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p53 Testing via IHC
p53 Testing via IHC
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FISH Purpose in CLL
FISH Purpose in CLL
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Negative p53 Stain Implication
Negative p53 Stain Implication
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Bcl-2 Translocation Assessment
Bcl-2 Translocation Assessment
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Markers for CLL diagnosis
Markers for CLL diagnosis
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CLL Indicator
CLL Indicator
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Centroblasts Visualisation
Centroblasts Visualisation
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Distinguishing Histiocytes
Distinguishing Histiocytes
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Immunoblast
Immunoblast
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Smaller Immunoblasts
Smaller Immunoblasts
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Confirming Follicles
Confirming Follicles
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Staining Area in Follicle
Staining Area in Follicle
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Ki67 Prognosis Impact
Ki67 Prognosis Impact
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Distinguish Reactive vs Neoplastic
Distinguish Reactive vs Neoplastic
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Reed-Sternberg Markers
Reed-Sternberg Markers
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Bone Marrow Biopsy
Bone Marrow Biopsy
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Bone Marrow Aspiration
Bone Marrow Aspiration
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Preferred Site for Bone Marrow Procedures
Preferred Site for Bone Marrow Procedures
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Jamshidi Needle
Jamshidi Needle
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Anesthesia Importance in Bone Marrow Biopsy
Anesthesia Importance in Bone Marrow Biopsy
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Dry Tap
Dry Tap
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Aplastic Anemia Effect on Bone Marrow
Aplastic Anemia Effect on Bone Marrow
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Bone Marrow Hypercellularity
Bone Marrow Hypercellularity
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Bone Marrow Fibrosis
Bone Marrow Fibrosis
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Morphological Features of Bone Marrow
Morphological Features of Bone Marrow
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Expected Normal Adipose Tissue
Expected Normal Adipose Tissue
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Myeloblast
Myeloblast
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Cell Maturation in Marrow
Cell Maturation in Marrow
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Megakaryocytes
Megakaryocytes
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Plasma Cells in Marrow
Plasma Cells in Marrow
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Study Notes
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Aspiration and biopsy have a relative advantage and performing both may cover the individual pitfalls.
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A biopsy is more traumatic as it obtains a tissue cylinder, requiring a needle of at least 1.5 mm in length and 0.5 in thickness.
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The posterior iliac crest is the preferable site for biopsy or aspiration.
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The sternum used to be a preferable site, but had risks related to the heart which could lead to cardiac tamponade from needle passage.
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The sternum risks were prominent in patients with weakening of the sternum due to lytic lesions from multiple myeloma or plasma cell dyscrasia.
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These procedures are performed at the posterior iliac crest to avoid sternum risks.
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Performing a biopsy requires consideration of a hard structure to overcome in the bone.
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At the iliac crest, there is spongy bone surrounded by a hard cortex
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The first step is to force the cortex for the needle to enter bone marrow cavities.
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The Jamshidi needle has an internal diameter of 0.6 cm and forces the cortical bone when inserted into the patient.
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To force the bone, twisting motions must be applied, like with a cork, until 2 cm in depth.
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Once 2cm in depth is reached, removal of the needle will also remove the core biopsy.
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Put the device the opposite way to pull out the core biopsy.
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Fine needle aspiration can be performed through the same hole produced on the skin.
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Two kinds of material that can be retrieved with the same anatomical site are histology (core biopsy) and cytology (FNA).
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The major complication of a bone marrow biopsy, nowadays, is pain.
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To avoid pain, anesthetizing the periosteum as it's well-innervated, is recommended.
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Anesthesia has its issues however, and in most cases, patients feel some level of pain.
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Even in patients thrombocytopenic (low levels of platelets leading to a higher risk of hemorrhages), major complications are not present.
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Aspiration can be unsuccessful in conditions such as a dry tap.
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Mechanical conditions leading to aspiration failure: absence of bone marrow, overproduction of bone marrow, and fibrosis.
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Absence of bone marrow as in aplastic anemia, resulting in the bone marrow filled with adipose tissue.
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Overproduction of bone marrow leads to blasts sticking together, and happens in cases of hypercellularity like acute leukemia.
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Fibrosis impairs aspiration, and happens in metastatic involvements of the bone marrow.
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Core biopsy results take a few days to come out because of the bone, making quick diagnoses to start therapeutic treatments difficult.
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Touch imprint of the core biopsy on a slide before putting the biopsy in a fixative can reduce time to diagnosis, however it is less reliable as FNA on a smear.
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Histological material can become cytological ones as with core biopsy imprint.
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Bone marrow biopsy indications: staging of lymphoma, diagnosing lymphoproliferative disorders, suspicious metastatic involvement, chronic myeloproliferative disorders, aplastic anemia, myelodysplastic syndromes, fever of unknown origin, inadequate bone marrow aspiration, plasma cell dyscrasia, acute leukemia, amyloidosis, bone disease.
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Performing a bone marrow biopsy requires conformation of pre-existing lymphoma through nodal or extranodal mass (bulky disease).
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Bone marrow main structures: bone lamellae (pinkish areas), adipose tissue (whitish, emptied areas), and hematopoietic marrow (in between the adipose tissue).
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Normal adipose tissue contents compared to bone marrow: the expected normal content of the adipose tissue, in percentage, corresponds to the age.
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A specimen of an 80-year-old patient should have 80% of adipose tissue and 20% of hematopoietic marrow.
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A specimen of a 15-year-old patient, you expect to see, physiologically, 15% of adipose tissue and 85% of hematopoietic marrow.
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Bone lamallae, in particular the channel with the osteocytes is found within the marrow.
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In the hematopoietic marrow, cells migrate from the paratrabecular area to the center of the interlamellar space as maturation proceeds.
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The myeloblast is most immature myeloid precursor with maturation steps : myeloblast, promyelocytes, myelocytes, metamyelocytes, band cells, and granulocytes.
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Architecture indicate pathologies when immature cells are found in locations they shouldn't be.
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Giemsa staining highlights erythrocytes' cytological features.
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Erythrocytes precursors are present as proerythroblasts, orthochromatic erythroblasts, and erythroblasts.
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Orthochromatic erythrocytes are small cells with a dark purple nucleus, surrounded by narrow rings of cytoplasm similar to the mature erythrocyte.
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Megakaryocytes in bone marrow produce platelets and explode when finished.
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Sinusoids are found closer to megakaryocytes because these types of vessels are fenestrated making it easier for platelets to enter the circulatory system.
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Plasma cells are located around the capillaries in a ring-like structure.
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Plasma cells have a central nucleus with salt-and-pepper chromatin and a prominent clear area close to the nucleus in the cytoplasm (representing the Golgi).
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The organization of the bone marrow provides more information about possible lymphoma infiltration.
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The colors corresponding to each infiltration are: pink represents the bone lamellae, the white represents the adipose tissue, the yellow represents the hematopoietic marrow and the black represents the lymphoma infiltration.
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Different patterns in bone marrow: Intratrabecular, Para-Trabecular, Intrasinusoidal. Diffused Interstitial, and Diffuse Solid.
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Intratrabecular is the formation of nodules called intratrabecular because they are placed between the bone lamellar.
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Paratrabecular lymphoma follows the profile of the bone lamellae.
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Intrasinusoidal is found within sinosoidal lumen.
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Diffuse Interstitial is formed when the nodules do not have well defined margins.
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Diffuse solid has an area completely replaced by the lymphomatous infiltration.
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Certain lymphomas can favor a pattern of pattern but it is not absolute.
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The growth pattern of the bone marrow is not to be relied on to identify the type of lymphoma and can not diagnose the histotype of lymphoma on a bone marrow biopsy alone.
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The biopsy is superior in detecting lymphoma in both biopsy and aspiration since it gains much more cells.
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A biopsy of healthy tissue because the lymphoma location missed will not be detected.
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FNA can result in affected lymphoma getting aspirated and the bone marrow is affected by the lymphoma.
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Both procedures should be used to detect disease because aspiration can detect where the biopsy cannot due to a particular lymphomas pattern.
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There is no certainty in a patient being 100% healthy an not ill for lymphoma when taking a random biopsy and finding it negative.
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Follicular lymphoma can be found with a para-trabecular pattern has some lymphocytic infiltrates.
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Smear for FC contains cleaved nucleus (Typical of central cells.)
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Follicular Lymphoma diagnosis depends on Precise Markers to confirm which marker it is. -LBCL (Large B-Cell Lymphoma) can superimpose already. Present Lymphoma, its possible for the LBCL to be limited to LN; therefore, doesn't occur in bone marrow.
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Grading is necassary with Lymphoma as ammt centeroblast doesn't reflect the lymphnode or marrow (grade 2 LN is grade 1 in bone marrow for patients.)
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Bone Marro involvement of follicular lymphoma is very frequent and involves almost 60-70 patients at staging level lymphoma patients but with few exceptions bone marrow biopsy necassary for staging lymphomas
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Indolent lymphoma is LBLC and when became the disease have already dissenimate Less possiblitiy with LBCL to have bone marro involvement as something feels wrong ealier with the patient and lymphoma. Having bone marrow involvment unportionally on ammount bone marrow involvmvent worst for progrnosis, less frequent and significat than Follicular lymphoma T-Cell Rich-lymphomas can be seen with LBLC diffuse positive with CD20 Disorders with neopalstic cell sorrouned by less prevalent reactions can be lymphoma Exact diaognsis necesscary as treatments are different
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Cd20 help not forget expresesed different forms Lmphomas. Not one marker necesscary apply panel markers reliable statement possbile. Few neoplastic cell and adanant reactions markers such CD13,CD15 deep Positve! Bone Marrow does not occur frequenct.
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However bone marrow infitration occure becomes for worst.
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As professor said, some lphomas are exception in stage. three types look at bone marro biopsy
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Why are these cells called hairy cells on cells cytoplasm projections look hair, membrane is irregeluar and perfectly roun d apperance Disease occomplisehd by intrinsical Impregnation Rticualr fiber Higlighting with Gomori Trichome Fibers Gomori Fibers stripe fibers well cause Fiberous increase marrow
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Splenecytolmy risk to infctions
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Second Diagnosed by biopsy, zone B Cell Lmphoma Extra Nodal MALT Lmphoma Nodular Lmphoma,Splenic Zone
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Cell Stinace Cd 20, infiltrations pettern Heterous Nodule Middle Adopse tissues. Paar Tacular Difused Interste, India-FIle and dfficulat
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Third Type Lyphopolasmitic Lyphomia
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Sysmetic Disorder macroglobulinema High Quantities IgM cause High Complxss. Interfere With Periperal cirtulation In Small.
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Vessel affects eye brai cause cire death vessels of Body. Plasma Cell includes Share Presscene of Monocolal lmmungobun MGUS condition Abnormal protein is Mono protien or M Protien for plasma. Normal Conten plasma bone marrow or 5 Percent Increase plasma have understand. Increase palasm multple mylemona 10% bone marro smear plasma diagnosis.
-
Other increase palasm in marriw innflmation and infections
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HIV patient bioyc reacht 30-40 percent cell for plaam cel
-
disrcima eReacat poption palams from plasit Populaotn Y-p/Lambda
-
Need nonocla stain steile sectios secions for Pappa Lambda Calacalte Lambda ratio
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Noremal value ratio 3 - 1 noeraml lanmnda ratio Highher-3,1 Foromal Proff colnality , say palasm for Pappa Light Chain Stinai By Imauniohistochemis one portin stain for pappa cyltoipm contrian ligh chan much ner sate sytin lmbda ont only one Stinned Therefoe ratios are more than -3 to--1Monoclonal O Immunoglobulan SO presnec sor galble apperneac caled ussel cell can be senncell Highglt professor pointer Over Prodtion Wvenr prodcution of Lihh chaing , comple, dform Amloyid. Detect amloid with congo red
Congor Confriation nneed palozing Lighht develop
-
Appple gren
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Hemoatioti marriw marrew anothe Marriw diease afftect hemapoi
-
Primr Heotioi marrow
-
While to patholigist pysicia idea kind disease suspiciing
-
feauter pation suggeting havning mde not mdo
-
-Cyiopenta pheriap blod cytopena can mono uncyiopenti , alnrealtnvi, leupokeopa, thnroboyntia Leopkeon normalo platests
-
unyitipnet llll lineages poorly prenest
-
how diettic e disease celualrty hypoalsic this
-
Inffeciteve hemoptoei marriw creast celluari marriw ro more Marriiw balans
Therfoee mmrarriwiw , ceualr Pararioxicntion do not see Same cwell peripheral .
Myelporifetaive, mdo ells hperturli cellualr. feuatrw petie affter yelpriotaive blood in phri myelofiorsi to progresive marrow
-
ver erll phase thonbocytisw
-
rel blood dunterstand certitin disroer can dise
-
-
- Tradiotinnal Still -yeras ago wwner sucing dMde
-
-
- -biopy Matrion effrct
-
- muvh easier Apperaction on mer iwdentify mattrion efect Tndionall Smea
-
archture casially dMmdes
-
exhibt architecture disarri groups precurs far rom
trabalr clonies Erhtrou precursor cdto trabeac with megatyctes
-Important ascpeect detect mer and call polar ctopla in md element ,granupoioeses celalr elements Is risfful to atrient Have. md drisk . Developem Mdeis also caled pre uker disorder but emberm that ge from ukemia
- is Not requt
- Oth 70 percent paiients a shor life Expectic
Due poosblt yinf din bledin plats ate afftected affecto
-
The take home memssge oul s not interret The abscence preucrs
-
As confinriom ot that paeitn will have Poblems tu
Cell Can due to thrmbocyet penai hypothi infecitn
Neccary avoice cormodisties case Cardio acful patient May
-
- -Aciute
Bane Marriw biyopt
Is not all to be s asyou Agniz periph blpod alot of alst homere bone marriw Biopy disclase shur mrarriow. Evert is
-
Acuartiezed by Poualtis
-
Don't ranulocuets .
Dsome exhibit some Cter Cgmarker
-
- -Pgm-1 st calss Primer myelofibersoi
-
- Thjere progresse incrse in foberi fivris Contnen marrow the marrwi Eocme sufficent Mehtyocutes cell are Llcatted With in the vessel not sndiwd.
-
Wheven to devlope prgeesr fiberoius Like cases, marri eleemnt don
Maroiwtheyhomne Some area Which feel able gro like andestoen
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