Lab 3: Lymphoma and Myeloma Hematology Unit 2017
Lab 3: Lymphoma and Myeloma
Hematology Unit
2017
Objectives• Laboratory Instructor will:
– Review pathophysiologic processes of lymphoma and myeloma
– Review morphologic and laboratory features of lymphoma and myeloma
– Assist students during self study
• Students will:
– Study the case histories provided
– Examine the pathological material related to each case using virtual microscopy
– Answer the questions related to each case
Lymphadenopathy: Differential Diagnosis
Diagnostic ApproachLymphadenopathy
Benign Malignant
Clinical Assessment
Treat Accordingly CBC
Normal
LN Biopsy
Elevated ALC
Flow Cytometry
FISH
Diagnostic Non-DiagnosticALC: Absolute Lymphocyte Count
Proposed Cellular Origin of B-Cell Malignancies
The cellular origin of the different lymphoid malignancies can be inferred from immunoglobulin gene rearrangement status and membrane phenotype. Mantle cell lymphoma and a proportion of B-cell chronic lymphocytic lymphoma (B-CLL) cases have unmutated immunoglobulin genes whereas marginal zone lymphoma, diffuse large cell lymphoma, follicle cell lymphoma, lymphoplasmacytoid lymphoma and some B-CLL cases have mutated immunoglobulin genes.
Hyperplasia
Lymph Node Biopsy: Benign vs Malignant
Diffuse Lymphoma
Follicular LymphomaNormal
Leukemia vs Lymphoma
1. Leukemia = Blood and
BM presentation– Abnormal CBC
– Circulating malignant cells
– Bone marrow involvement (≥ 20%)
2. Lymphoma = LN/
soft tissue presentation– Lymphadenopathy
3. Leukemia/Lymphoma : 1 + 2
Examples:
CLL/SLL; B-ALL/BL; T-ALL/LBL
CLL vs SLL
Lymphoma: Histology vs Cytology
Cytology = Cells on a smearLeft: small lymphocyteRight: Large (activated) lymphocyte or a blast
Histology = Tissue sectionLarge cells: vesicular nuclei, open chromatinSmall cells: compact nuclei
Follicular NHL vs Nodular Sclerosis HL
Follicular Lymphoma
Lymphoma: Morphology of Interest
Plasma Cell Myeloma
MM: Clinical Manifestations: C.R.A.B
Calcium Renal
Bone Disease
Anemia
Note
Rouleaux
formation