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