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Week 11: Lymphoproliferative Disorders

Multiple myeloma Plasma cell Monoclonal gammopathy Bence-Jones protein Protein ELP Hairy cell leukemia TRAP. Lymphoma Hodgkin’s disease Reed-Sternberg cell Mycosis fungoides Sezary cell. Week 11: Lymphoproliferative Disorders. Multiple Myeloma. Plasma cell leukemia

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Week 11: Lymphoproliferative Disorders

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  1. Multiple myeloma Plasma cell Monoclonal gammopathy Bence-Jones protein Protein ELP Hairy cell leukemia TRAP Lymphoma Hodgkin’s disease Reed-Sternberg cell Mycosis fungoides Sezary cell Week 11: Lymphoproliferative Disorders

  2. Multiple Myeloma • Plasma cell leukemia • Monoclonal gammopathy ELP pattern with sharp  region spike • High ESR, rouleaux, Bence-Jones protein, Platelet dysfunction • Osteolytic (punched out) bone lesions

  3. Myeloma cells in peritoneal fluid

  4. Rouleaux

  5. Other Plasma Cell Disorders • Waldenstrom’s macroglobulinemia • IgM • Soft tissue involvement • CD 20 (B cell) but no CD 21 (mature B) or PC 1 (plasma cell) • Heavy chain disease • Plasmacytoid lymphocyte

  6. Unusual plasma cells

  7. Osteoblasts

  8. Hairy Cell Leukemia • Leukemic reticuloendotheliosis • Probably B cell origin • CD 19, 20, 22, 24 (B cell), 25, 11c (granulocyte), sIg, some CD 5 (pan-T) • Tartrate resistant acid phosphatase (TRAP)

  9. Hairy Cell Leukemia

  10. LRE: Ruptured Spleen

  11. Acid Phosphatase Naphthol AS-BI phosphate ACP in acid pH > Free naphthol AS-BI + FastGarnet GBC Magnesium > Maroon deposits

  12. Tartrate Resistant ACP: TRAP + Tartrate

  13. Non-Hodgkin’s Lymphoma • Lymphocytes with clefted nuclei • Sezary cells in mycosis fungoides have many clefts • Rappaport classification based on morphology and differentiation • Lukes-Collin classification with cell types identified • International Working Formulation with tumor aggressiveness and histology • Revised European/American Lymphoma (REAL) classification is most recent

  14. Lymphoma Cells

  15. Bone Marrow: Focal Involvement

  16. WHO Classification of Acute Lymphoproliferative Syndromes • Precursor B Lymphoblastic Leukemia/Lymphoma (ALL/LBL) -- ALL in children (80-85% of childhood ALL); LBL in young adults and rare; FAB L1 or L2 blast morphology • Precursor T ALL/LBL -- 15% of childhood ALL and 25% of adult ALL • Burkitt Leukemia/Lymphoma (FAB L3)

  17. Mycosis Fungoides: T-cell Lymphoma of skin

  18. Skin Biopsy Skin Imprint Sezary Syndrome

  19. PAS Positive: Sezary Syndrome

  20. Hodgkin’s Lymphoma • Reed-Sternberg cell (RS): lobated nuclei, mutinucleate variants, lacunar cells, lymphocytic-histiocytic cell (LH) • RS: has CD 15 (granulo/mono) and CD 30 (B cell) • Lymphocyte predominant type CD 20 (B cell) • Clinical staging I through IV according to number and location of tumors

  21. Reed-Sternberg Cell

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