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

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

Myeloma cells in peritoneal fluid

Rouleaux

Other Plasma Cell Disorders Waldenstrom’s macroglobulinemia 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 Heavy chain disease  Plasmacytoid lymphocyte

Unusual plasma cells

Osteoblasts

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

Hairy Cell Leukemia

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

Lymphoma Cells

Bone Marrow: Focal Involvement

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 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 Precursor T ALL/LBL -- 15% of childhood ALL 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, mutinucleate variants, lacunar cells, lymphocytic-histiocytic cell (LH) 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) RS: has CD 15 (granulo/mono) and CD 30 (B cell) Lymphocyte predominant type CD 20 (B cell) Lymphocyte predominant type CD 20 (B cell) Clinical staging I through IV according to number and location of tumors Clinical staging I through IV according to number and location of tumors

Reed-Sternberg Cell