The hematopoietic and lymphoid systems - The lymphoid systems

23 important questions on The hematopoietic and lymphoid systems - The lymphoid systems

What are the parts of the lymphoid systems?

- Lymph nodes
- Lymphoid organs and extranodal tissue

What is the difference between B- and T-lymphocytes in terms of their maturation?

Both are produced in the bone marrow, but
- the B-lymphocytes mature in the bone marrow,
- the T-lymphocytes mature in the thymus (the common lymphoid progenitor travels to the thymus)

How is T-cell maturation and differentiation regulated in the thymus?

By thymic hormones, that are produced by the thymic epithelium.
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What are the parts of a lymph node?

Inside to outside:
- Medulla
- Paracortex
- Cortex with primary and secondary follicles

What is the cortex of a lymph node surrounded with?

With (subcapsular) sinuses, which are surrounded by the capsule.

What process takes place in the follicles?

The B cell response, which includes somatic hypermutation (to find the type of B cell that binds the pathogen best).

What process takes place in the paracortex?

The T-cell response, which includes the selection of antigen-specific T-cell subsets.

What is the function of the sinuses?

The transport of migrating cells and proteins, also macrophages are present here.

What is meant by follicular hyperplasia?

The swelling of the follicles of the lymph nodes during a bacterial infection, or when there is an auto-immune disease.
Therefore, follicular hyperplasia is most often benign.

What is meant by paracortical hyperplasia?

The swelling of the paracortex of the lymph node when there is a viral infection, or as a reaction to a vaccination.
Therefore, paracortical hyperplasia is most often benign.

What is meant by sinus histiocytosis?

An increase in the size of the sinuses of lymph nodes during infection or inflammation, because of an increase in the number of histiocytes/macrophages.

What is the difference between leukemia and lymphoma?

- Leukemia = malignant cells in bone marrow & blood
- Lymphoma = malignant cells in lymphoid organs / lymphoid structures forming masses

What are the 4 types of B-cell lymphomas?

- Precursor B-lymphoblastic lymphoma (immature B-cells)
- Cancer of naive B-cells (mature B-cells)
  • Mantle cell lymphoma
  • Chronic lymphocytic leukemia
- Cancer of germinal center B-cells (mature B-cells)
  • Follicular lymphoma
  • Burkitt lymphoma
  • Hodgkin lymphoma
- Cancer of post-germinal center B-cells (mature B-cells)

What are the characteristics of non-Hodgkin lymphoma?

- Entity and treatment protocol depends on the type of NHL
- Distribution is unpredictable and dependent on the type
- Staging only limitedly correlates with the outcome

What is the difference between indolent and agressive non-Hodgkin lymphoma?

- Indolent: does often not immediately require treatment, often only treatment when the patient gets symptoms.
- Agressive: immediately requires treatment.

Based on what four criteria are lymphomas characterised?

1. Morphology: of the lymph node (growth pattern), and the lymphocytes.
2. Immunophenotype: protein expression
3. Genetics: translocations or mutations
4. Clinical features: location of lymphadenopathy/mass

What are the most prevalent lymphoma types?

- B-cell lymphomas, both aggressive and indolent
- Multiple myeloma

Which gene is overexpressed in follicular lymphoma?

The Bcl2 gene (it is translocated to a very active site in the B-cell DNA)

What kind of DNA alterations are very common in malignant lymphomas?

Translocations.

Which gene is translocated in Burkitt lymphoma?

The MIB gene.

Which two things are characteristic for Burkitt lymphoma?

- Extranodal expression (masses), in for example the head-neck region or abdomen
- It is endemic in Africa (primarily in young people)

When is the prognosis of Hodgkin lymphoma good?

- When the stage is limited (there are only masses above the diaphragm)
- When the patient has no B-symptoms (like fever)

What is the histological hallmark of Hodgkin lymphoma?

Hodgkin cells in an appropriate reactive background (= sporadic large cells, the reactive background primarily causes the tumor growth)

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