WBC

NON-NEOPLASTIC

SLIDE DIAGNOSIS CHARACTERISTICS

Gaucher’s Disease • Organ: Spleen
• Cluster of autosomal recessive disorders resulting from mutations in the gene
encoding glucocerebrosidase
• Most common lysosomal storage disorder
• Glucocerebrosidase
o Enzyme that normally cleaves the glucose residue from Ceramide
o Accumulate in massive amounts within phagocytic cells throughout the
body
• Gaucher’s Cells
o Distended phagocytic cells
o Enlarged cells; have one or more dark eccentrically placed nuclei, and
fibrillary type of cytoplasm likened to crumpled tissue paper (d/t
accumulation of glucocerebroside)
o Enlarged, pale, eccentrically placed nuclei

Sinus Histiocytosis • Organ: Lymph Node

• Other names: Reticular Hyperplasia or Sinus Hyperplasia
• Increase in the number and size of the cells that line lymphatic sinusoids
(particularly of the medulla)
• Non-specific finding indicative of a reactive process
• Prominent in lymph nodes draining cancers such as carcinoma of the breast

MORPHOLOGY
• Expanded lymphatic sinus at the medulla of lymph node
• Medulla exhibits expansion of the lymphatic sinuses
• Expanded pale areas show hyperplasia of the macrophages called Histiocytes in
the medullary portion near the blood vessel
• The capillaries that supply these areas exhibit hypertrophy of the endothelial
lining epithelium
 Follicular Hyperplasia • Caused by stimuli that activates humoral immune responses (reactive process)
• Presence of large oblong germinal centers (secondary follicles) which are
surrounded by a collar of small resting naïve B cells (Mantle zone)

FEATURES
1. Preservation of lymph node architecture – including the interfollicular T cell
zones & sinusoids
2. Marked variation in the shape & size of the follicles
3. Presence of frequent mitotic figures, phagocytic macrophages, recognizable light
& dark zones – all of which tend to be absent from neoplastic follicles

Reactive Hyperplasia Organ: Tonsils

Epithelial Lining: Stratified Squamous Epithelium
• Germinal centers are normally polarized, containing at least 2 distinct regions
o Dark zones – contains proliferating blastlike B cells (Centroblasts)
o Light zones – composed of B cells with irregular or cleaved nuclear
contours (Centrocytes)
Interspersed between the germinal centers is an inconspicuous network of antigen-
presenting follicular dendritic cells called tangible-body macrophages

Passive Congestion, Spleen Organ: Spleen

Caused by: Chronic venous outflow obstruction

• Liver Cirrhosis – main cause of massive congestion splenomegaly

o Circulation of portal vein shunted out other collaterals such as the
circulation to the spleen
o “Pipe-steam” hepatic fibrosis of Schistosomiasis
o Alcoholic cirrhosis
• Congestive splenomegaly
o Caused by obstruction of the extrahepatic portal vein or splenic vein
o Spontaneous portal vein thrombosis or inflammation of the portal vein
(Pylephlebitis)

MORPHOLOGY
• Red pulp – expanded & is heavily congested
• Constriction of the space occupied by the white pulp
• Spleen appears heavier than normal
• Condition associated with this in the peripheral blood
• Hyperfunctioning
• Sequestration of blood cells producing
o Anemia
o Depletion of thrombocytes or platelets which are also present
in the spaces
o Increased vulnerability of the spleen to blunt trauma producing
bleeding
NEOPLASTIC

SLIDE DIAGNOSIS CHARACTERISTICS

Plasmacytoma Multiple Myeloma: a plasma cell neoplasm commonly associated with lytic bone
lesion, hypercalcemia, renal failure, & acquired immune abnormalities
o Usually presents as destructive plasma cell tumors (Plasmacytoma)
involving the axial skeleton
o The marrow constitutes more than 30% of the cellularity

PATHOGENESIS
o Rearrangements involving the IgH locus & various proto-oncogenes

• Plasma cells
o Nuclei has a unique pattern called Spokes of Wheel or Clockface
Chromatin Pattern
o Perinuclear Halo – a pale space considered to be the Golgi Zone
where the secretory vesicles are made, and these cells are capable
of producing huge amounts of antibodies

Follicular Lymphoma Organ: Lymph Node

Hallmark: (14;18) Translocation

• Arises from germinal center B cells and is strongly associated with

chromosomal translocations involving BCL2 gene (Gene is involved or
associated with apoptosis)
• Nodular or nodular & diffuse pattern of growth
• Absence of light & dark zones in the germinal center
• 2 principal cells
o Centrocytes – small cells with irregular or cleaved nuclear
contours & scant cytoplasm
o Centroblasts – larger cells with open nuclear chromatin, several
nucleoli, & modest amounts of cytoplasm
 Large Cell Lymphoma
Hodgkin Lymphoma, Nodular Sclerosing
Type
Gastric Lymphoma
Other name: Diffuse Large B Cell Lymphoma (DLBCL)
• Most common form of Non-Hodgkin lymphoma
PATHOGENESIS
• Dysregulation of BCL6, a DNA-binding zinc-finger transcriptional repressor
that is required for the formation of normal germinal centers. The majority
are of B cell lineage.
• Translocations that have in common a breakpoint in BCL6 at Chromosome
3q27
Known as: Classical Hodgkin Lymphoma
Neoplastic cells: Reed-Sternberg cells
o Release factors that induce accumulation of reactive
lymphocytes, macrophages, & granulocytes
• Most common form of Hodgkin Lymphoma
• Uncommonly associated with EBV
• Presence of sclerosis
• Presence of heterogenous mixture of cells
REED-STERNBERG CELL VARIANTS
1. Mononucleate – most common
2. Binucleate – classical
3. Lunar – presence of space within its lacuna
4. Multinucleated – appearance of coins on a plate
5. Popcorn – L&H variant
6. Mummified – Pyknotic, rarest kind
• Gastric lymphomas are nearly 5% primary lymphomas
o Most common: Indolent extra nodal marginal zone B-cell
lymphoma
• Often refers to as lymphomas of Mucosa-associated lymphoid tissue
(MALT) or MALTomas
o Usually arise at sites of chronic inflammation
o Proliferating element: Marginal Zone
o Often regress or do not develop further or heal themselves once
the cause of inflammation is treated
o Most cases: H. pylori
• Commonly transforms into Diffuse Large B Cell Lymphoma
• Proliferation of neoplastic cells beneath the mucosa in the lamina propria &
sometimes the submucosa
• Infiltrates the smooth muscle layer
Acute Granulocytic Leukemia • Acute Myelogenous Leukemia (AML) that invaded extramedullary organs &
tissues
• Leukemia – primarily concerns the bone marrow but when it spills &
invades the soft tissue then it is termed as lymphoma