VII.C: Mature B-Cell Lymphomas and Myelomas

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VII.C.001

Burkitt lymphoma. Lymph node biopsy. Low power. H&E stain. Characteristic sheets of lymphoblasts with interspersed macrophages, the latter giving it a “starry sky” appearance.

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VII.C.002

Burkitt lymphoma. Lymph node biopsy. Ki-67 nuclear stain giving a red-brown color to the lymphoblasts and confirming high proliferative rate of >90% of cells. Ki-67 is cell cycle regulatory protein.

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VII.C.003

Burkitt lymphoma. Lymph node biopsy. Wright’s Giemsa stain of air-dried lymph node touch preparation shows blast-like large lymphoid cells with prominent nucleoli and frequent cytoplasmic vacuoles. Mitotic figures. Tissue equivalent of acute lymphoblastic leukemia of Burkitt type.

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VII.C.004

Burkitt lymphoma. Lymph node biopsy. Low power view. Note areas of clearing that impart the so-called “starry sky” appearance. These areas represent tingible-body macrophages within the tumor that are recruited to phagocytize cellular debris. A similar appearance may also be seen in other lymphomas that have a high proliferative rate.

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VII.C.005

Burkitt lymphoma. Lymph node. Biopsy. Higher power view. Individual tumor cells have a high nuclear: cytoplasmic ratio, round nuclear contours, and small, barely perceptible nucleoli (sometimes called “inconspicuous” nucleoli). These overall features are often referred to as a “small non-cleaved” cell or “small transformed” cell cytology.

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VII.C.006

Burkitt lymphoma. Lymph node biopsy. (A) Lower power view showing diffuse replacement of nodal tissue with Burkitt lymphoblasts with classical interspersed macrophages presenting a starry sky appearance. (B) Higher power view. Burkitt lymphoblasts with prominent nucleoli. Interspersed macrophages with ingested cellular debris. Relative increase in mitotic figures.

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VII.C.007

Burkitt lymphoma. Lymph node biopsy. (A) Lower power view showing diffuse replacement of nodal tissue with Burkitt lymphoblasts with classical interspersed macrophages presenting a starry sky appearance. (B) Higher power view. Burkitt lymphoblasts with prominent nucleoli. Interspersed macrophages with ingested cellular debris.

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VII.C.008

Cryoglobulinemia. Blood films. (A) Gray precipitates in blood taken from a finger stick (acral cooling). Hypersegmented neutrophil. (B) Gray precipitates in blood taken from finger stick (acral cooling). Small platelet aggregate.