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1S [LEC]: Acute Leukemias Flashcards

1
Q

Genes where gain of function mutations happen

A

Proto-oncogenes

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2
Q

Genes where loss of function mutations happen

A

Tumor suppressor genes

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3
Q

Uncontrolled proliferation and accumulation of various types of immature or mature leukocytes in the bone marrow and/or peripheral blood

A

Leukemia

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4
Q

Identify whether acute or chronic leukemia:

Short duration

A

Acute

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5
Q

Identify whether acute or chronic leukemia:

Immature cell form in the bone marrow and/or peripheral blood

A

Acute

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6
Q

Identify whether acute or chronic leukemia:

Prognosis if untreated: several weeks to several months

A

Acute

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7
Q

Identify whether acute or chronic leukemia:

Long duration

A

Chronic

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8
Q

Identify whether acute or chronic leukemia:

Mature cell form in the bone marrow and/or peripheral blood

A

Chronic

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9
Q

Identify whether acute or chronic leukemia:

Prognosis if untreated: months to many years

A

Chronic

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10
Q

Classification scheme of leukemia based primarily on morphology and cytochemical staining of blasts

A

French-American-British (FAB) Classification

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11
Q

In FAB classification, blast should be how many percent for the diagnosis of leukemia?

A

> 30%

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12
Q

Classification scheme of leukemia that emphasizes molecular and cytogenetic changes

A

World Health Organization (WHO) Classification

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13
Q

Classification scheme of leukemia that considers morphology, cytochemistry, immunophenotype, genetics, and clinical features

A

World Health Organization (WHO) Classification

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14
Q

In WHO classification, blast should be how many percent for the diagnosis of leukemia?

A

> 20%

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15
Q

Which classification scheme is now the standard of leukemia diagnosis?

A

WHO classification

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16
Q

T/F: In the WHO classification scheme, even if the blast cells do not reach 20%, diagnosis of leukemia is still possible

A

True (if + for molecular/genetic testing)

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17
Q

Cytochemical stains to distinguish leukemias is used for what specimen/s?

A

Blood and bone marrow cells

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18
Q

Myeloperoxidase (MPO) stain primarily stains what structure?

A

Enzyme of the primary granules of granulocytic cells (peroxidase)

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19
Q

Which cells would be positive to MPO stain?

A

Myelocytes

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20
Q

Which specific structure observed in disease conditions is stained by MPO?

A

Auer rods

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21
Q

T/F: All lymphoblast will stain positive with MPO

A

False: only myelocytes will be MPO (+)

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22
Q

Which stain is mainly used to differentiate acute myeloid and acute lymphocytic leukemia?

A

Myeloperoxidase stain

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23
Q

Give the results of MPO stain when used in AML and ALL

A

(+) AML; (-) ALL

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24
Q

Describe the appearance of MPO stain

A

Dark brown/ Black granules/ ppt.

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25
Q

Anticoagulant of choice when staining with MPO

A

EDTA or heparin

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26
Q

Stain that stains lipids present in granulocytes and monocytes, but monocytes will have varied results

A

Sudan Black B stain (SBB)

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27
Q

T/F: SBB may also be used to differentiate AML from ALL

A

True: since it has the same results with MPO

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28
Q

Give the results of SBB stain when used in AML and ALL

A

(+) AML; (-) ALL

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29
Q

Describe the appearance of positive SBB stain

A

Dark purple-black granules

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30
Q

T/F: SBB staining can be done on stored specimens such as air-dried bone marrow smear

A

True

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31
Q

Which one between MPO and SBB requires fresh sample?

A

MPO

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32
Q

Stain used to differentiate myeloblasts and granulocytes from cells of monocytic origin

A

Esterases

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33
Q

Identify whether specific or nonspecific esterase:

Naphthol AS-D chloroacetate esterase (NASDCA)

A

Specific

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34
Q

Identify whether specific or nonspecific esterase:

Alpha-naphthyl acetate esterase (ANAE)

A

Nonspecific

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35
Q

Identify whether specific or nonspecific esterase:

Alpha-naphthyl butyrate esterase (ANBE)

A

Nonspecific

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36
Q

Give the results of specific esterase staining for granulocytic and monocytic cells

A

Granulocytic (+)
Monocytic (-)

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37
Q

Give the results of nonspecific esterase staining for granulocytic and monocytic cells

A

Granulocytic (-)
Monocytic (+)

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38
Q

Describe the appearance of a positive specific esterase stain

A

Bright red granules

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39
Q

A stable enzyme that lasts for months

A

Esterase

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40
Q

T/F: In using esterase stains, the sample should be anticoagulated or fresh

A

False: air dried blood/bone marrow smears or blood anticoagulated with EDTA or heparin may be used

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41
Q

Esterase stains primarily distinguishes between which two cells?

A

Granulocytic and Monocytic

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42
Q

Describe the appearance of a positive nonspecific esterase stain

A

Dark red ppt

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43
Q

Monocytes, in nonspecific esterase, is inhibited by which anticoagulant?

A

Sodium fluoride

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44
Q

If a sample has a dark red precipitate during nonspecific esterase staining even after the addition of sodium fluoride, the origin of leukemia may be ___

A

Megakaryocytic (the addition of fluoride renders the monocytic cells negative)

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45
Q

Marker stain for glycogen glycoproteins, mucoproteins, and high MW carbohydrates

A

Periodic Acid Schiff (PAS)

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46
Q

Which among AML, ALL, and erythroblast will be negative for PAS stain?

A

AML (ALL and erythroblast will be positive)

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47
Q

Stain primarily used for the diagnosis of FAB M6 Erythroleukemia

A

PAS stain (ALL and erythroblast will be positive, but it is now more used for erythroleukemia)

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48
Q

Acid phosphatase will stain ACP present in which cell?

A

Lymphocyte

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49
Q

Which acute leukemia will stain positive for ACP?

A

Acute Lymphoblastic Leukemia (ALL)

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50
Q

Which reagent will inhibit ACP?

A

Tartrate

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51
Q

A blood sample is added with tartrate and stained with ACP. The blood stained positive. What may be the diagnosis?

A

Hair cell leukemia (Chronic lymphocytic leukemia)

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52
Q

Which specific cell is tartrate resistant when stained with ACP?

A

Hairy cells (B lymphocyte with hairy cytoplasm)

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53
Q

LAP score is also known as ___

A

Kaplow count

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54
Q

Detects alkaline phosphatase enzyme activity in primary granules of neutrophils

A

Leukocyte/Neutrophil alkaline phosphatase (NAP)

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55
Q

Specimen required for LAP/NAP staining

A

Fresh specimen anticoagulated with heparin

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56
Q

Describe the appearance of a positive LAP/NAP stain

A

Dark ppt

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57
Q

If you are to differentiate CML from neutrophilic leukemoid reaction, which stain would you use?

A

Leukocyte alkaline phosphatase (LAP)

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58
Q

Identify whether the LAP will be >100 or <10:

Chronic myelogenous leukemia (CML)

A

<10

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59
Q

Identify whether the LAP will be >100 or <10:

Viral infections

A

<10

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60
Q

Identify whether the LAP will be >100 or <10:

Paroxysmal nocturnal hemoglobinuria

A

<10

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61
Q

Identify whether the LAP will be >100 or <10:

Neutrophilic leukemoid reaction (bacterial infection)

A

> 100

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62
Q

Identify whether the LAP will be >100 or <10:

Polycythemia vera (PV)

A

> 100

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63
Q

Identify whether the LAP will be >100 or <10:

Myelofibrosis with myeloid metaplasia (MMM)

A

> 100

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64
Q

Identify whether the LAP will be >100 or <10:

Essential thrombocytopenia

A

> 100

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65
Q

Identify whether the LAP will be >100 or <10:

Third trimester pregnancy

A

> 100

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66
Q

Identify the cell based on the CD marker:

CD 13, CD 33

A

Myeloid

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67
Q

Identify the cell based on the CD marker:

CD 14, CD 11b, CD11c, CD64

A

Monocytic lineage

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68
Q

Identify the cell based on CD markers:

CD14, CD11b

A

Monocytic lineage

69
Q

Identify the cell based on the CD marker:

CD 45, CD 71

A

Erythroblasts

70
Q

Identify the cell based on the CD marker:

CD 41 (Glycoprotein IIb), CD 42b (Glycoprotein Ib)

A

Megakaryoblast

70
Q

Identify the cell based on the CD marker:

CD 79a, CD10, TdT CD19

A

Precursor B cell/ B cell lineage

71
Q

CD10 is also known as ___

A

Common acute lymphoblastic leukemia antigen (CALLA)

72
Q

Identify the cell based on the CD marker:

CD 3, CD 2, CD 5, CD 7, TdT

A

Precursor T cell/ T-lineage/ Tcell

73
Q

Identify the cell based on the CD marker:

Both or neither CD4 & CD8

A

Immature T-cell

74
Q

Give the FAB classification:

Acute Myeloid Leukemia with Minimal Differentiation

75
Q

Identify the leukemia:

Undifferentiated myeloid blasts

A

FAB M0: Acute Myeloid Leukemia with Minimal Differentiation

76
Q

Acute Myeloid Leukemia with Minimal Differentiation is also known as ___

A

AML not otherwise categorized or AML minimally differentiated

77
Q

FAB M0 or Acute Myeloid Leukemia with Minimal Differentiation accounts for how many percent of AML cases?

78
Q

What will be the result of MPO and SBB stain in FAB M0?

A

MPO (-)
SBB (-)

79
Q

T/F: Auer rods will be present in FAB M0

A

False (no Auer rods, since minimally differentiated; thus no primary granules to be fused)

80
Q

Identify the leukemia:

In flow cytometry, the present CD markers include CD13, CD33, CD34, and CD117. When the peripheral blood smear was examined, there is an abundant number of myeloid blasts and no Auer rods found.

A

FAB M0: Acute Myeloid Leukemia with Minimal Differentiation

81
Q

Identify the leukemia:

In flow cytometry, the present CD markers include CD13, CD33, CD34, and CD117. When the peripheral blood smear was examined, there is 35% of myeloid blasts, 6% granulocytic cells, and 93% myeloblasts. Auer rods found.

A

FAB M1: Acute Myeloid Leukemia without Maturation

82
Q

In FAB M1, how many percent of cells will show maturation to the promyelocyte stage or beyond?

83
Q

Will Auer rods be seen in the peripheral blood film of a FAB M1 patient?

A

Yes (granulocytic cells will be present, forming Auer rods)

84
Q

Localized tumor masses consisting of myeloblasts present in FAB M1

85
Q

Patients in which leukemia classification will present chloroma?

A

FAB M1: Acute Myeloid Leukemia without Maturation

86
Q

What will be the staining result of FAB M1 in MPO and SBB?

A

MPO (+)
SBB (+)

87
Q

In FAB M1, how much blast cells is seen in the patient’s blood smear?

88
Q

Give the FAB classification:

Acute Myeloid Leukemia without Maturation

89
Q

Give the FAB classification:

Acute Myeloid Leukemia with Maturation

90
Q

Identify the leukemia:

Demonstrate maturation beyond the myeloblast and promyelocyte stage

A

FAB M2: Acute Myeloid Leukemia with Maturation

91
Q

Identify the leukemia:

Patient is found to have translocation 8;21. The blood sample is positive for specific esterase.

A

FAB M2: Acute Myeloid Leukemia with Maturation

92
Q

Identify the leukemia:

Patient is found to have RUNX1/RUNX1T1 gene. Auer rods are seen in his peripheral blood smear. 37% blasts and 14% granulocytic cells are observed.

A

FAB M2: Acute Myeloid Leukemia with Maturation

93
Q

In FAB M2, how many blast cells are found?

94
Q

In FAB M2, how many granulocytic cells are found?

95
Q

T/F: FAB M2 patients have more myeloblast than FAB M1 patients

A

False (FAB M1 has >90%, FAB M2 has <90%)

96
Q

Most aggressive acute leukemia

A

FAB M3: Acute Promyelocytic Leukemia

97
Q

Leukemia that has an increased incidence of Disseminated Intravascular Coagulation (DIC)

A

FAB M3: Acute Promyelocytic Leukemia

98
Q

Acute leukemia that has the most number of primary granules present

A

FAB M3: Acute Promyelocytic Leukemia

99
Q

In FAB M3, which blood cell predominates in the bone marrow?

A

Promyelocytes

99
Q

Cell with mass or bundles of Auer rods

A

Faggot cells

100
Q

Faggot cells are most commonly found in which leukemia?

A

FAB M3: Acute Promyelocytic Leukemia

101
Q

Identify the leukemia:

Patient has translocation 15;17 and has 47% promyelocyte, with visible Auer rods in his peripheral blood film.

A

FAB M3: Acute Promyelocytic Leukemia

102
Q

FAB M3: Acute Promyelocytic Leukemia management that induces promyelocyte differentiation

A

Therapy with retinoid acid (ATRA)

103
Q

What gene mutation has occurred in the case of Promyelocytic Leukemia/ Retinoid Acid Receptor Alpha?

104
Q

Give the FAB classification:

Acute Myelomonocytic Leukemia

105
Q

Naegeli’s type of monocytic leukemia

A

FAB M4: Acute Myelomonocytic Leukemia

106
Q

In FAB M4, how many percent of monocytic cells constitute the marrow cells?

A

at least 20%

107
Q

FAB classification of the leukemia with both myeloid and monocytic cells present

108
Q

FAB classification of the leukemia with eosinophilic variant

109
Q

Eosinophilic variant of FAB M4

A

FAB M4Eo: Acute Myelomonocytic Leukemia with Eosinophilia

110
Q

Identify the leukemia:

Flow cytometry reveals CD13, CD33, CD11b, CD11c with 25% monocytic cells

A

FAB M4: Acute Myelomonocytic Leukemia

111
Q

Identify the leukemia:

Patient’s bone marrow aspiration reveals myeloblasts and monoblasts along with abnormal eosinophils

A

FAB M4Eo: Acute Myelomonocytic Leukemia with Eosinophilia

112
Q

If the patient has inv(16) or t(16;16), it is possible he has which leukemia classification?

A

FAB M4: Acute Myelomonocytic Leukemia

113
Q

If the patient has the CBFB-MYH11 gene, it is possible he has which leukemia classification?

A

FAB M4: Acute Myelomonocytic Leukemia

114
Q

Give the FAB classification:

Acute Monocytic Leukemia

115
Q

In FAB M5, how many percent of the marrow cells are of monocytic origin?

116
Q

Give the FAB classification:

Acute Monocytic Leukemia, poor differentiation

117
Q

Give the FAB classification:

Acute Monoblastic Leukemia

118
Q

Give the FAB classification:

Acute Monocytic Leukemia, well-differentiated

119
Q

Leukemia that is characterized by large monoblasts with more than or equal to 80% in bone marrow and peripheral blood

A

FAB M5a: Acute Monocytic Leukemia, poor differentiation

120
Q

Schilling’s type of Acute Leukemia

A

FAB M5a: Acute Monocytic Leukemia, poor differentiation

121
Q

Between FAB M5a and M5b, which has better prognosis?

122
Q

If the patient has translocation 9;11, which leukemia does he possibly have?

A

FAB M5: Acute Monocytic Leukemia

123
Q

If the patient has the gene KMT2A (MLL) - MLLT3, it is possible that he has which leukemia classification?

A

FAB M5: Acute Monocytic Leukemia

124
Q

Give the FAB classification:

Acute Erythroleukemia

125
Q

Identify the leukemia:

Di Guglielmo Syndrome

A

FAB M6: Acute Erythroleukemia

126
Q

Identify the leukemia:

Erythemic myelosis

A

FAB M6: Acute Erythroleukemia

127
Q

Identify the leukemia:

Pure erythroid leukemia

A

FAB M6: Acute Erythroleukemia

128
Q

M:E ratio in FAB M6: Acute Erythroleukemia

129
Q

Determining stain in FAB M6: Acute Erythroleukemia

A

Periodic Acid Schiff (PAS)

130
Q

In FAB M6: Acute Erythroleukemia, how much nucleated RBCs are present?

131
Q

In FAB M6: Acute Erythroleukemia, what comprises of the bone marrow cells?

A

80% Erythroid
30% Proerythroblast

132
Q

Give the FAB classification:

Acute Megakaryoblastic Leukemia

133
Q

Identify the leukemia:

Flow cytometry reveals presence of CD41, CD42b, and CD61

A

FAB M7: Acute Megakaryoblastic Leukemia

134
Q

Identify the leukemia:

Patient has t(1;22)

A

FAB M7: Acute Megakaryoblastic Leukemia

135
Q

Identify the leukemia:

Patient has RBM15-MKL1 gene

A

FAB M7: Acute Megakaryoblastic Leukemia

136
Q

Identify the cell based on the CD marker:

CD 34

A

Hematopoietic stem cell

137
Q

Identify the cell based on the CD marker:

CD 20, CD 19, CD 22, CD 79a, CD 21

138
Q

Identify the acute leukemia type based on the cytochemical reaction:

MPO (-)
SBB (-)
NASDA (-)
ANBE (V)
ANAE (V)

A

Acute Lymphoblastic Leukemia (ALL)

139
Q

Identify the acute leukemia type based on the cytochemical reaction:

MPO (+)
SBB (+)
NASDA (+)
ANBE (-)
ANAE (-)

A

Acute Myeloid Leukemia (AML)

140
Q

Identify the acute leukemia type based on the cytochemical reaction:

MPO (+)
SBB (+)
NASDA (-)
ANBE (+)
ANAE (+)

A

Acute Monoblastic Leukemia (AMoL)

141
Q

Identify the acute leukemia type based on the cytochemical reaction:

MPO (+)
SBB (+)
NASDA (+)
ANBE (+)
ANAE (+)

A

Acute Myelomonocytic Leukemia (AMML)

142
Q

Identify the acute leukemia type based on the cytochemical reaction:

MPO (-)
SBB (-)
NASDA (-)
ANBE (-)
ANAE (-)

A

Acute Megakaryocytic Leukemia

143
Q

Acute leukemia classification that will have positive result of PAS staining

A

FAB M6: Acute Erythroleukemia
FAB M7: Acute Megakaryocytic Leukemia

144
Q

Defined as greater than 50% dysplasia in at least two cell lineages

A

Multilineage dysplasia

145
Q

Refers to extramedullary proliferation of blasts of one or more myeloid lineages that disrupts tissue architercure

A

Myeloid Sarcoma

146
Q

A condition where tissues commonly affect the skin, GI tract, and lymph nodes

A

Myeloid Sarcoma

147
Q

A condition where approx. 10% of newborns with down syndrome present with transient abnormal myelopoiesis

A

Myeloid Proliferation Related to Down Syndrome

148
Q

Myeloid Proliferation Related to Down Syndrome is morphologically indistinguishable from which leukemia type?

A

Acute Myeloid Leukemia (AML)

149
Q

Among individuals with down syndrome, there is a ___ increased incidence of AML

150
Q

What gene mutation has occurred in Myeloid Proliferation Related to Down Syndrome?

A

GATA1 mutation

151
Q

Leukemia where there is no clear evidence of differentiation along a single cell line

A

Acute Leukemia of Ambiguous Lineage (ALALs)

152
Q

Leukemia that demonstrates a multiplicity of antigens

A

Mixed phenotype acute leukemias

153
Q

Acute Lymphoblastic Leukemia is the most common cancer in what population?

154
Q

The most common cancer in children

A

Acute Lymphoblastic Leukemia (ALL)

155
Q

Classify the ALL:

Small cells predominant; nuclear shape is regular with an occasional cleft

A

L1 homogenous

156
Q

Classify the ALL:

Large cells with an irregular nuclear shape

A

L2 heterogenous

157
Q

Classify the ALL:

Cells are large and homogenous; cytoplasm is basophilic with vacuoles

A

L3 Burkitt Lymphoma type

158
Q

Classify the ALL:

Present in older children and adult

A

L2 heterogenous

159
Q

Non-malignant form of FAB L3

A

Mononucleosis (due to Epstein-Barr virus)

160
Q

Which cell lineages does FAB L3 affect?

A

B cell lineage

161
Q

A type of ALL with recurrent genetic abnormality that has a presence of Philadelphia chromosome

A

B-lymphoblastic Leukemia

162
Q

A type of ALL with recurrent genetic abnormality that is more common in adults than in children

A

B-lymphoblastic leukemia with t(9;22)

163
Q

A type of ALL with recurrent genetic abnormality that is common in very young infants

A

B-lymphoblastic leukemia with t(v;11q23)

164
Q

T/F: In B-lymphoblastic leukemia with t(v;11q23), translocation may occur in utero

165
Q

B-lymphoblastic leukemia with good prognosis

A

B-lymphoblastic leukemia with t(12;21)

168
Q

T/F: CML patients with t(9;22) has a good prognosis compared to ALL patients with the same mutation which has the worst prognosis

169
Q

A tyrosine kinase inhibitor that has shown success in treating CML

MT6325 (14 decks)

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