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Oral Pathology Exam 2 > 5 Hematologic Diseases (Malignancies) > Flashcards

5 Hematologic Diseases (Malignancies) Flashcards

1
Q

malignant lymphoproliferative disorder

A

hodgkin’s lymphoma

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2
Q

Reed-Sternberg cell, likely of B-cell origin, only makes up 1-3% of cells in the enlarged nodes

A

hodgkin’s lymphoma

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3
Q

approx 9,000 cases annually

A

hodgkin’s lymphoma

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4
Q

EBV linkage suggested

A

hodgkin’s lymphoma

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5
Q

male predilection

A

hodgkin’s lymphoma

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6
Q

Two age peaks of hodgkins lymphoma

A

15-35 and > 50

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7
Q

Clinical findings: persistently enlarging lymph nodes start off freely moveable but become fixed and matted to adjacent tissue

A

hodgkin’s lymphoma

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8
Q

30-40% of patients have other symptoms –> night sweats, weight loss, fever, generalized itching

A

hodgkin’s lymphoma

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9
Q

survival rate of hodgkins lymphoma stage I/II vs III/IV

A

Stage I or II = 80-90% relapse free 10-yr survival rate

Stage III/IV = 55-75% 10-yr survival

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10
Q

Clinical findings: an enlarging nontender discrete mass in one lymph node region

A

Hodgkin’s lymphoma

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11
Q

In 70-75% of cases of Hodgkin’s lymphoma, this is the initial site of presentation. What are other sites of involvement?

A
  • cervical and supraclavicular lymphadenopathy
  • axillary lymphadenopathy
  • mediastinal lymphadenopathy
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12
Q

lymphoreticular malignancy, most often arise within lymph nodes and grow into solid masses

A

non-Hodgkin’s lymphoma

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13
Q

malignant cells do NOT usually circulate in the peripheral blood

A

non-Hodgkin’s lymphoma

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14
Q

70,000 cases/year in the US, 1/3 die of it each year

A

non-Hodgkin’s lymphoma

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15
Q

What does non-Hodgkin’s lymphoma originate from?

A

B-lymphocytes (85% of US cases)

T-lymphocytes (less common)

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16
Q

classification of non-Hodgkin’s lymphoma

A
  • low, intermediate, or high grade (indicate increasing aggressiveness)
  • REAL classification
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17
Q

extranodal site of development, make up 20-40% of lymphomas in US

A

non-Hodgkin’s lymphoma

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18
Q

can develop in the soft tissues or centrally within the jaws, present as nontender diffuse swellings

A

non-Hodgkin’s lymphoma

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19
Q

Oral manifestations:

  • nontender diffuse swellings
  • hard palate, buccal vestibule, gingiva
  • erythematous
  • purplish-blue
  • may be ulcerated
  • surface telangiectasia
A

non-Hodgkin’s lymphoma

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20
Q

tx of non-Hodgkin’s lymphoma

A

radiation, chemo, or a combo

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21
Q

high grade B cell lymphoma, linked to EBV infection as etiologic agent (90% of tumor cells express the EBV nuclear antigen)

A

Burkitt lymphoma

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22
Q

more common in males, children

A

Burkitt lymphoma

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23
Q

areas of the world with an increased prevalence of Burkitt lymphoma

A

sub-Saharan Africa, northeastern Brazil, immunodeficiency type

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24
Q

ill-defined, ragged radiolucency on radiographs

A

Burkitt lymphoma

25
Q

malignancy of hematopoietic stem cell origin (one stem cell undergoes malignant transformation and proliferates within the marrow, overflows into the peripheral blood stream)

A

leukemia

26
Q

2.9% of all cancers, 4.1% of all cancer deaths

A

leukemia

27
Q

more frequently with certain genetic syndromes and alterations, also caused by environmental agents (benzene, pesticides, ionizing radiation, viruses)

A

leukemia

28
Q

13 cases/100,000 people annually

A

leukemia

29
Q

classification system of leukemia

A

Clinical course:
A or C: acute vs chronic
- acute = aggressive course, more lead to death, more common in children
- chronic = slow course but still fatal, more common in adults

Cell or origin:
M or L: myeloid or lymphocytic/lymphoblastic
- myeloid = broader age range, kids to age 40
- lymphocytic = most common type, older adults
- lymphoblastic = children

30
Q

first genetic abnormality of leukemia reported

A

CML- 9:22 translocation (“Philadelphia chromsome”)

31
Q

symptoms result from crowding out of normal red and white blood cells from the marrow, malignant cells replace normal cells and results in myelophthisic anemia

A

leukemia

32
Q

specific anemia related to cancer (leukemia, multiple myeloma)

A

myelophthisic anemia

33
Q

symptoms include fatigue, dyspnea with mild exertion, fever, frequent infections (intraoral herpes, candidiasis)

A

leukemia

34
Q

frequent oral infections that occur in leukemia patients

A

intraoral herpes

candidiasis

35
Q

easy bruising and bleeding from thrombocytipenia, spontaneous gingival bleeding can be seen

A

leukemia

36
Q

cancerous cells can infiltrate the oral mucosa and cause diffuse, boggy swelling of the soft tissues (may simulate periapical disease clinically and radiographically)

A

leukemia

37
Q

When malignant leukemia cells infiltrate organs:

A

splenomegaly
hepatomegaly
lymphadenopathy

38
Q

dx of leukemia

A

presence of poorly differentiated leukemic cells in the peripheral blood and bone marrow

39
Q

tx of leukemia

A
  • chemo (induction or maintenance)
  • radiation
  • bone marrow transplant
40
Q

induction vs maintenance chemo for tx of leukemia

A

Induction chemo- rapidly destroying the atypical cells

  • hige dose toxic chemotherapeutics
  • hopefully destroys all of the cancerous cells and puts the patient into remission
  • transfusions with platelets
  • encourage excellent OH to help prevent oral infections

Maintenance chemo- lower dose
- maintains remission following induction therapy

41
Q

Why must radiation AND chemo be used to treat leukemia?

A

for the CNS –> many chemotherapeutics do not cross the BBB

42
Q

malignancy of plasma cell origin, originates in bone (single malignant precursor cell gives rise to the entire proliferation, cells spread throughout the body and produce proteins, abnormal immunoglobulins, that deposit in soft tissue as amyloid)

A

multiple myeloma

43
Q

~22,000 cases diagnosed annually

A

multiple myeloma

44
Q

age = 60-70

A

multiple myeloma

45
Q

2x more common in blacks than whites

A

multiple myeloma

46
Q

most common hematologic malignancy in black patients

A

multiple myeloma

47
Q

Clinical symptoms:

  • bone pain
  • pathologic fracture from tumor destruction of bone
  • fatigue (myelophthisic anemia)
  • petechial hemorrhages in soft tissues (10-15% of patients) due to accumulation of the light chain proteins
  • kidney failure due to overload of light chain proteins
  • increased Bence Jones proteins in the urine (30-50%)
A

multiple myeloma

48
Q

rad: multiple, well-defined, punched-out radiolucencies, 30% of patients have jaw lesions

A

multiple myeloma

49
Q

30% of patients have jaw lesions

A

multiple myeloma

50
Q

tx of multiple myeloma

A
  • chemotherapy + corticosteroids (60% of patients respond however most experience relapse)
  • bisphosphonate medications given to reduce the possibility of myeloma related fractures but do not increase survival
  • otherwise healthy patients under age 55-65 can try aggressive chemo and bone marrow transplantation (5 yr survival = 50%)
51
Q

solitary/unifocal monoclonal, neoplastic proliferation of plasma cells usually arising within bone

A

plasmacytoma

52
Q

most common site of plasmacytoma

A

spine

53
Q

Name the hematologic malignancy: 55 yo average age, M: F = 2:1

A

plasmacytoma

54
Q

symptoms include swelling or bone pain, can develop outside of bone as a soft tissue mass (extramedullary = 25% occur in the head and neck)

A

plasmacytoma

55
Q

rad: well-defined, unilocular radiolucency, punched-out RL, may have ragged irregular borders

A

plasmacytoma

56
Q

tx of plasmacytoma

A

radiation therapy (50% of patients show disseminated disease within 2-3 years)

57
Q

increased Bence Jones proteins in the urine (30-50%)

A

multiple myeloma

58
Q

Multiple myeloma cells produce proteins (abnormal immunoglobulins) that deposit in soft tissue as amyloid. What % of myeloma patients have deposition of amyloid on soft tissues due to accumulation of the light chain proteins? What is a symptom that arises from this deposition?

A

10-15%

kidney failure due to overload of light chain proteins (increased Bence Jones proteins in urine 30-50%)

Oral Pathology Exam 2 (8 decks)

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