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Oral and Maxillofacial Pathology > Chapter 13: Hematologic Disorders > Flashcards

Chapter 13: Hematologic Disorders Flashcards

1
Q
A

leukemia

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2
Q

is burkitt’s lymphoma an aggressive malignancy?

A

yes

the untreated patient will succomb to the disease in 6 months

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3
Q

platelet count less than ___/mm3 is considered severe thrombocytopenia and can result in massive bleeding and death

A

10,000

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4
Q

___ are dendritic mononuclear cells normally found in the epidermis, mucosa, lymph nodes, and bone marrow

A

langerhans cells

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5
Q

burkitt’s lymphoma has a predilection for the jaws. what specific locations are more common?

A

posterior jaws > anterior

maxilla > mandible

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6
Q

what are the neoplastic cells of hodgkin’s lymphoma?

A

reed-sternberg cells

typically binucleated (“owl eye” nuclei)

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7
Q

are males or females more commonly affected by hodgkin’s lymphoma?

A

males

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8
Q
A

mycosis fungoides

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9
Q
A

hodgkins lymphoma

reed-sternberg cells (owl-eye nuclei)

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10
Q

the decrease in platelets in thrombocytopenia may be due to what 3 things?

A
  • reduced production
  • increased destruction
  • sequestration in the spleen
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11
Q

what are the two types of hodgkin’s lymphoma?

A
  • nodular lymphocyte - predominant
  • classical
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12
Q

what are the radiographic features of multiple myeloma?

A
  • multiple, well-defined “punched out” radiolucencies
  • may be ragged radiolucent lesions
  • especially evident on skull film
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13
Q

what should you be able to see on a radiograph of a patient with langerhans cell histiocytosis?

A
  • sharply demarcated (punched-out) readiolucencies
  • occasionally may be ill-defined
  • mandibular lesions appear scooped out because the superficial alveolar bone is destroyed
  • extensive alveolar bone involvement resembles severe periodontitis clinically and radiographically the teeth look like they are floating in air
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14
Q

what is an example of a virus that can cause leukemia?

A

human T-cell leukemia/lymphoma virus type 1 (HTLV-1) transmitted by blood

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15
Q
A

multiple myeloma

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16
Q

plasmacytoma typically arises in what tissue?

A

bone

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17
Q

what is the treatment for burkitt’s lymphoma?

A

intensive chemotherapy

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18
Q

with acute infections, how does lymphoid hyperplasia present?

A

the lymphoid hyplerplasia (tonsillar) appears as enlarged, tender, soft, freely movable nodules

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19
Q

what is the prognosis of langerhans cell histiocytosis?

A
  • good if it is limited to bone
  • those with visceral and cutaneous involvement have a poor prognosis
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20
Q

what are the oral symptoms of agranulocytosis?

A

necrotizing, deep, punched out ulcerations of the buccal mucosa, tongue, and palate

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21
Q

at what platelet count is clinical evidence of thrombocytopenia seen? this condition is often initially detected due to what?

A
  • below 100,000/mm3
  • oral lesions
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22
Q

non-hodgkins lymphoma is also called a ___

A

lymphoma

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23
Q

___ lesions are the most common presentation of langerhans cell histiocytosis

A

bone

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24
Q

the abnormal cells of myltiple myeloma are ___, which likely arise from ___

A
  • monoclonal
  • a single precursor that undergoes uncontrolled mitotic division
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25
Q

what is the treatment for anemia?

A

depends on correcting the underlying condition

refer to physician

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26
Q

what is this, and what hematologic disorder is it associated with?

A

petechiae

thrombocytopenia

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27
Q

non-hodgkins lymphoma occurs primarily in what age patient?

A

adults

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28
Q
A

mycosis fungoides

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29
Q

50% of patients with plasmacytoma will have multiple myeloma within ___ years

A

2-3

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30
Q

lymphoid hyperplasia may affect what tissues?

A
  • lymph nodes
  • waldeyer’s ring
  • aggregates of lymphoid tissues scattered throughout the oral cavity
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31
Q

some patients with multiple myeloma may have pathologic ___, complain of ___, or have ___

A
  • fractures
  • fatigue
  • petechiae
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32
Q

radiographic features of burkitt’s lymphoma are consistent with ___

A

a malignant process

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33
Q

what is the prognosis for multiple myeloma? what is the median survival?

A
  • prognosis is poor
  • median survival of 3 years
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34
Q

NK/T cell lymphoma is also known as ___

A

angiocentric T-cell lymphoma

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35
Q

what is the prognosis for someone with burkitt’s lymphoma?

A
  • stage I or II - 5-year survival is 90%
  • stage III or IV - 5-year survival is 80%
    • due to aggressive treatment
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36
Q

what is the prognosis of patients with chronic myeloid leukemia?

A

5-year surivival is 80%, but once blast transformation occurs, the patient will usually die within 6 months

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37
Q

what is the treatment of multiple myeloma? does it relapse?

A
  • chemotherapy is typically used, 60% respond
  • virtually all cases relapse
  • bisphosphonates are given to reduce fractures
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38
Q

because african burkitt’s lymphoma is seen in other areas of the world, some prefer to call it ___

A

endemic burkitt’s lymphoma

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39
Q

___ and ___ contribute to the development of leukemia

A

environmental and genetic factors

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40
Q

reduced platelet count in thrombocytopenia may e the result of what?

A

various causes, such as infiltration of the bone marrow by malignant cells or the toxic effects of cancer chemotherapy

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41
Q

___ is a unifocal, monoclonal neoplastic proliferation of plasma cells

A

plasmacytoma

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42
Q

what is the treatment for NK/T cell lymphoma?

A

lesions typically respond to radiation therapy

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43
Q

if leukemia is suspected, what should happen?

A

referral to appropriate physician is mandatory

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44
Q

hodgkin’s lymphoma is a malignant ___ disorder

A

lymphoproliferative

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45
Q

what is normal platelet count?

A

200,000-400,000/mm3

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46
Q

growth of a burkitt’s lymphoma tumor mass may cause ___ and ___

A

facial swelling and proptosis (protrusion of the eye)

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47
Q

agranulocytosis is associated with bacterial infections because ___

A

neutrophils are the first line of host defense

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48
Q

the following is an oral symptom of what hematologic disorder?

A

anemia, as characterized by a bald tongue

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49
Q

what are the 5 histologic subtypes of the classical presentaiton of hodgkins lymphoma?

A
  • lymphocyte rich
  • nodular sclerosis - F>M; 70% of cases
  • mixed cellularity
  • lymphocyte depletion
  • unclassifiable
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50
Q

what is the prognosis for patients with acute myeloid leukemia?

A

40% survival if they are younger than 60

10% if not

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51
Q

multiple myeloma is a malignancy of ___ origin

A

plasma cell

it has a multicentric origin within bone

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52
Q

plasmacytoma probably gives rise to ___

A

multiple myeloma

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53
Q

what is the average age patient with mycosis fungoides? male or female predilection?

A

average age is 60

M:F 2:1

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54
Q

in thrombocytopenia patients, the small capillaries leak blood which results in ___. if a larger quantity of blood is extravasated, a ___ will result. even larger amounts of extravasated blood results in a ___.

A
  • petechiae (pinpoint hemorrhagic lesions)
  • ecchymosis
  • hematoma
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55
Q

what are 4 general symptoms related to the reduced oxygen-carrying capacity of the blood?

A
  • tiredness
  • headache
  • fainting/feeling lightheaded
  • pallor
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56
Q

___ is the enlargement of lymphoid tissue

A

lymphoid hyperplasia

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57
Q

what type of thrombocytopenia is a serious disorder of coagulation and is probably due to endothelial damage? you should refer to a physician for treatment; 70% survival

A

thrombotic thrombocytopenic purpura

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58
Q

which stage of mycosis fungoides is characterized by distinct papules and nodules, and has visceral involvement?

A

tumor

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59
Q

what is the treatment of lymphoid hyperplasia?

A

once the diagnosis is confirmed, no treatment is necessary

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60
Q

what is the bimodal pattern of age at diagnosis of hodgkin’s lymphoma?

A
  • between 15-35
  • after age 50
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61
Q

what are the histopathologic features of mycosis fungoides?

A
  • atypical lymphocyte cells infiltrate the surface epithelium (epidermotropism is a propensity to invade the epidermis of the skin)
  • these atypical lymphocytes are termed mycosis cells or sezary cells
  • the atypical lymphocytes form small intraepithelial aggregates termed pautrier’s microabscesses
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62
Q
A

langerhans cell histiocytosis

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63
Q

renal failure may be a presenting sign in multiple myeloma because kidneys become overburdened with excess circulating proteins, termed ___ proteins

A

bence jones proteins

up to 50% of multiple myeloma patients will have these proteins in their urine

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64
Q

what are the most common accompanying symptoms of langerhans cell histiocytosis?

A

pain and tenderness

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65
Q

what radiographic changes are seen in non-hodgkins lymphoma?

A

ill-defined or ragged radioluscency

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66
Q

langerhans cell histiocytosis lesions are found most commonly in what 4 locations?

A
  • skull
  • ribs
  • vertebrae
  • mandible - jaws are affected in 15% of cases
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67
Q

if patients with non-hodgkins lymphoma wear a denture, what might they compain of?

A

they may complain that their denture has become too tight

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68
Q

what population was burkitt’s lymphoma first documented in?

A

african american children

this is why it is termed african burkitt’s lymphoma

69
Q

which spectrum of langerhans cell histiocytosis is characterized by the involvement of bone, skin, and viscera; more prominent involvement; mostly in infants (letterer-siwe disease)

A

acute disseminated histiocytosis

70
Q

what is the most common type of non-hodgkin’s lymphoma of the oral cavity?

A

diffuse large B cell (DLBC)

71
Q

clinical signs and symptoms of leukemia relate to what?

A
  • the reduction in numbers of normal RBCs and WBCs
    • decreased oxygen-carrying capacity of the blood leads to fatigue
    • patients may experience easy bruising due to lack of platelets
72
Q

which stage of mycosis fungoides is often mistaken for psoriasis, and is characterized by well-demarcated, scaly, itchy, erythematous plaque?

A

eczematous

73
Q

___ leukemias run an aggressive course and will lead to the death of the patient in a few months if untreated

74
Q

85% of non-hodgkins lymphoma are ___ origin

A

B-lymphocyte

75
Q

what is the treatment for mycosis fungoides?

A
  • topical therapy is initiated first but will ultimately fail
  • aggressive chemotherapy is usually necessary, especially with visceral involvement
  • the disease is not curable, but is usually slowly progressive
76
Q

non-hodgkins lymphoma swellings are characteristically ___

77
Q

___ is a rare process that is characterized clinically by an aggressive, nonrelenting destruction of the midling structures of the palate and nasal processes

A

NK/T cell lymphoma

78
Q
A

lymphoid hyperplasia

79
Q

what is the most common type of leukemia? what is the treatment?

A
  • chronic lymphocytic leukemia, occurs in adulthood
  • it is incurable, patients typically survive 10 years
80
Q

what are 4 examples of leukemia?

A
  • acute myeloid leukemia
  • chronic myeloid leukemia
  • acute lymphoblastic leukemia
  • chronic lymphocytic leukemia
81
Q

the process that leads to hodgkins lymphoma almost exclusively begins in what tissue?

A
  • the lymph nodes, and any node is susceptible
  • 75% occur in the cervical and supraclavicular nodes
82
Q

___ is the general term for a decrease in volume of RBCs or in the concentration of hemoglobin

83
Q

what can lymphoma of bone be mistaken for?

A

it can cause vague pain or discomfort that can be mistaken for a toothache

84
Q

what is this, and what hematologic disorder is it associated with?

A

purpura

thrombocytopenia

85
Q
A

NK/T cell lymphoma

aka angiocentric T-cell lymphoma

86
Q

oral non-hodgkins lymphomas usually appear in either the ___ or ___

A

soft tissues or within the jaws

87
Q

notice the mass is posterior

A

burkitt’s lymphoma

this patient also had abdominal involvement

88
Q

signs and symptoms of multiple myeloma result from uncontrolled proliferaiton of ___ and the uncontrolled manufacture of their ___

A
  • tumor cells
  • protein products
89
Q

what chronic infections, how does lypmhoid hyperplasia present?

A

chronic infection (tonsillar) produce enlarged, nontender, firm, freely movable nodules

90
Q

which leukemia shows specific chromosomal abnormalities?

A
  • chronic myeloid leukemia (CML) has a translocation of the chromosomal material between the long arms of chromosomes 9 and 22
    • termed the philadelphia chromosome
91
Q

in hodgkins lymphoma cases, after 15 years posttreatment, patient mortality is due typically to what?

A

complications of therapy (secondary malignancy or cardiovascular disease)

92
Q

once mycosis fungoides progresses beyond cutaneous involvement, what happens?

A

the patient usually dies within a year from organ failure or sepsis

93
Q

what are the 4 histological types of hodgkins lymphoma?

A
  • lymphocyte predominant (7%) - best prognosis
  • nodular sclerosing (64%) - worst prognosis
  • mixed cellularity (25%)
  • lymphocyte depleted (4%)
94
Q

non-hodgkins lymphoma lesions are typically what color?

A

erythematous or purple

95
Q

what is the differential for a hole in the palate?

A
  • syphilis
  • NK/T cell lymphoma
  • deep fungal infection
  • recreational drug abuse
96
Q

anemia is often a sign of what possible underlying diseases?

A
  • renal failure
  • liver disease
  • chronic inflammatory conditions
  • malignancies
  • vitamin or mineral deficiencies
97
Q

___ is the most common hematologic malignancy of african americans

A

multiple myeloma

98
Q
99
Q

what is the most common cutaneous lymphoma?

A

mycosis fungoides

100
Q
A

hodgkins lymphoma, characterized by a prominent supraclavicular and cervical masses

101
Q

___ represents several types of malignancies of hematopoietic stem cell derivation; begins as the malignant transformation of a stem cell, which proliferates in the bone marrow and overflows into the peripheral blood

102
Q
A

burkitt’s lymphoma

notice the starry sky pattern

103
Q

which type of leukemia is one of the more common childhood malignancies? what percent of children survive this type of leukemia?

A
  • acute lymphoblastic leukemia
  • 80% of children survive
104
Q

what do intraoral lymphoid hyperplasia lesions appear as? lesions in what location are usually bilatera?

A
  • discrete, nontender, submucosal swellings
    • may be normal in color or yellow
    • if lesions appear on the posterior lateral tongue, they are usually bilateral
105
Q

a significant percentage of hodgkins lymphoma is linked to which virus?

106
Q
107
Q

what is the average age of a patient with multiple myeloma? more common in males or females? african americans or caucasians?

A

65yo

M>W

AA>C

108
Q

what is this, and what hematologic disorder is it associated with?

A

hematoma

thrombocytopenia

109
Q

how are bone lesions from langerhans cell histiocytosis treated?

A

curettage or low-dose radiation

110
Q

mycosis fungoides is so-named because it resembles a fungal infection, but it is actually a ___ lymphoma

111
Q

what are some of the environmental factors which may lead to leukemia?

A
  • exposure to pesticides and/or benzene
  • ionizing radiation
112
Q

without treatment, what will happen to a patient with NK/T cell lymphoma?

A

the patient will succumb to secondary infection, massive hemorrhage, or infiltration of vital structures

113
Q

which stage of mycosis fungoides is characterized by elevated red lesions?

114
Q

unlike most malignancites, hodgkin’s lymphoma neoplastic cells make up ___% of the cells in the lesion

A

1-3% (this is a very low number)

115
Q
A

langerhans cell histiocytosis

116
Q

leukemias are classified according to their histogenesis and clinical behavior. what are the classifications?

A
  • myeloid vs lymphoid
  • acute vs chronic
117
Q

___ leukemias run a more indolent course, though patients eventually succumb to the disease

118
Q

is lymphoid tissue more prominent in older or younger patients?

A

younger patients, peaking around age 20, then decreasing in size

119
Q

if large tonsils are symmetrical and asymptomatic, is it likely normal for that patient?

A

yes

tonsillar asymmetry is a potentially serious sign that should be further evaluated to rule out a metastatic tumor or lymphoma

120
Q

which spectrum of langerhans cell histiocytosis is characterized by one or multiple lesions with no visceral involvement?

A

eosinophilic granuloma of bone

121
Q

what is the average age patient with burkitt’s lymphoma? male or female predilection?

A

average age is 7

M>F

122
Q

what is the goal of treatment of multiple myeloma?

A

to make the patient confortable and control the malignancy

123
Q

which spectrum of langerhans cell histiocytosis is characterized by involvement of bone, skin, and viscera (hand-schuller-christian disease)?

A

chronic disseminated histiocytosis

124
Q

mycosis fungoides progresses through 3 stages. what are they?

A
  1. eczematous
  2. plaque
  3. tumor
125
Q

what is a granulocytic sarcoma?

A

a boggy, nontender swelling produced when leukemic cells infiltrate the oral soft tissues

126
Q

increased destruction of platelets in thrombocytopenia can be due to what?

A
  • immunologic reaction
  • often precipitated by drugs - heparin is the most common
  • autoimmune reaction
  • component of a systemic disease, like SE or HIV
  • abnormal blood clot formation, such as in patients with thrombic thrombocytopenic purpura (TTP)
127
Q

most cases of agranulocytosis are induced by ___

A

drugs, specifically anticancer treatment

128
Q

is topical therapy useful for mycosis fungoides?

A

it is initiated first but will ultimately fail

129
Q

lymphoid hyperplasia is typically due to ___

130
Q
A

lymphoid hyperplasia

131
Q

what 2 conditions is agranulocytosis characterized by?

A
  • neutropenia - decrease in neutrophils (<1500/mm3)
  • lymphopenia - decrease in lymphocytes (immunosuppression); viral and fungal infections
132
Q

over 90% of patients with burkitt’s lymphoma are positive for what virus?

133
Q

with nodal presentaiton of non-hodgkins lymphoma, the patient is usually aware of a nontender mass that has been slowly enlarging for months. what happens as the malignancy progresses?

A
  • the nodes become more numerous and are fixed
    • nodes become fixed because tumor cells violate the capsule and infiltrate the adjacent tissues
134
Q

american (or sporadic) burkitt’s lymphoma usually appear as a ___ mass

135
Q

chronic hyperplastic lymph nodes may be difficult to distinguish clinically from ___

136
Q

what is the median survival time for patients with mycosis fungoides?

137
Q

what are the radiographic features of burkitt’s lymphoma?

A
  • radioluscent destruction of the bone with ragged, ill-defined margins
  • may begin as several smaller sites, which eventually enlarge and coalesce
  • patchy loss of the lamina dura is an early sign
138
Q

what is the 5-year survival rate of patients with NK/T cell lymphoma? what about for patients with disseminated disease?

A
  • 85%
  • disseminated disease requires chemotherapy and have a 40% 5-yr survival rate
139
Q

sezary syndrome (aggressive expression of mycosis fungoides) runs a fulminant course and results in the patient’s death within ___ years

140
Q

___ is a hematologic disorder characterized by a markedly decreased numer of circulating blood platelets

A

thrombocytopenia

141
Q
A

plasmacytoma involving the left maxillary sinus and nasal cavity

142
Q
A

mycosis fungoides, characterized by Pautrier’s microabscesses

143
Q

more than half of patients with langerhans cell histiocytosis are under what age?

144
Q

what is the spectrum of langerhans cell histiocytosis?

A
  • eosinophilic granuloma of bone
  • acute disseminated histiocytosis
  • chronic disseminated histiocytosis
145
Q

if metastatic disease is excluded, multiple myeloma accounts for ___% of all malignancies that involve bone

146
Q

non-hodgkins lymphoma is a diverse and complex group of ___ that usually arise within ___ and grow as ___

A
  • malignancies
  • lymph nodes
  • solid masses (70%)
147
Q

NK/T cell lymphoma is typically found in adults or children?

148
Q

what are the oral symptoms of anemia?

A

mucosa may show pallor or the patient may have a bald tongue (tongue atropy) depending on the type of anemia, as well as burning (glossopyrosis) and pain (glossodynia) localized to the tongue

149
Q

normally, what fraction of the platelet population is sequestered in the spleen? what happens to the platelets if a condition causes splenomegaly?

A
  • 1/3
  • larger numbers of platelets are taken out of circulation
150
Q
A

langerhans cell histiocytosis

151
Q

burkitt’s lymphoma has a predilection for what location?

A

the jaws (up to 70% present in the jaws)

152
Q

what does agranulocytosis mean?

A

without granulocytes (usually neutrophils)

153
Q

what is numb-chin syndrome?

A

some patients with a non-hodgkin’s lymphoma can have parasthesia, particular with a mandibular lesion

154
Q

burkitt’s lymphoma is a malignancy of ___ origin

155
Q

what type of thrombocytopenia occurs in childhood, classically after a viral infection? (90% of these cases resolve in 6 months)

A

idiopathic (immune) thrombocytopenia

156
Q

what is the usual presenting sign of hodgkins lymphoma?

A

persistently enlarging, nontender, discrete mass or masses in a lymph node region

early lesions are movable, late lesions are more matted and fixed

157
Q

___ is an aggressive expression of mycosis fungoides that represents dermatopathic T-cell leukemia

A

sezary syndrome

158
Q

aggregates of lymphoid tissue are most comonly seen where?

A
  • oropharynx
  • soft palate
  • lateral tongue
  • floor of mouth
159
Q

what are some other lesions that can occur due to thrombocytopenia?

A
  • spontaneous gingival hemorrhage
  • bleeding from minor sites of trauma
160
Q
A

lymphoid hyperplasia

this is not a mucocele because those are usually solitary

161
Q

what is the most characteristic presenting symptom of multiple myeloma? in what location specifically?

A

bone pain, most common in the lumbar spine

162
Q

plasmacytoma shares all the same demographics, signs, and symptoms as ___

A

multiple myeloma

163
Q

what are the histoplathologic features of langerhans cell histiocytosis?

A
  • identification of a lesional langerhans cell is necessary to confirm diagnosis
  • ultrastructurally, langerhans cells contain rod-shaped cytoplasmic structures known as birbeck granules, which differentiate them from other APCs
164
Q

___ may result in abnormal bleeding (blood can’t clot, blood leaks out of vessels, etc.)

A

thrombocytopenia

165
Q

intraoral soft tissue non-hodgkins lymphoma lesions typically appear how? what tissues do they affect?

A
  • nontender, diffuse swellings
  • posterior hard palate, gingiva, buccal vestibule
166
Q

___ is the volume of RBCs

A

hematocrit

167
Q

what is the histopathology of burkitt’s lymphoma?

A

low-power magnification will show the classic “starry sky” pattern, which is due to macrophages within tumor tissues

168
Q

langerhan’s cells are ___-presenting cells

Oral and Maxillofacial Pathology (45 decks)

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