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Hematology > ALL (Exam III) > Flashcards

ALL (Exam III) Flashcards

1
Q

Lymphocyte Ontogeny

A

Starts with a hematopoietic stem cell
- specific growth factor determines if it’s a B or T lymph

Antigen dependent matuaration
- B lymphocytic cells develop in BM
- T lymphocytic cells develop in the thymus (committed cells that migrated there from the BM)

Migrate to secondary lymphoid organs (lymph nodes, spleen and other)
- wait for antigen presentation

Antigen dependent maturation

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2
Q

Lymph node structure

A

Going from outside in:

Cortex
- B lymphocytes populate outermost region for growth and development

Paracortex
- T lymphocytes

Medulla
- B lymphocytes and plasma cells

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3
Q

Cases of ALL occur in

A

75% in children

Children have a higher rate of remission (85%) than adults

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4
Q

WBC count in ALL

A

> 100,000 / ul

More often in T-ALL

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5
Q

ALL symptoms

A
  • Splenomegaly
  • hepatomegaly
  • thrombocytopenia
  • bleeding
  • nosebleeds
  • bruises
  • CNS Involvement
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6
Q

ALL classification depends on

A
  • Molecular and cytogenetics
  • Immunophenotype
  • Cytochemistry
  • Morphology
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7
Q

Most common ALL type

A

B cell ALL

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8
Q

WHO ALL and Lymphoma classification

A

ALL
- >25% lymphoblasts in BM (out of all nucleated cells)

Lymphoma (LBL)
- equal or less than 25% lymphoblasts in BM
- Lymphoblastic leukemia process mass lesion elsewhere in the body

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9
Q

Most common Lymphoma

A

T cell Lymphoma

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10
Q

B cell ALL

A
  • B cell lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities
  • B cell lymphoblastic leukemia/lymphoma, not otherwise specified
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11
Q

ALL in children, what age is affected a lot?

A

1-4 years of age

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12
Q

T cell Lymphoma

A
  • Ealry T cell precursor lymphoblastic leukemia
  • Natural killer cell (NK) cell lymphoblastic leukemia / lymphoma
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12
Q

T cell Lymphoma

A
  • Ealry T cell precursor lymphoblastic leukemia
  • Natural killer cell (NK) cell lymphoblastic leukemia / lymphoma
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13
Q

CALLA

A

common acute lymphoblastic leukemia antigen

CD10

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14
Q

CD10 =

A

CALLA

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15
Q

B lymphocyte development review

A

CHECK POWERPOINT

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16
Q

Plasma cells

A

secrete antibodies

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17
Q

memory B cell

A

Contains antibodies on cell surface

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18
Q

CD19 and CD20, CD10(CALLA)

A

indicates B cell lineage. (ALL)

present when the cell is young

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19
Q

TdT

A

cytochemistry is used to detect TdT

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20
Q

CD19 + CD20

A

indicates immature stafes

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21
Q

NOS (not otherwise specified group) of ALL

A

Lymphoblast morphology
- 2x size of resting mature lymphocyte
- condensed nuclear chromatin
- small scanty cytoplasm

OR/AND

  • larger blasts
  • dispersed nuclear chromatin
  • Moderate Basophilic cytoplasm
22
Q

Immunophenotype in NOS ALL

A
  • HLA-DR, CD10, CD19, CD20, CD34, cytoplasmic CD22, CD79a
23
Q

Cytochemistry NOS ALL

A

MPO neg, SBB Neg, TdT+

24
Q

Cytochemistry - Terminal deoxynucleotidyl transferase (TdT)

A

Stains terminal deoxynucleotidyl transferase (TdT) activity

  • positive staining = Fluorescence
  • Present in PreB and preT lymphoblasts, but not in mature lymphocytes
25
Q

TdT +

A

indicates ALL

26
Q

TdT -

A

indicates AML

27
Q

B cell ALL/LBL

t(9;22)(q34;q11)

28
Q

B cell ALL/LBL

t(v;11q23)

A

KMT2A rearranges

29
Q

B cell ALL/LBL

t(12;21)(p13;q22)

A

ETV6-RUNX1

30
Q

B cell ALL/LBL

Hyperdiploidy

A

50-66 chromosomes in lymphoblasts

31
Q

B cell ALL/LBL

Hypoploidy

A

<45 chromosomes in lymphoblasts

32
Q

B cell ALL/LBL

t(5;14)(q31;q32)

A

IL3-IGH

Eosinophilia

33
Q

B cell ALL/LBL

t(1;19)(q23;p13)

A

TCF3-PBX1

Additional immunophenotype marker; cytoplasmic mu

Similar to FAB L3 or Burkitt’s classification

34
Q

B cell ALL/LBL

BCR-ABL1-like

A

gene expression present but BCR-ALB1 fusion lacking

35
Q

B cell ALL/LBL

intrachromosomal amplificaiton of chromosome 21 (iAMP21)

A

RUNX1 gene on chromosome 21 amplified, more or equal to 5 times

36
Q

T Lymphocyte development

A

REVIEW PPT

37
Q

T cell can become

A

CD4 = helper ce

CD8 = cytolytic killer cell

38
Q

CD3 in T cells

A

mature T cells

39
Q

CD8 in T cells

A

suppressor cells

40
Q

CD4T cells

A

helper cells

41
Q

CD7 T cells

A

Pan T, immature

42
Q

T lymphoblastic leukemia/lymphoma
cases:

A

More prevalent in adolescents than children

Males>females

43
Q

Lymphoblast morphology

T Lymphoblastic Leukemia

A
  • medium size
  • prominent nucleoli; occasional nuclear clefting
  • moderate cytoplasm

OR/AND

  • small size
  • HIGH N:C ratio
  • Scanty, indistinct cytoplasm
44
Q

Immunophenotype

T lymphoblastic Leukemia/Lymphoma

A

Cytoplasmic CD3, CD7 and variable CD1, CD2, CD4, CD5, CD8, CD10
- most identified as Prothymocyte

Possible myeloid CD expression (CD13 and CD34)

45
Q

Cytochemistry

T cell Lymphoblastic Leukemia/Lymphoma

A

MPO neg, SBB neg, TdT+

46
Q

Cytochemistry - Acid phosphatase

A

stains “acid phosphatase” activity
- has 7 isoenzymes classified
- positive staning - orange/red precipitate
- Present in all hematopoietic cells - T lymphocytes stain stronger than B lymophocytes

Used to differentiate lymphoblasts in suspected acute T cell lymphocytic leukemia

47
Q

NK Lymphoblastic Leukemia / lymphoma

A

Little is known about this disease

Immunophenotype
- CD56 (NK cell marker)
- Immature T cell markers present (CD2 and Cd7)
- Myeloid markers absent
- B lymphoid markers absent

Need to exclude Blastic Plasmacytoid Dendritic cell
Leukemia prior to diagnosis

48
Q

TdT present in

(B cell)

A
  • stem cell
  • early pre B cell
  • Pre B cell
49
Q

CD10 and CD19 present in

(B cell)

A
  • early pre B cell
  • Pre B cell
  • B cell
50
Q

CD20 present in
(B cell)

A
  • pre B cell
  • B cell
51
Q

TdT present in (T cell)

A
  • prothymocyte
  • cortical thymocyte
52
Q

CD7 presen in (T cell)

A
  • prothymocyte
  • cortical thymocyte
  • medullary thymocyte
  • Mature T cell (peripheral)
53
Q

CD3 present in (T cell)

A
  • cortical thymocyte
  • medullary thymocyte
  • mature T cell (peripheral)

Hematology (36 decks)

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