Blood Cancers 2 Flashcards
describe leukemoid reaction
an elevated WBC count (leukocytosis)
a physiological response to stress or infection (as opposed to a priamry blood malignancy, such as leukemia)
neutrophilic leukemoid reaction characteristics
mimics CML (leukemia tests negative)
characterized by neutrophilia with a left shift
typically less than 50,000/cubic mm seen with severe bacterial infections
normal to elevated leukocyte alkaline phosphatase levels
abscense of philadelphia chromosome
WBC 38
segs (50-70) 50
bands (0-6) 30
lymphs (20-40) 20
38 WBCs (leukemoid reactions or possibly leukemia)
cell type implies neutrophils
mimics CML
evidence of severe infection
neutrophilic leukemoid reaction is due to?
severe bacterial infection
how do you tell the difference between CML and neutrophilic leukemoid reaction
CML has a philadelphia chromosome
neutrophilic leukemoid reaction does not
what are the types of myelocytic leukemoid reactions?
neutropilic leukemoid reaction
eosinophilic leukemoid reaction
basophilic leukemoid reaction
monocytic leukemoid reaction
lymphocytic leukemoid reaction is characterized by?
lymphocytosis (lymphs>segs)
mimicing CLL
what is the difference between lymphocytic leukemoid reaction and CLL
less than 50,000/cubic mm
absecne of lymphocytic leukemia cells in bone marrow
negative lymph node biopsy
evidence of primary infection
30 year old 42 WBCs 35 segs 60 lymphs 5 monocytes
most likely lymphocytic leukemoid reaction (too young to be CLL)
lymphocytic leukemoid reaction is usually due to?
severe viral infection
lymphoma definition
group of malignant disorders that originate from unregulated lymphoid tissue growth
predominantly limited to lymph nodes (or bone, liver, spleen)
leukemia definition
neoplastic cells involve predominantely the blood and bone marrow
common early sign of Hodgkin’s or non-Hodgkin’s is?
painless enlargement of one or more lymph nodes
S/S of lymphoma
painless swollen lymph nodes, in the neck, chest, armpit, groin or spleen sweating/fever, at night abnormla tiredness weight loss loss of appetite persistent itching perisstent cough persistent breathlesness pain in the lymph nodes after drinking alcohol
stage 1 lymphoma
disease is limited to one set of lymph nodes
stage 2 lymphoma
more than one site, only one side of the diaphragm
stage 3 lymphoma
lymph tissue or spleen on both sides of diaphragm
stage 4
other organ involvement, bone marrow and liver
what is the special kind of cells involved with Hodgkin lymphoma?
Reed-Sternberg cells
definition of Hodgkin lymphoma
malignancy derived from lymphoid tissue, primarily lymph node tissue and bone, especially involved B cells and the presence of Reed Sternberg cells
Hodgkin lymphoma demographics
males
15-35, after 50
how do you diagnose Hodgkin lymphoma?
lymph node biopsy
S/S of Hodgkin lymphoma
painless, enlarged lymph node usually in the neck, night sweats, low grade fever and weight loss, itching
neutrophilia
monocytosis
associated with Epstein Barr virus
when looking at a lateral chest, what are the spaces that should be dark?
retrosternal clear space
retrocardial clear space
possibly meganblas
DDX for ivory vertebra?
pagets, blastic mets, lymphoma
DDX for scalloping of the anterior bodies of the vertebra
aneuysm, lymphadenopathy, tumor, etc
Non-Hodgkin lymphoma definition
malignancy derived from lymphoid tissue including lymph node tissue, spleen, liver, GI tract, bone, may involve B and T cells
S/S of Non-Hodgkin lymphoma
males (all ages) non contiguous spread painless enlarged lymph nodes, espeically cervical extranodal GI, skin, lungs normal blood findings
if there is something in the retrosternal clear space, what is the DDX?
thymoma
teratoma
thyroid (goiter)
terrible lymphoma (Hodgkin lymphoma)
what are the different labels for the chest view?
aorto-pulmonary window azygous fissure azygous vein right para-tracheal stripe right/left hilar point right/left main bronchus trachea aorta carina
on the right side of the sternum on a chest view, what do you see? left?
right atrium
left ventricle
how do you determine if a radiolucency is the nipple or not?
put BBs on their nipples and re-xray
ranke complex
seen in healed primary TB comprised of 2 parts:
ghon lesion (calcified parenchymal tuberculoma)
ipsilateral calcified hilar node
MC tumor of bone
osteochondroma
MC tumor of bone in spine
hemangioma
MC benign tumor of hand
enchondroma
MC malignant tumor of bone
lytic mets
MC primary malignancy of bone
multiple myeloma
top 4 primary malignant bone tumors
multiple myeloma
osteosarcoma
chrondrosarcoma
Ewing’s sarcoma
definition of multple myeloma
AKA Kahler’s disease
neoplastic proliferation of plasma cells primarily in the bone marrow
monoclonal gammopathy
demogrpahics for multiple myeloma
twice as common in African Americans
S/S of multiple myeloma
bone pain (back, long bones, skull, ribs, pelvis) pathologic fractures fatigue weight loss multiple punched out lesions symptoms of hypercalcemia (anorexia, nausea, vomiting, somnolence, polydipsia recurrent infections normocytic normochromic anemia renal disease rouleax formation
lab significances for multiple myeloma
bone marrow has at least 10% plasma cells serum globulins are increased ESR elevated hypercalcemia M spike bence jones proteins CRAB
rouleax formation
RBCs stick together
CRAB
calcium (elevated)
renal failure
anemia
bone lesions
if a child has a pathological fracture, what is the most likely diagnosis?
eosinophilic granuloma
what do you do to figure out if a ppatient has osteoporosis, lytic mets, or multiple myeloma?
history, clinical presentation
old films, if not helpful
labs (CBC, ESR, C-RP, BCP, UA)
what if labs lok like lytic mets?
bone scan
MRI
biopsy
what is labs look like multple myeloma?
PEP (urine and blood)
skeletal survey
MRI
biopsy
