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(OMS2) SBL Exam 1 (Pathology + Clinical Medicine) > Case studies in Leukemia and Lymphoma > Flashcards

Case studies in Leukemia and Lymphoma Flashcards

1
Q

Myelodysplastic syndromes (MDS) occurs due to age-related acquired genetic damage to?

It is marked by what blood cell conditions?

A

1) Hematopoietic cells

2) Cytopenias and dysmorphic blood cells

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2
Q

What symptoms may we find on physical examination that point towards acute myeloid leukemia?

A

1) Petechiae

2) Conjunctival pallor

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3
Q

What lab values may we acquire that point towards acute myeloid leukemia?

A

1) Elevated WBC

2) Low platelet count

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4
Q

What would a Peripheral blood smear show for suspected acute myeloid leukemia?

A

Large cells with large nuclei and visible nucleoli

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5
Q

What would flow cytometry show for suspected acute myeloid leukemia?

Where would it be highest?

A

1) Myeloid blasts

2) Bone marrow

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6
Q

A patient with AML arising from MDS with have what presentation?

A

1) Anemia
2) Thrombocytopenia
3) Neutropenia

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7
Q

When starting chemotherapy on an AML patient, what should the process be?

A

1) 2 week course based on AML subtype and genetic profile

2) Recheck bone marrow at 2 weeks

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8
Q

What can cause fever in a patient that has AML?

A

Severe neutropenia leading to infection

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9
Q

What do you treat a neutropenic patient with to get their count back up?

A

GM-CSF

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10
Q

What is Induction chemo?

What is Consolidation chemo?

What is Maintenance chemo?

A

1) Initial chemo to induce a remission
2) Intensifying chemo to make sure no cancer cells are left in the body
3) Longer term therapy to maintain the remission and prevent relapse for certain cancers

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11
Q

What symptoms may we find on physical examination that point towards acute promyelocytic leukemia?

A

1) Purpura

2) Conjunctival pallor

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12
Q

What lab values may we acquire that point towards acute promyelocytic leukemia?

A

1) Low WBC
2) Low platelet
3) High PT/aPTT time
4) Low fibrinogen
5) High D-dimer

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13
Q

In Disseminated Intravascular Coagulation (DIC), endothelial injury and anticoagulant dysfunction cause?

A

Widespread thrombin release

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14
Q

What is a significant histological finding seen in acute promyelocytic leukemia?

A

Auer rods

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15
Q

What genetic finding confirms diagnosis of Acute Promyelocytic Leukemia?

A

t(15;17)

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16
Q

In Acute Promyelocytic Leukemia, the leukemic cells express?

What does each do?

A

1) Tissue Factor which activates factor X

2) Annexin II which converts plasminogen into plasmin

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17
Q

Patients with Acute Promyelocytic Leukemia with DIC are immediately treated with?

A

1) Platelet transfusion

2) Factor replacement

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18
Q

What is comprised of the special chemotherapy tailored to Acute Promyelocytic Leukemia?

A

1) Arsenic trioxide

2) All trans retinoic acid (vitamin A derivative)

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19
Q

What are two fatal consequences of Acute Promyelocytic Leukemia with DIC?

A

1) Pulmonary hemorrhage

2) Cerebral hemorrhage

20
Q

What physical findings can be found on exam in patients with chronic myeloid leukemia?

A

Splenomegaly

21
Q

What lab findings can be found in patients with chronic myeloid leukemia?

A

1) Normocytic anemia
2) Very high WBC (leukocytosis)
3) Low Leukocyte Alkaline Phosphatase

22
Q

As WBC count gets closer to 100, what condition should be your first thought?

A

Leukemia

23
Q

What will the buffy coat look like in a centrifuged sample for a patient with leukemia?

A

Thick buffy coat layer

24
Q

When is positive Leukocyte Alkaline Phosphatase (LAP) staining seen?

A

Leukemoid reactions

25
Q

What does absent LAP staining indicate?

A

Neoplasm

26
Q

What bone marrow findings do we see in patients with CML?

A

1) Hypercellularity of white cells
2) Pseudo-Gaucher cells (blue-green macrophages)
3) t(9:22) Philadelphia chromosome

27
Q

In the Philadelphia chromosome, what rearranged gene creates a protein that causes a constitutively active tyrosine kinase?

A

BCR-ABL

28
Q

What is the treatment for CML?

What is its MOA?

A

1) Imatinib (Gleevec)

2) Tyrosine kinase inhibitor

29
Q

What do you use to monitor CML?

With what testing?

A

1) BCR-ABL

2) Fluorescence in-situ hybridization (FISH) or PCR

30
Q

So what defines successful treatment for CML?

A

1) White count normalizes (Hematologic response)

2) Negative BCR-ABL PCR (Molecular response)

31
Q

What do we see in the accelerated phase (CML-AP)?

A

1) Circulating blasts 10-19%
2) Thrombocytopenia
3) Basophilia

32
Q

What do we see in the blast phase (CML-BP), aka “Blast crisis”?

A

Circulating blasts 20% or higher

33
Q

What symptoms and findings should raise suspicion for malignant lymphadenopathy and should be biposed?

A

1) Subclavian LAD
2) Fixed, hard LAD
3) Lymph node >4 cm

34
Q

A tender LAD is often categorized as?

A

Benign

35
Q

Flow cytometry works best for what conditoin?

A

Non-Hodgkin’s lymphoma

36
Q

What is the only way to diagnose Hodgkin Lymphoma?

Why?

A

1) Excision/excisional biopsy

2) To be able to view diagnostic Reed-Sternberg cells

37
Q

Burkitt lymphoma is an example of a lymphoma that is likely to present with a what type of mass?

A

Rapidly enlarging mass

38
Q

What is the translation for Burkitt lymphoma?

The genes invovled?

A

1) t(8;14)

2) IGH/MYC

39
Q

What chemotherapy is used for Burkitt lymphoma with CNS involvement?

A

Chemo with intrathecal administration

40
Q

What condition causes the patient’s urine output decreases dramatically and there are increases in potassium, serum creatinine, and BUN?

It is successfully treated with?

A

1) Tumor lysis syndrome

2) Aggressive hydration

41
Q

Involvement of what tissue/system are more likely with this lymphoma than other NHL types?

A

CNS and bone marrow

42
Q

Pruritus and chest pain from taking a drink are symptoms of what condition?

A

Hodgkin Lymphoma

43
Q

What is very effective in treating Hodgkin Lymphoma?

A

Chemo

44
Q

When may a Hodgkin Lymphoma not produce any symptomatology?

A

When its limited to a mediastinal mass

45
Q

What physical findings can be found in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)?

A

1) Conjunctival pallor
2) Petechiae
3) Axillary and cervical LAD

46
Q

CLL/SLL often presents as?

It is found and diagnosed in?

A

1) Asymptomatic

2) Peripheral blood

47
Q

If CLL/SLL begins to progress what happens?

A

1) Bone marrow involvement

2) Richter’s transformation (transition to high grade lymphoma)

(OMS2) SBL Exam 1 (Pathology + Clinical Medicine) (16 decks)

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