CIS: Leukemias and Lymphomas and White Cell disorders Flashcards
Definition of Leukemia
autonomous clonal proliferation of malignant cells that proliferate in the bone marrow and usually are readily observable in the peripheral blood
Acute leukemia
the cells represent immature precursor cells
chronic leukemia
the cells are more mature appearing cells
What disease is Benzene associated with?
AML
What is the big risk factor for leukemias?
alkylators
What is radiation not associated with
CLL
To look like a rockstar, what should we offer as a diagnosis in older patients with mild pancytopenia and macrocytosis?
myelodysplasia or early AML
What does the 9-22 translocation give us?
the BCR-ABL proto-oncogene
-fusion gene with tryosine kinase activity
What is 9;22 associated with?
CML
What is 15;17 associated with
APL
How do acute leukemias present generally?
very rapid onset and clinical course
-if untreated the median duration of survival for adult acute leukemia is 3 months or less
How do chronic leukemias present generally?
- slow onset and chronic course
- half of all patients with chronic lymphocytic leukemia are still alive and have not required treatment 6 years after diagnosis
What do most patients with leukemia present with?
- hx of fever, easy bruisability, fatigue, weight loss, or shortness of breath
- in acute leukemias (ALL) patients often complain of bone pain
What labwork gives us the suspicious of chronic leukemia usually?
CBC done as part of a routine workup for another problem
At the time of diagnosis, how are most patients with chronic leukemias?
asymptomatic
What is Sweet’s syndrome?
- acute febrile neutrophilic dermatosis (AFND)
- Cutaneous manifestation of AML…. bx demonstrates myelopblasts in the dermis (histiocytic variant of AFND)
What do we not want to confuse sweet’s syndrome with?
pyoderma gangrenosum
Tx of sweet’s syndrome?
management of AML
What are Auer Rods?
azurophilic rods in the cytoplasm of patients with AML
-may resemble a bundle of sticks in some cells of patients with APL
If the Auer rods look like a bundle of sticks in cells, what do we call those cells?
faggot cells
If we see gingival hypertrophy, what should we think of?
most common in the M4 and M5 variants of AML
What do we think of when we see smudge cells?
CLL
What do we treat people with APL t(15;17) with?
ATRA
-all trans retinoic acid
What can APL (acute promyelocytic leukemia) drive ?
DIC
-fibrinogen will be low
What weird neuro finding is ALL associated with?
leptomeningeal carcinomatosis
What nerve will get damaged in ALL?
CN6 because it is the longest nerve up there
What translocation is ALL in that 18 year old girl?
t(4;11)
What do we treat the leptomeningeal carcinomatosis from the ALL with?
intrathecal methotrexate
What do we use to deliver intrathecal therapy?
ommaya reservoir
What is intrathecal therapy?
injection of drugs into the spinal canal
When I say TRAP test, you say
Hair Cell Leukemia
name and describe the Rai stages?
- 0: lymphocytosis only (>15,000)
- 1: + LAD
- 2: + splenomegaly
- 3: + anemia
- 4: + thrombocytopenia
What is the Rai staging used for?
CLL
How are lymph nodes in lymphomas?
typically non-tender and rubbery in consistency
What happens after drinking beer with Hodgkin lymphoma?
pain in lymph nodes
What can suggest retroperitoneal lymph node enlargement
Back pain and leg edema
What is Richter’s syndrome?
when ppl with CLL develop DLBCL
-represents clonal evolution with additional cytogenetic abnormalities… tough to kill
What are B symptoms?
- important
- fever, drenching night sweats, 10% weight loss in previous 6 months
- likely paraneoplastic and associated with worse prognosis
What are Immunosuppressed patients at increased risk for?
primary CNS lymphoma
What infectious agents can lymphomas be linked to?
EBV- HD, Burkitt
H. pylori… gastric MALToma
What should we consider if we see patients with cervical adenopathy?
infection
lymphoma
unusual disorders
What is D-dimer?
a fibrin degradation product
What is more common, benign causes of leukocytosis or malignant ones?
benign
-same goes for neutropenia
What is a very general thing that can cause leukocytosis?
inflammation
What is another thing that he had listed three times that can cause leukocytosis?
Drugs, drugs, DRUGS
-same for neutropenia
In a smoker who has neutrophilia, what may be responsible for raising the count?
smoking….
What’s a weird thing that might cause neturopenia?
infections
-and drugs too
What should we suggest as being responsible for a patient with neutropenia?
medications, nutritional deficiencies, or sequestration
