EXAM #2: CANCER & HEMATOLOGICAL MALIGNANCY Flashcards
What is the definition of a Leukemia?
- Unregulated growth of WBCs (leukocytes) in the bone marrow
Note that this can leads to either increases or decreases of WBCs in the peripheral blood AND bone marrow failure i.e. pancytopenia.
What is the broad definition of a Lymphoma?
Discrete tumor masses in the lymph nodes
What is the difference between a Leukemia and Lymphoma?
Leukemia= neoplasm of the bone marrow
Lymphoma= neoplasm of the lymph nodes
What is the general difference between an acute and chronic leukemia?
Acute= will kill within weeks without treatment
Chronic= patient may survive for years without treatment
What do the terms myeloid, myelogenous, and myeloproliferative refer to?
Tumors involving the:
- Granulocytes
- RBCs
- Platelets
And their progenitors*
What do the terms lymphoid, lymphocytic, lymphoblastic, and lymphoproliferative refer to?
Tumors involving the:
- B-cells
- T-cells
- NK-cells
And their progenitors
What are the two types of acute leukemia?
Acute myeloblastic (AML) Acute lymphoblastic (ALL)
What is the root of symptoms for patients with ALL and AML?
Pancytopenia
What is the difference between ALL-B and ALL-T?
Cell of origin is B vs. T cell in “Acute Lymphoblastic Leukemia”
What is the general feature of all AMLs?
Undifferentiated myeloblasts accumulating in the bone marrow
What is the most common acute leukemia in adults?
AML
What is the basis for the FAB categorization of AML?
Appearance of cells under microscope
What is the basis of the WHO categorization of AML?
Pathology, cytogenetics, and molecular characteristics
What are the two types of ALL? Which is more common?
B-ALL* (B-cell)
T-ALL (T-cell)
This is the most common type of all ALL cases
What is the most common acute leukemia in children?
ALL
What is the difference between a myeloproliferative neoplasm and AML?
Myloeproliferative neoplasm can lead to AML
List the major myeloproliferative neoplasms.
1) Polycythemia vera
2) Essential thrombocytpoenia
3) Primary myelofibrosis
What is polycythemia vera?
RBC overproduction i.e. Hct >55%
What is the mutation associated with polycythemia vera?
JAK2 mutation
What is Essential Thrombocythemia?
Overproduction of megakaryocytes/ abnormal platelets
What mutations are associated with Essential Thrombocythemia?
JAK2 or MPL
What is Primary Myelofibrosis?
Fibrosis that obliterates the bone marrow and produces atypical megakaryocytes
What is the genetic mutation associated with Primary Myelofibrosis?
JAK2 or MPL
What is CML?
Overgrowth of granulocytic and megakaryocytic precursors in bone marrow due to BCR-ABL fusion gene
Can convert to AML
What is myelodysplastic syndrome?
Class of stem cell disorders that result in ineffective hematopoiesis; causes defects in cell maturation of all non-lymphoid lineages
Can convert to AML
What viral infection causes the predominance of B-cell Lymphoid malignancies?
EBV
What cells is ALL typically derived from?
Immature B-cells
In CLL and lymphoma, what is the malignant cell population?
Mature B-cells
What is the difference between the locations of malignant cells in CLL and lymphoma?
CLL= blood
Lymphoma= lymph node or other tissues
What cells are malignant in myeloma?
Plasma cells
What do malignant plasma cells in myeloma produce?
Monoclonal immunoglobulin
What is the difference between Hodgkin and Non-Hodgkin Lymphoma?
Presence of absence of Reed-Sternberg cell
What are Reed-Sternberg cells, and what are the characteristics of Reed-Sternberg cells?
These are tumor giant cells seen in Hodgkin’s Disease. Characteristics include:
- Large size
- 2+ nuclei (bilobed) that give an “OWL EYE” appearance
- Eosinophilic nucleolus
- CD15 and CD30+
Describe the progression of Hodgkin Lymphoma.
- Hodgkin Lymphoma is localized to a single group of lymph nodes
- Spread is contiguous and predictable
What is the prognosis for Hodgkin Lymphoma?
60-90% cure rate with radiation and chemotherapy i.e. GOOD PROGNOSIS
What are the three categories of Non-Hodgkin Lymphoma?
Indolent
Aggressive
V. aggressive
What are the characteristics of CLL?
- Increased small round lymphocytes
- Smudge cells
Smudge cells are fragile cells that break on PBS–causing a smudge*
What the major plasma cell disorders.
- Multiple myeloma
- Plasmacytoma
- Primary Amyloidosis
- MGUS
- POEMS Syndrome
- Waldenstrom Macroglobinemia
What is Multiple Myeloma?
Mature B-cell (plasma cell) cancer
What PBS features is characteristic of Multiple Myeloma?
Rouleaux formation, which is RBCs stacked like poker chips on PBS
What lab features are characteristic of Multiple Myeloma?
Increased immunoglobulin (IgG or IgA) in serum or urine
What is a Solitary Plasmacytoma? What lab feature is characteristic of this disease?
This is a plasma cell tumor characterized by a single plasma cell tumor in the bone marrow.
- NO or low immunoglobulin in the blood
What is Primary Amyloidosis?
Plasma cells secrete monoclonal light chains
- These are misfolded and form fibril deposits in tissue
- Disrupts organ function
What is MGUS?
“Monoclonal Gammopathy of Undetermined Significance”
- This is the ASYMPTOMATIC PRECURSOR of mutiple myeloma see with production of immunoglobulin detected in serum or urine
**Only 1-2% of patients with MGUS progress to Multiple Myeloma per year; hence the “undetermined significance”
What lab value is associated with Waldenstrom Macroglobulinemia?
IgM
Associated with hyperviscosity syndrome*
How is Leukemia diagnosed?
PBS
Bone marrow biopsy
What is lymphoma diagnosed?
Lymph node biopsy
How are plasma cell neoplasms diagnosed?
Bone marrow biopsy
