Gen Path Exam 2 - WBC Disorders Flashcards by A G | Brainscape

Q

What are the 4 main compartments WBCs occupy in the body?

A

Bone marrow
Bloodstream
Lymph nodes
Site of infection or immune stimulation

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Q

What is the site of WBC production?

A

Bone marrow

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Q

What is the site of WBC transport?

A

Bloodstream

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Q

What is the site of WBC immune activation?

A

Lymph nodes

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Q

What is the site of WBC infection or immune stimulation?

A

Any organ or soft tissue

(what you see clinically)

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Q

Decreased serum level of leukocytes

A

Leukopenia

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Q

Elevated serum level of leukocytes, mostly neutrophils

A

Leukocytosis

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Q

What is the normal level of neutrophils? What about during leukocytosis?

A

Normal = 4-10,000 ul
Leukocytosis = 15-20,000 ul

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Q

Bacterial infections or when there is tissue necrosis (burns, MI)

A

Neutrophilic

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Q

Chronic infections and some viral infections

A

Lymphocytotic

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Q

Chronic infections

A

Monocytotic

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Q

Allergies (asthma, hay fever), parasitic infections, drug rxns

A

Eosinophilic

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Q

When you evaluate lymph nodes, what should they normally look like?

A

Small and non-palpable

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Q

What do lymph nodes look like in lymphadenopathy?

A

Firm, enlarged

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Q

Seen in the lymph node that is draining a region of infection

A

Painful lymphadenopathy

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Q

Seen with chronic inflammation. metastatic cancer, or lymphoma

A

Non-painful lymphadenopathy

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Q

Which disease?

Most cases are self-limited and benign, particularly in children

A

Lymphadenopathy

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Q

Which disease?

Often localized but if generalized, there is often an underlying systemic disease

A

Lymphadenopathy

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Q

Which disease?

<2 weeks or >1 year without size change is unlikely to be a neoplasm

A

Lymphadenopathy

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Q

Which disease?

Risk for cancer: >6 weeks and not better by 12 weeks

A

Lymphadenopathy

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Q

Which disease?

Workup includes serology, imaging, possible biopsy

A

Lymphadenopathy

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Q

What are the Lymphadenopathy etiologies?

A

MIAMI - malignancy, infectious, autoimmune, miscellaneous, iatrogenic

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Q

What type of Lymphadenopathy etiology?

Fever, drenching night sweats, unexplained weight loss >10% of body weight

A

Malignancy

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Q

What type of Lymphadenopathy etiology?

Supraclavicular lymphadenopathy adults or children - up to 50% have intraabdominal malignancy

A

Malignancy

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Q

What type of Lymphadenopathy etiology?

Fever, chills, fatigue, malaise

A

Infectious

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Q

What type of Lymphadenopathy etiology?

Arthralgias, muscle weakness, rash

A

Autoimmune

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Q

What type of Lymphadenopathy etiology?

Other specific findings of each condition

A

Miscellaneous

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Q

What type of Lymphadenopathy etiology?

History of new meds

A

Iatrogenic

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Q

Decreased neutrophils in blood

A

Neutropenia

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Q

Decreased granulocytes (neutrophils, basophils, eosinophils) in blood

A

Agranulocytosis

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Q

Which disease?

Pathogenesis = decreased production in bone marrow or increased destruction in the peripheral blood

A

Neutropenia
Agranulocytosis

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Q

Which disease?

Most common sequela is infection

A

Neutropenia
Agranulocytosis

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Q

Which disease?

Symptoms are malaise, fever, chills, weakness, ulceration (oral, gingival) that is deep and punched out

A

Neutropenia
Agranulocytosis

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Q

Which lymph node?

Drain scalp, skin

A

Preauricular

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Q

Which lymph node?

Differential diagnosis is scalp infection, mycobacterial infection

A

Preauricular
Posterior cervical

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Q

Which lymph node?

Malignancies are skin neoplasm, lymphomas, head and neck squamous cell carcinomas

A

Preauricular

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Q

Which lymph node?

Drain scalp, neck, upper thoracic skin

A

Posterior cervical

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Q

Which lymph node?

Drain GI tract, genitourinary tract, pulmonary

A

Supraclavicular

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Q

Which lymph node?

Differential diagnosis is thyroid/laryngeal disease, mycobacterial/fungal infections

A

Supraclavicular

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Q

Which lymph node?

Malignancies are abdominal and thoracic

A

Supraclavicular

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Q

Which lymph node?

Drain oral cavity

A

Submandibular

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Q

Which lymph node?

Squamous cell carcinoma of head and neck, lymphoma, leukemia

A

Submandibular

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Q

Which lymph node?

Drain larynx, tongue, oropharynx, anterior neck

A

Anterior cervical

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Q

Which disease?

Causes of decreased production in bone marrow include: chemo, aplastic anemia, leukemia

A

Neutropenia
Agranulocytosis

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Q

Which disease?

Causes of increased destruction of peripheral cells causing hypercellular marrow include: immune-mediated injury (drugs), overwhelming infections, splenomegaly

A

Neutropenia
Agranulocytosis

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Q

What causes this in neutropenia and agranulocytosis?

Transient marrow hyoplasia, decreasing neutrophil production

A

Chemo

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Q

What causes this in neutropenia and agranulocytosis?

Chronic marrow hypoplasia

A

Aplastic anemia

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Q

What causes this in neutropenia and agranulocytosis?

Replacement of normal marrow

A

Leukemia

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Q

What causes this in neutropenia and agranulocytosis?

Uses up peripheral cells

A

Overwhelming infections

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Q

What causes this in neutropenia and agranulocytosis?

Accelerates removal of granulocytes

A

Splenomegaly

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Q

Which disease?

Tx is removal of offending agent, control infection, give granulocyte colony-stimulating factor to stimulate granulocyte production

A

Neutropenia
Agranulocytosis

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Q

What are WBC neoplasm classifications based on?

A

Morphologic and molecular criteria

(lineage-specific protein markers and genetic changes)

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Q

What are the 3 broad categories of WBC neoplasms that are based on origin/differentiation?

A

Lymphoid neoplasms
Myeloid neoplasms
Histiocytic neoplasms

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Q

What is the cause of lymphoid neoplasms?

A

Increased risk for translocations/transformation in B cells

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Q

Why is there an increased risk for translocations/transformation in B cells?

A

B cells undergo somatic hypermutation and class switching

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Q

Increases AB affinity

A

Somatic hypermutation (B cells)

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Q

Produces multiple AB types to the same antigen

A

Class switching (B cells)

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Q

Which cells are genomically stable, making them an UNCOMMON cause of lymphomas?

A

T cells

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Q

Involvement of bone marrow and peripheral blood

A

Leukemia

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Q

Tumor masses in lymph nodes or other tissues

A

Lymphoma

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Q

All lymphoid neoplasms can spread where?

A

To lymph nodes and other tissues

(ex: spleen, bone marrow, peripheral blood)

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Q

Lymphoid neoplasm classification focuses on ___________ and _________ characteristics of the tumor cells due to overlap in clinical behavior and location

A

morphology; molecular

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Q

What is meant by shape and size?

A

Morphology

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Q

What is meant by surface markers?

A

Molecular characteristics

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Q

What tumors come from cells arrested at or derived from a specific stage of normal lymphocyte differentiation?

A

B and T cell tumors

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Q

As B and T cell tumors progress through each stage of differentiation, what changes?

A

Morphology
Surface markers

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Q

What is the classification criteria for lymphoid neoplasms?

A

Morphology
Cell origin
Clinical features
Genotype

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Q

What cancers account for the largest proportion of cancers in children by tumor type?

A

Leukemia and lymphoma

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Q

Which disease?

Group of hematologic malignancies characterized by tumor cells that originate in bone marrow and spill over into blood

A

Leukemia

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Q

What are the 2 main mechanisms that lead to the formation of B cell lymphomas?

A

Somatic hypermutation
Class switching

Q

Which disease?

Diffuse infiltration into lymph nodes, spleen, liver, and gingiva, causing general enlargment

A

Leukemia

Q

Which disease?

Derived from single transformed cell exhibiting clonal growth

A

Leukemia

Q

Which disease?

Typically, all of the clonal cell population have the same surface markers

A

Leukemia

Q

Which disease?

Causes are ionizing radiation, toxins, antineoplastic chemo drugs, chromosomal abnormalities

A

Acute leukemia

Q

Which disease?

Pathophysiology is myelophthisic anemia, neutropenia, anemia, thrombocytopenia

A

Acute leukemia

Q

Replacement of normal hematopoietic cells by neoplastic “blasts” (myeloblasts, erythroblasts, and megakaryocytes) in bone marrow

A

Myelophthisic anemia

Q

What does Myelophthisic anemia cause?

A

Neutropenia
Anemia
Thrombocytopenia

Q

Leads to bacterial, viral, and fungal infections

A

Neutropenia

Q

Leads to hypoxia causing fatigue, shortness of breath, and pallor (decreased RBCs)

A

Anemia

Q

Leads to bleeding and petechiae

A

Thrombocytopenia

Q

What do the pathophysiologic changes (myelophthisic anemia, neutropenia, anemia, and thrombocytopenia) in acute leukemia lead to?

A

Extramedullary hematopoiesis

Q

What is the MOST COMMON cancer in children?

A

ALL (acute lymphoblastic leukemia)

Q

Does ALL have a good outcome/cure rate?

A

Yes!

Q

Which acute leukemia primarily affects older adults?

A

AML (acute myeloid leukemia)

Q

Does AML have a good outcome/cure rate?

A

No :(

Q

Which disease?

Neoplasm of mature circulating lymphocytes, causing high WBC count

A

Chronic leukemia

Q

Which disease?

Either lymphocytic or myeloid

A

Chronic leukemia

Q

Which disease?

Slow onset in adult pts with common symptoms like weakness/fatigue, weight loss, night sweats, swollen abdomen, infections, easy bruising

A

Chronic leukemia

Q

Which disease?

High WBC - neutrophils

A

CML (chronic myeloid leukemia)

Q

Which disease?

High WBC - lymphocytes

A

CLL (chronic lymphocytic leukemia)

Q

What is the MOST COMMON leukemia of ADULTS in the western world?

A

CLL

Q

Which chronic leukemia?

Indolent, slow growing tumor, often asymptomatic

A

CLL

Q

Which chronic leukemia?

Increased BCL 2

A

CLL

Q

What is BCL 2?

A

Anti-apoptotic protein

Q

Which chronic leukemia?

If it involves lymph nodes, it is called Small Lymphocytic Lymphoma (SLL)

A

CLL

Q

Which chronic leukemia?

Cure only achieved with hematopoietic stem cell transplant

A

CLL

Q

Which chronic leukemia?

Some tumors transform to more aggressive diffuse large B cell lymphoma, and pts die within 1 year

A

CLL

Q

Which chronic leukemia?

A myeloproliferative disorder that particularly shows an increase in granulocytes

A

CML

Q

Which chronic leukemia?

Philadelphia chromosome: BCR-ABL t(9:22) translocation causing a fusion protein

A

CML

Q

Which chronic leukemia?

Some cases undergo transformation into an acute leukemia (“blast crisis”)

A

CML

Q

Which chronic leukemia?

Tx is tyrosine kinase inhibitors induce sustained remissions and prevent progression to blast crisis

A

CML

Q

Name an example of a tyrosine kinase inhibitor

A

Imatinib (Glecvec)

Q

Which disease?

Disordered maturation defect where bone marrow is replaced by clonal, multipotent stem cells with capacity for differentiation into red cells (erythroid precursors), granulocytes, and platelets

A

Myelodysplastic syndrome (MDS)

Q

Which disease?

Usually idiopathic, but can develop after chemo or exposure to ionizing radiation

A

MDS

Q

Which disease?

Marrow is hypercellular/normocellular, but the peripheral blood shows cytopenias

A

MDS

Q

Which disease?

High risk of transformation to AML

A

MDS

Q

What are the 3 types of B cell lymphomas?

A

Hodgkin lymphoma
Non-hodgkin lymphoma
Plasma cell disorders (multiple myeloma)

Q

Which B cell lymphoma?

Typified by the Reed-Sternberg (RS) cell which is a germinal center B cell

A

Hodgkin lymphoma

Q

Which B cell lymphoma?

Some have EBV infection

A

Hodgkin lymphoma

Q

Which B cell lymphoma?

Affects adolescents/young adults or patients >50 yrs

A

Hodgkin lymphoma

Q

Which B cell lymphoma?

Painless LAD: single node spreads to contiguous nodes (lower cervical, supraclavicular, mediastinal)

A

Hodgkin lymphoma

Q

What are the contiguous nodes?

A

Lower cervical
Supraclavicular
Mediastinal

Q

Which B cell lymphoma?

“B symptoms,” pruritus and anemia occur with more advanced disease

A

Hodgkin lymphoma

Q

What are the “B symptoms”?

A

Fever, weight loss, night sweats

Q

Which B cell lymphoma?

Tx is chemo, radiotherapy; immunotherapy for refractory disease

A

Hodgkin lymphoma

Q

Which B cell lymphoma?

Prognosis: 5 year survival is > 90%

A

Hodgkin lymphoma

Q

Which B cell lymphoma?

Most have the characteristic t(14;18) translocation, causing overexpression of BCL-2 protein

A

Follicular lymphoma

Q

Which B cell lymphoma?

Affects adults > 50 years old

A

Follicular lymphoma

Q

Which B cell lymphoma?

Painless, generalized lymphadenopathy

A

Follicular lymphoma

Q

Which B cell lymphoma?

Incurable, indolent lymphoma; tx is reserved for bulky or symptomatic disease

A

Follicular lymphoma

Q

Which B cell lymphoma?

30-40% progress to diffuse large B cell lymphoma

A

Follicular lymphoma

Q

What % of follicular lymphoma cases will progress to diffuse large B cell lymphoma?

A

30-40%

Q

Which B cell lymphoma?

Arise in MALT associated with epithelium (stomach, salivary glands, etc) and can cause swelling

A

Marginal zone lymphoma

Q

Which B cell lymphoma?

Sustained by chronic inflammation triggered by autoimmune disorders or sites of chronic infection

A

Marginal zone lymphoma

Q

Which B cell lymphoma?

H pylori-specific T cells drive growth and survival of B cells. If you kill the bug, the tumor will shrink, but polyclonal B cell growth can evolve into monoclonal change and spread to distant sites

A

Marginal zone lymphoma

Q

Which B cell lymphoma?

When localized, cured by simple excision and radiotherapy

A

Marginal zone lymphoma

Q

What is the most common lymphoma in adults?

A

Diffuse large B cell lymphoma

Q

Which B cell lymphoma?

Some have a t(14;18) translocation of BCL-2, and others have translocations of MYC (oncogene)

A

Diffuse large B cell lymphoma

Q

Which B cell lymphoma?

Often symptomatic; rapidly enlarging mass within a lymph node, or extranodal in any organ/tissue

A

Diffuse large B cell lymphoma

Q

Which B cell lymphoma?

Aggressive tumor; requires intensive combo of chemo and anti-CD20 drugs w/ 60-80% complete remission

A

Diffuse large B cell lymphoma

Q

What is the fastest growing human tumor?

A

Burkitt lymphoma

Q

Which B cell lymphoma?

t(8;14) translocation of MYC and IgH

A

Burkitt lymphoma

Q

Which B cell lymphoma?

Effects mainly children and young adults at extranodal sites

A

Burkitt lymphoma

Q

Which B cell lymphoma?

Jaw masses associated with EBV occur in Africa and in ~20% of other cases

A

Burkitt lymphoma

Q

Which B cell lymphoma?

In North America, typically presents as an abdominal mass

A

Burkitt lymphoma

Q

Which B cell lymphoma?

Highly aggressive, but with intensive chemo, most pts are cured

A

Burkitt lymphoma

Q

Which B cell lymphoma?

“Starry sky” histologic appearance

A

Burkitt lymphoma

Q

What do neoplastic plasma cells secrete?

A

Monoclonal immunoglobulin (M protein)
Immunoglobulin fragments with pathologic consequences

Q

Are M proteins large or small?

A

Large

Q

Where are M proteins restricted to?

A

Plasma

Q

If immunoglobulin light chains are also made by neoplastic plasma cells, where can they be detected?

A

Urine and blood

Q

Name the conditions with abnormal immunoglobulins

A

Multiple myeloma
Monoclonal gammopathy of undetermined significance (MGUS)
Amyloidosis
Waldenstrom’s macroglobulinemia

Q

Light chain deposition with or without multiple myeloma

A

Amyloidosis

Q

Increased IgM blood levels in association with lymphoplasmacytic lymphoma

A

Waldenstrom’s macroglobulinemia

Q

Which B cell lymphoma?

A common lymphoid malignancy

A

Multiple myeloma

Q

Which B cell lymphoma?

Median age is 70 yrs

A

Multiple myeloma

Q

Which B cell lymphoma?

Involves bone marrow associated with lytic lesions (often “punched out” radiolucencies) throughout the skeleton

A

Multiple myeloma

Q

Which B cell lymphoma?

Most frequent M protein is IgG

A

Multiple myeloma

Q

Which B cell lymphoma?

If kappa or lambda light chains are produced, their small size allows excretion in the urine (Bence-Jones proteins)

A

Multiple myeloma

Q

Which B cell lymphoma?

Defective production of normal B cells -> high risk for bacterial infections

A

Multiple myeloma

Q

Which B cell lymphoma?

Renal dysfunction due to:

Obstructive proteinaceous casts
Light chain deposition in glomerulus or interstitial
Hypercalcemia leads to dehydration/renal stones
Bacterial pyelonephritis due to hypogammaglobulinemia

A

Multiple myeloma

Q

Name 3 examples of obstructive proteinaceous casts causing renal dysfunction in multiple myeloma

A

Bence-Jones proteins
Complete Ig
Albumin

Q

Which B cell lymphoma?

Bone resorption causing chronic pain and pathologic fracture

A

Multiple myeloma

Q

Which B cell lymphoma?

“Punched out” radiolucencies in bone

A

Multiple myeloma

Q

Which B cell lymphoma?

Hypercalcemia causes confusion, weakness, lethargy

A

Multiple myeloma

Q

Which B cell lymphoma?

Recurrent bacterial infections

A

Multiple myeloma

Q

Which B cell lymphoma?

Renal insufficiency & failure

A

Multiple myeloma

Q

Which B cell lymphoma?

Definitive diagnosis requires bone marrow exam

A

Multiple myeloma

Q

Which B cell lymphoma?

Tx is chemo and bisphosphonates

A

Multiple myeloma

Q

Drugs that inhibit bone resorption and reduce fractures/hypercalcemia

A

Bisphosphonates

Q

Which B cell lymphoma?

Death occurs within 1 year if untreated

A

Multiple myeloma

Q

Which B cell lymphoma?

Some patients have “smoldering myeloma” that may be asymptomatic for many years

A

Multiple myeloma

Q

Which B cell lymphoma?

Median survival is 4-7 years

A

Multiple myeloma

Q

What is the median survival for multiple myeloma?

A

4-7 years

Q

Variety of proliferative disorders of dendritic cells or macrophages

A

Histiocytosis

Q

Range from highly malignant rare neoplasms to benign/reactive proliferations in lymph nodes

A

Histiocytic neoplasms

Q

What disease lies between the range of highly malignant rare neoplasms to benign/reactive proliferations in lymph nodes?

A

Histiocytosis X or Langerhans cell histocytosis

Q

Immature dendritic cells that capture antigens and present them through MHC class II to T cells

A

Langerhans cells

Q

What disease?

Neoplastic cells look more like tissue macrophages than dendritic cells; eosinophils also present

A

Langerhans cell histocytosis

Q

What disease?

Acute/chronic presentations that affect skin, viscera, and bone

A

Langerhans cell histocytosis

Q

What disease?

Eosinophilic granuloma of bone is the most common clinical manifestation

A

Langerhans cell histocytosis

Q

What parts of the body are commonly affected in Langerhans cell histocytosis?

A

Skull, ribs, vertebrae, mandible

Q

What disease?

Dull pain and tenderness often present

A

Langerhans cell histocytosis

Q

What disease?

Punched out or ill-defined radiolucency on X-Ray

A

Langerhans cell histocytosis