Hematologic Malignancies

Question 1

Name 3 ways that hematologic malignancies may manifest

Answer 1

1. ) Leukemia - seen in blood and marrow
2. ) Lymphoma - lymphocyte derivatives, solid mass
3. ) Extramedulary granulomic tumor (granulocytic sarcoma) - derived from myeloid cells, present as solid mass

Question 2

Name one example in which leukemia/lymphoma may overlap

Answer 2

CLL/SLL (chronic lymphocytic leukemia/ small cell lymphocytic lymphoma)

Same exact disease, differing whether its mostly in blood and marrow (CLL) or presents as a solid growth (SLL)

Can be both! Called CLL/SLL

Question 3

Difference between high grade vs low grade lymphomas

Answer 3

High grade - rapidly enlarging, poorer diagnosis. Usually acute leukemias

Low grade - slowly enlarging mass, may take yrs to present. Chronic leukemias

Question 4

Difference between acute vs chronic leukemia presentation

Answer 4

Acute - high white cell count, near replacement of cells with marrow. Present w/ significant malaise symptoms

Chronic - often present w/o symptoms. Slightly elevated WBCs, usually incident finding

Question 5

Why do many lymphomas contain balanced translocations involving immunoglobulin and T-cell receptor genes?

Answer 5

Due to natural susceptibility of genome to translocations during periods of genetic instability - particularly initial immunoglobulin/T-cell receptor rearrangement during maturation of B-cells/T-cells.

Including recombination and somatic hypermutation in B-cells.

Question 6

List 3 viruses that have oncogenic roles in some cases of lymphoma

Answer 6

1. ) Epstein-Barr virus - may contribute to classical Hodgkins Lymphoma, Burkitt Lymphoma, B-cell non-Hodgkins
2. ) Human T-Cell Leukemia Virus-1 (HTLV-1) - Adult T cell leukemia/kymphoma
3. ) Kaposi Sarcoma herpesvirus/Human herpesvirus-8 - primary effusion lymphoma

Question 7

Compare incidence of leukemia and lymphoma in adult vs child populations

Answer 7

Leukemia - 10th most common in adult, 1st most common in children

Lymphoma - 7th most common for adults, 3rd for children

Question 8

What are myeloid malignancies?

Answer 8

Arise from mature/immature membrers of the granulocytic, monocytic, erythroid, megakaryocytic and mast cell lineages.

Question 9

What are lymphoid malignancies?

Answer 9

Arise from mature/immature members of B-cell, T-cell, or NK cell lineages.

Question 10

What is Myelodisplastic Syndrome (MDS)?

Answer 10

group of conditions, clonal population takes over marrow, not making normal blood cells.

Can progress to AML

Question 11

What are Myeloproliferative Neoplasms?

Answer 11

normal functioning cells of multiple lineages, but too many.

May progress to AML

Question 12

Classical Hodgkins Lymphoma

Answer 12

B-cell lymphoma characterized by Hodgkin-Reed-Sternberg Cell. P. unique.

Question 13

Non-Hodgkins Lymphoma

Answer 13

mature B-cells, T-cells, NK cells. MOST are B-cell lymphomas.

Question 14

Plasma Cell Neoplasms

Answer 14

MGUS, plasmacytoma, multiple myeloma

Question 15

What are some diagnostic features to look for when diagnosing hematologic malignancies?

Answer 15

1. ) Microscopic appearence of malignant cells
2. )Histologic growth pattern
3. ) Presence/absense of cytogenetic findings
4. )Relative amount of malignant cells in marrow/blood
5. )Cell surface markers/cytoplasmic markers/nuclear markers