Hematology: Malignant Lymphoproliferative Flashcards
Slow uncontrollable growth of abnormal lymphoid cells in the BM, spleen and lymph nodes
Anemia, granulocytopenia, thrombocytopenia
Acute Lymphoblastic leukemia
- Normocytic, normochromic anemia
- CNS involvement with scrotal infiltration
- Petechiae, purpura and/or hemorrhage (secondary to thrombocytopenia)
- neg SBB, MPO
+ pos TdT, ACP, NSE
ALL
Most common type (74%) of childhood leukemia
best prognosis
L1
Burkitt type (Leukemic phase of Burkitt lymphoma)
L3
Lymphoblasts are very small & homogenous
Scanty cytoplasm (↑N/C ratio)
Nucleus is round and regular in shape with inconspicuous nucleoli
L1
Lymphoblasts are larger and variable (heterogenous) in size
Abundant, basophilic cytoplasm
Clefted nucleus with nucleoli present
L2: Large cell,
Heterogenous
Lymphoblast is large but varies little with size
Moderate and deeply basophilic cytoplasm often with vacuoles
Nucleus is round with 1-3 nucleoli
L3
Chronic disorder characterized by lymphadenopathy and infiltration of BM and peripheral blood by mature lymphocytes
More common among men, 40 to 60 y.o.
Chronic Lymphocytic Leukemia (CLL)
Most common early signs: enlarged lymph nodes, splenomegaly (and hepatomegaly later)
Bacterial infection is the major cause of death
AIHA in 10% of cases
CLL
-SMUDGE CELLS
-Hypogammaglobulinemia
CLL
RAI CLASS
+ thrombocytopenia
STAGE 4
Absolute lymphocytosis (>15 × 109/L) in the peripheral blood and BM
STAGE 0
80% are of the B cell type
typically shows large lymphocytes with moderately abundant cytoplasm, and prominent nucleoli
Prolymphocytic Leukemia
Leukemic Reticuloendotheliosi
lymphoproliferative disorder characterized by pancytopenia
Pancytopenia – most consistent laboratory observation
Normocytic, normochromic anemia
HCL
Monoclonal neoplastic proliferation of one of the cellular components of the lymphoid system
LYMPHOMA
LYMPHOMA DIAGNOSIS
LN BIOPSY
LYMPHOMA VS LEUKEMIA
LYMPHOMA = LOCALIZED, LYMPHOID
LEUKEMIA = SYSTEMIC, BM
enlarged, painless, cervical lymph nodes
Reed-sternberg cells (OWL’S EYE)
INC ESR, LAP
HODGKIN’S
78%, lacunar cells IN HODGKIN’S IS WHAT
nodular sclerosis
ann arbor stage where >2 lymph nodes on one side of the diaphragm
stage II
ann arbor stage where lymph nodes on both sides of the diaphragm and spleen
stage III
ann arbor stage where involves single lymph node region
stage I
Proliferation of malignant lymphocytes that are arrested at certain stages of maturation (neoplasms of B cells and T/NK cells)
Non-Hodgkin’s Lymphoma
causes skin itching, leading to ulcerative skin tumors
Lymphoid cells show a predilection for the epidermis (epidermotropism) and dermis and may spread to regional lymph nodes.
Mycosis Fungoides
Leukemic phase of mycosis fungoides
T/NK , resembles monocyte
Disseminated disease with widespread skin involvement (erythroderma), lymphadenopathy, and circulating lymphoma cells
Sēzary Syndrome
A B-cell neoplasm. t(8,21)
Found most often in children in Africa & new guinea & commonly affects the jaw & facial bones;
Burkitt’s Lymphoma
Rapid growth and tumor cell death results in “starry sky” appearance of biopsy caused by macrophage cleaning the dead cells
Tumor growth rate is the highest of any tumor (doubling each day)
Burkitt’s Lymphoma
Incidence of Hodgkin
Bimodal
Incidence of non Hodgkin
No pattern
Spread of Hodgkin
Predictable / Stepwise
Malignant proliferation of a monoclonal population of plasma cells that may or may not secrete detectable levels of a monoclonal immunoglobulin
PLASMA CELL DYSCRASIA
↑of one specific type of Ig produced by one neoplastic clone of plasma cells
Monoclonal gammopathy
Main clinical finding is bone pain (bone lesions/fractures)
Renal failure (BJP toxic to tubular epithelial cells) and bacterial infection are the major cause of death
MM
Marked rouleaux; ↑ ESR
Blue background to blood smear
increase gamma band containing an M-spot which is composed of monoclonal CHONs
MM
MM + for BJP in urine. True or False.
True
Increased macroglobulins produce “hyperviscosity syndrome” which causes neurologic symptoms, CHF, visual impairment, nose/gum bleeding
ALSO MARKED ROULEAUX AND ESR
Waldenström
Macroglobulinemia
IMMUNOGLOBULIN IN MM
IgG
Malignant proliferation of lymphoid cells which produce incomplete Ig
Heavy Chain Disease
Mediterranean lymphoma
ALPHA HCD
resembles lymphoma, common in the elderly
Gamma HCD
resembles myeloma
Delta HCD
Generally found as an acute terminal stage in multiple myeloma
9 mos survival
Plasma Cell Leukemia