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Pathology (Mine) > Hematopoetic Pathology > Flashcards

Hematopoetic Pathology Flashcards

1
Q

What is leukocytosis?

A

Characterized by an elevated white blood cell count.

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2
Q

What is neutrophilia?

A
  1. Increased bone marrow production is seen with acute inflammation associated with pyogenic bacterial infection or tissue necrosis
  2. Increased released from bone marrow storage pool may caused by corticosteroids, stress, or endotoxin
  3. Increased bands (“left shift”) noted in peripheral circulation
  4. Reactive changes include Dohle bodies (aggregates of RER), toxic granulations (prominent granules), and cytoplasmic vacuoles of neutrophils
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3
Q

What is eosinophilia?

A

Increased eosinophils

Occurs with allergies and asthma (Type I hypersensitivity), parasites, drugs (especially in hospitals), and certain skin diseases and cancers (adenocarcinomas, Hodgkin disease)

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4
Q

What is monocytosis?

A

Increased monocytes

Occurs with certain chronic diseases such as some collagen vascular diseases and inflammatory bowel disease, and with certain infections, especially TB

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5
Q

What is lymphocytosis?

A

Increased lymphocytes

Occurs with acute (viral) diseases and chronic inflammatory processes

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6
Q

Characteristics of infectious mononucleosis

A

Acute, self-limited disease, which usually resolves in 4-6 weeks, is an example of a viral disease that causes lymphocytosis. The most common cause is Epstein-Barr virus (a herpes virus) though other viruses can cause it as well (heterophile-negative infectious mononucleosis is most likely due to cytomegalovirus.

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7
Q

What disorders are increased basophils seen?

A

Chronic myeloproliferative disorders such as polycythemia vera

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8
Q

What is leukopenia?

A

Characterized by a decreased white blood cell count

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9
Q

What is lymphadenopathy?

A

Lymph node enlargement due to reactive conditions or neoplasia

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10
Q

Characteristics of acute nonspecific lymphadenitis

A
  1. Produces tender enlargement of lymph nodes; focal involvement is seen with bacterial lymphadenitis.
  2. Microscopically, there may be neutrophils within the lymph node.
  3. Cat scratch fever (due to Bartonella henselae) causes stellate microabscesses
  4. Generalized involvement of lymph nodes is seen with viral infections
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11
Q

Characteristics of chronic lymphadenitis

A

Non-tender enlargement of lymph nodes

Follicular hyperplasia involves B lymphocytes and may be seen with rheumatoid arthritis, toxoplasmosis, and early HIV infections.

Paracortical lymphoid hyperplasia involves T cells and may be seen with viruses, drugs (Dilantin), and SLE.

Sinus histiocytosis involves macrophages and is nonspecific

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12
Q

Characteristics of neoplasia

A

Nontender enlargement of lymph nodes

The most common tumor is involved lymph nodes is metastatic cancer (e.g., breast, lung, malignant melanoma, stomach and colon carcinoma), which is initially seen under the lymph node capsule

Other important causes of lymphadenopathy are malignant lymphoma and infiltration by leukemias

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13
Q

Chronic lymphocytic leukemia (CLL) vs. Small lymphocytic lymphoma (SLL)

A

Patients who present with lymph node findings are classified as having SLL.

Patients who present with blood findings are classified as having CLL; 50% of CLL patients also have lymph node involvement

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14
Q

Characteristics of Chronic lymphocytic leukemia (CLL)

A

CLL is the most indolent of all the leukemias

Mean age at time of diagnosis is age 60

The malginant cells are nonfuncional, so patients develop hypogammaglobulinemia, leading to an increased rick of infections

CLL is associated with warm autoimmune hemolytic anemia (AIHAD) which will cause spherocytes to be observed in peripheral blood

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15
Q

How are CLL and SLL catergorized?

A

Categorized by the markers present on the cells

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16
Q

Characteristics of B-chronic lymphocytic leukemia

A

Have B-cell markers, such as CD19 and CD20. One T-cell marker CD5 is present.

Cells are CD23 positive and CD10 negative

SLL occurs only as this type

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17
Q

Characteristics of T-chronic lymphocytic leukemia

A

Have T-cell markers.

The histology of affected lymph nodes reveals only a diffuse pattern (not nodular) but proliferation centers may also be present

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18
Q

Characteristics of Hairy cell leukemia

A

B-cell neoplasm that causes indolent disease in middle aged Caucasian men.

There can be a “dry tap” with bone marrow aspiration.

Lymphocytes have “hair-like” cytoplasmic projections; the diagnostic stain is positive tartrate-resistant acid phosphatase (TRAP)

Enlarged spleen due to infiltration of red pulp by malignant cells

Treatment is 2-chloro-seoxyadenosine (2-Cd-A)

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19
Q

Characteristics of follicular lymphoma

A

Well-differentiated B-cell lymphoma with follicular architecture.

Derived from B lymphocytes

Frequently presents with disseminated disease

Prognosis is better than diffuse lymphoma but doesn’t respond to therapy

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20
Q

What translocation causes follicular lymphoma?

A

t(14;18)

Involves the heavy chain and BCL2 gene

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21
Q

Characteristics of Diffuse large B-cell lymphoma

A

High gradelarge B-cell lymphoma with a diffuse growth pattern.

It is an aggressive, rapidly proliferating tumor which may respond to therapy.

Special subtypes include immunodeficiency-associated B-cell lymphomas (EBV) and body cavity large B-cell lymphoma (human herpes virus-8)

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22
Q

Characteristics of small noncleaved lymphoma (Burkitt lymphoma)

A

High grade B-cell lymphoma

it is composed of interemediate-sized lymphoic cells with a “starry sky” appearance due to numerous reactive tingible-body macrophages

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23
Q

What causes Burkitt’s lymphoma?

A

t(8;14) translocation
t(2,8) translocation
t(8,22) translocation

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24
Q

What are the two types of burkitt lymphoma?

A

African types: endemic form
Involvement of mandible or maxilla is characteristic, is associated with Epstein-Barr virus

American type: nonendemic, sporadic form
Involvement of the abdomen (such as bowel, retroperitoneum, or ovaries); has a high incidence in AIDS patients

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25
Q

Characteristics of mantle cell lymphoma (MCL)

A

Rare B-cell lymphoma in which the tumor cells arise from mantle zone B lymphocytes

26
Q

What causes mantle cell lymphoma (MCL)?

A

t(;14) translocation

Involving CCD1 and the heavy chain locus

27
Q

How to diagnosis mantle cell lymphoma (MCL)?

A

Positive for:
CD19, CD20, CD5

Negative for:
CD23

28
Q

Characteristics of marginal zone lymphoma (MALToma)

A

Diverse group of B-cell neoplasms that arise within lymph nodes,spleen, or extranodal tissue.

It is associated with mucosa-associated lymphoid tissue (MALTomas).

This lesion begins as a reactive polyclonal reaction and may be associated with previous autoimmune disorders or infectious disease (Sjogren disease, Hashimoto thyroiditis, Helicobacter gastritis)

29
Q

Characteristics of multiple myeloma

A

Malignant neoplasm of plasma cells

Most common primary tumor arising in the bone marrow of adults

Bence Jones proteins are light chains that are small and can be filtered into the urine

Monoclonal immunoglobulin spike IgG spike

30
Q

What is cause of multiple myeloma?

A

t(11;14) translocation cyclin D1;IgH

t(6;14) translocation cyclin D3;IgH

31
Q

Mnemonic for multiple myeloma

A 
Old CRAB
Old- Old age
C: hyperCalciumia
R: Renal failure
A: Anemia
B: Bone lytic fractures
32
Q

Characteristics of plasmacytoma

A

Solitary myeloma within bone or soft tissue

Within bone: precursor lesion that can later develop into myeloma

Outside bone (extramedullary): usually found within upper respiratory tract

33
Q

Characteristics of monoclonal gammopathy of undetermined significance (MGUS)

A

Old name was benign monoclonal gammopathy

M spike

Incidence increases with increasing age

34
Q

Characteristics of lymphoplasmacytic lymphoma

A

Also known as Wldenstrom macroglobulinemia

Small lymphocytic lymphoma with plasmacytic differentiation .
M spike present

Russel bodies present (cytoplasmic immunoglobin)

Dutcher bodies present (intranuclear immunoglobin)

35
Q

Symptoms of lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)

A

Hyperviscosity- due to IgM

Visual abnormalities- vascular dilatations and hemorrhages in retina

Neurologic symptoms- headaches and confusion

Bleeding and cryoglobulinemia can be due to abnormal globulins

36
Q

Characteristics of peripheral T-cell lymphoma, unspecified

A

“Wastebasket” diagnostic category

37
Q

Characteristics of adult T-cell leukemia/lymphoma (ATLL)

A

Malignant T-cell disorder (CD4-T cells) due to HTLV-1 infection

Clinical symptoms:
Skin lesions
Hypercalcemia
Enlarged lymph nodes
Heptomegaly
Splenomegaly

Microscopic- hyperlobated “4 leaf clover” lymphocytes

38
Q

Characteristics of mycosis fungoides

A

Malignant T-cell disorder (CD4+ cells) that has a better prognosis than ATLL

It can present with pruritic erythematous rash

Microscopically, atypical PAS-positive lymphocytes are present in the epidermis; aggreagates of these cells are called Pautrier microabscesses

39
Q

Characteristics of Sezary syndrome

A

Like mycosis fungoides

If erythroderma and cerebriform Sezary cells are present in peripheral blood

40
Q

Characteristics of Hodgkin lymphoma

A

May present similar to infection (with fever)

Spread is continuous to adjacent node groups

No leukemic state

Extranodal spread is uncommon

Malignant cells are Reed-Sternberg cells (intermixed with reactive inflammatory cells)

Reed-Sternberg cell is a large malignant tumor cell that has a bilobed nucleus with a prominent large inclusion-like nucleolus in each lobe

41
Q

What is the classification of hodgkin lymphoma?

A 
Lymphocyte-rich
Lymphocyte-predominant
Mixed cellularity
Lymphocyte-depleted
Nodular sclerosis
42
Q

Characteristics of Lymphocyte-rich hodgkin

A

Rare

Composed primarily of reactive lymphocytes associated with Epstein- Barr virus

43
Q

Characteristics of lymphocyte-predominant hodgkin

A

Type: has lymphohistocytic variants (L&H cells, called “popcorn cells” ) and a unique phenotype (CD45+, CD15-, CD30-, CD20+)

44
Q

Characteristics of mixed cellularity hodgkin

A

Type: occurs in middle-aged and older males; the increased number of eosinophils is related to IL-5 secretion

45
Q

Characteristics of lymphocyte-depleted lodgkin

A

Type: presents with abdominal adenopathy; Reed-Sternberg predominate

46
Q

Characteristics of nodular sclerosis

A

type: is the only type with which females>males

Lymph node has broad collagen bands

Reed-Sternberg cell has clear space in the cytoplasm

47
Q

Characteristics of acute leukemia

A

Peripheral blood has decreased mature forms and increased immature forms called blasts.

Acute symptoms are due to bone marrow failure: decreased erythrocytes, decrease leukocytes and decreased platelets

48
Q

Characteristics of acute lymphoblastic leukemia (ALL)

A

B-cell lineage expresses CD19, CD10 and CD20 markers

T-cell lineage express CD2, CD3, CD5, CD7

49
Q

Characteristics of acute myelogenous leukemia (AML)

A

Cancer of the myeloid line of blood cells

Symptoms include fatigue, unusual bleeding and infections

Auer rods (linear condensations of cytoplasmic granules) are characteristic of AML

50
Q

What causes acute myelogenous leukemia (AML)?

A

Promyelocytic leukemia has t(15;17) with fusion gene PML/RARA responds to all-transretinoic acid (ATRA); DIC common

AML t(8,21) or inv(16)

51
Q

Characteristics of myelodysplastic syndromes (MDS)

A

Classified according to the number of blasts in the marrow.

Dysplastic changes include Pelger-Huet cells (“aviator glasses” nuclei) ring sideroblastss, nuclear budding and “pawn ball” megakaryocytes

MDS are considered preleukemias, so patients are at increased risk of developing acute leukemias

52
Q

Characteristics of chronic myelogenous leukemia (CML)

A

Clonal proliferation of pluripotent granulocytic precursor stem cells. In most cases it is associated with a BCR-ABL fusion gene due to a balanced (9;22) translocation (Philadelphia chromosome)

53
Q

Characteristics of polycythemia vera

A

Increased erythroid precursors

Increased hemocrit

Increased blood viscosity

Decreased erythropoietin

Increased basophils

Increased eosinophils

High cell turnover

54
Q

Characteristics of essential thrombocythemia

A

Increased megakaryocytes in bone marrow.

Peripheral blood smear shows increased platelets, some with abnormal shapes.

Increased leukocytes

Excessive bleeding and occlusion of small vessels

55
Q

Characteristics of myelofibrosis (MF) with myeloid metaplasia

A

Marrow fibrosis

Bone marrow aspiration may be a “dry tap”

Enlarged spleen

Peripheral blood smear shows leukoerythroblastosis with teardrop RBCs

56
Q

Characteristics of Langerhans histiocytosis

A

Common in children

Affect many sites including skin, bone, CND (diabetes insipidus), and lungs,

Cells are CD1a positive show cytoplasmic Birbeck granules (tennis racket-shaped organelles)

57
Q

Characteristics of Letterer-Siwe disease

A

Multisystem variant of langerhans histiocytosis

Marrow involvement can be fatal

58
Q

Characteristics of Hand-Schuller-Christian

A

Another variant of langerhans histiocytosis

Triad is calvarial involvement, diabetes insipidus and exophtalmos

59
Q

Characteristics of unisystem variant of langerhans histiocytosis

A

Eosinophilic granuloma (most often in bone)

60
Q

Characteristics of thymomas

A

Low-grade tumors of the thymic epithelium with many histologic patterns

61
Q

Characteristics of tue thymic hyperplasia

A

Enlargement of a histiologically normal thymus; it can occur as a complication of chemotherapy

62
Q

Characteristics of thymic lymphoid hyperplasia

A

Shows germinal center hyperplasia

Pathology (Mine) (17 decks)

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