Hematopoietic Malignancies Flashcards
What is the definition of lymphoma?
Malignant tumor of lymphoid tissue
How would you typically diagnose lymphoma?
FNA, cytology
T/F: Neoplastic cells are fragile and must be handled with care when trying to obtain a sample
True
T/F: With lymphoma, >50% large lymphocytes/blasts indicates an intermediate to high grade lymphoma
True
Besides FNA/cytology, what other tests are available to diagnose lymphoma?
Tissue biopsy via punch, cut, or lymph node removal
What are some methods of identifying the cell architecture under a microscope?
Immunophenotyping, labeled Antibodies on the tissue
what is the most common type of B cell lymphoid cancer?
Diffuse large B Cells lymphosarcoma
What is the most important type of T cell/NK cell lymphoid cancer?
Peripheral T cell lymphoma
What does PARR do?
PCR for Antigen Receptor Rearrangement is used to identify the permanently rearranged DNA in a neoplastic lymphoid cell
How does flow cytometry work?
Counts and examines the cells by suspending them in fluid and counting through electronic detection machine.
What are the stages of canine lymphoma?
Stage 1 - solitary node
Stage 2 - regional nodes affected
Stage 3 - peripheral nodes affected
Stage 4- Liver/spleen/mediastinum +- peripheral nodes
Stage 5 - Bone arrow and other non-lymphoid tissues
What are some lymphoma and paraneoplastic syndromes?
Anemia (mild), hypercalcemia
What is the point of treating canine lymphoma?
High response to chemotherapy. Without it, pet will last only a few weeks
How do you assess the response to treatment against lymphoma?
Physical examination or imaging of tumors
Complete response, partial response, stable disease, progressive disease
What agent is best used for single agent therapy for high grade lymphoma?
Doxorubicin - higher response - 60%
Longer duration of remission - 7 months
What does CHOP used for?
High Grade LSA
What does CHOP stand for?
Cyclophosphamide
Hydroxydaunorubin (dox)
Oncovin (vincristine)
Prednisone
What is the response rate and remission duration for CHOP?
90% response
9-12 month remission (up to 2 years)
T/F: It is harder to treat B cell lymphoma than T cell.
False. T cell is harder
When should you start lymphoma therapy?
After it is confirmed to be lymphoma
How often should a lymphoma patient after treatment have a recheck?
1-2 months. confirm relapses with FNA
What is the typical treatment for low grade/small cell lymphoma?
Typically not CHOP, but prednisone or chlorambucil
What is the % survival for patients with low grade lymphoma?
90% after 1.5 years diagnosis
How much greater is the risk for a cat to obtain lymphoma if it has FeLV? FIV? Exposure to cigarette smoke?
FeLV - 60x
FIX - 6x
Cigarette - 3x
Where does lymphoma typically occur in young cats?
Mediastinum
What are the three major forms of feline lymphoma?
Lymphocytic - low grade
Intermediate grade
Lymphoblastic - high grade
Which form of feline lymphoma is diagnosed with FNA?
lymphoblastic lymphoma
What is the most common anatomic location for feline lymphoma?
Gastrointestinal
What are the three subtypes of GI lymphoma?
Lymphocytic, lymphoblastic, lymphoma of large granular lymphocytes
What are methods of diagnosing GI lymphoma?
Rads, U/S, Endoscopy, Surgical exploration, biopsy
What do you expect to see on lymphocytic GI lymphoma?
small, mature lymphocytes
What is a big ddx for lymphocytic GI lymphoma?
Infectious Bowel disease.
How do you differentiate between Lymphocytic GI lymphoma and IBD?
Immunohistochemistry.
IBD has a mixed lymphocyte population
Lymphoma is monoclonal (T cells)
T/F: You treat lymphocytic lymphoma with CHOP
False! Use prednisone!
How do you treat lymphoBLASTIC lymphoma?
CHOP
T/F: GI Lymphoma of large granular lymphocytes is poorly responsive to therapy
True
What therapy is most recommended to treat colonic lymphoma?
Chemotherapy
How do you typically diagnose mediastinal lymphoma?
radiographs, FNA cytology of mass
What is considered high grade with mediastinal lymphoma?
Large lymphoblasts
How should you treat mediastinal lymphoma?
Combo chemo, CHOP, with potential radiation
What is a sign of good response to treatment with cats?
Rapid, robust response
What will you see with acute lymphoblastic leukemia patients?
Young animals, FeLV, lymphadenopathy, splenomealy, circulating lymphoblasts
T/F: Prognosis for treatment of lymphoblastic leukemia is typically good with fast, quality treatment
False
What will you see with chronic lymphocytic leukemia?
Older pets, nonspecific signs, anorexia, weight loss
How do you confirm the diagnosis for chronic lymphocytic leukemia?
Flow cytometry
T/F: You don’t always have to treat chronic lymphocytic leukmia
True
When should you do chemo for a patient with chronic lymphocytic leukemia and what should you use?
Clinical signs, low cell counts
Use Chlorambucil and prednisone
T/F: All plasma cell tumors are extramedullary
True. B cells transform outside of the bone marrow
Where is plasma cell tumors most commonly occurring? How do you treat it?
Dermal (plasmacytoma)
Treat via surgical excision
T/F: Multiple myeloma is common
False. RARE
What are the must have’s in order to diagnose multiple myeloma?
- Plasma cells in the bone marrow/other organs
- Monoclonal gammopathy in serum and urine
- Osteolytic bone lesions
How do you treat multiple myeloma?
Melphalan - lifelong
Prednisone
Cyclophosphamide, chlorambucil
Which animal, dog or cat, responds better to treatment for multiple myeloma?
Dogs
T/F: Histiocytic tumors are rare in both cats and dogs
True
What tumor is considered a ‘strawberry’ lesion
Histiocytoma
T/F: Histiocytomas resolve on their own
True
T/F: Histiocytic Sarcomas have a low metastatic rate
False. 90%
How do you treat histiocytic sarcomas?
Surgery, radiation, chemo, prednisone
What is the prognosis of malignant histiocytosis?
Poor. <6 months
T/F: systemic histiocytosis is non-neoplastic.
True
T/F: Polycythemia vera is rare
True
How would you treat polycythemia vera?
Phlebotomy, chemotherapy
What are the most common malignancies seen in practice?
Lymphoma, plasma cell tumors, mast cell tumors, histiocytomas
