Hematopoietic Malignancies

Question 1

what’s the big difference between leukemia and lymphoma?

Answer 1

both are malignant diseases of hematopoietic cells

the big defining characteristic that separates leukemia and lymphoma is their place of origin

leukemia starts in the bone marrow, and lymphoma starts in lymph nodes

but they can look similar clinically because they can involve a lot of the same parts of the body

Question 2

what type of cells does leukemia involve?

Answer 2

leukemias may arise from either myeloid or lymphoid cells

Question 3

what type of cells does lymphoma involve?

Answer 3

lymphomas arise only from lymphoid cells

Question 4

what is leukemia?

Answer 4

arises from lymphoid or myeloid stem cells

starts in bone marrow then spreads to the blood stream

can be acute or chronic

Question 5

what is lymphoma?

Answer 5

arises from lymphoid cells only

starts in lymphatics tissues but can spread to bone marrow or blood

can be Hodgkin or non-Hodgkin

Question 6

what are the two basic types of lymphomas?

Answer 6

Hodgkin lymphoma (HL)

no-Hodgkin lymphoma (NHL)

Question 7

what’s the most important difference between HL and NHL?

Answer 7

Hodgkin lymphoma has a better prognosis than non-Hodgkin lymphoma

this is due in large to the way that lymphomas behave

HL starts in a single node and progresses in a predictable fashion to the next node in that particular chain, and then to the next lymph node region, and so on

NHL starts in a single node, but may next appear in a lymph node in a distant part of the body

Question 8

what population in HL most common in?

Answer 8

HL occurs most commonly in young men between the ages of 15 and 34

also has a second, smaller peak of incidence in patients over the age of 55

Question 9

what is HL?

Answer 9

defined by the presence of Reed-Sternberg cells

there are five subtypes of HL, each with its own morphologic appearance and prognosis

Question 10

what are Reed-Sternberg cells?

Answer 10

they have a very unusual morphology

they are gigantic and they have at least two big nuclei with single nucleoli, giving the cell an “owl’s eye” appearance

Question 11

what is NHL?

Answer 11

no Reed-Sternberg cells

it’s actually a big group of very different types of lymphoma

some NHLs grow very slowly and have a good prognosis while others grow in an explosive fashion and have a high mortality rate

Question 12

what are the two categories of NHL?

Answer 12

two big categories according to whether the malignant cells are B cells or T cells

Question 13

what are some of the more important and common NHLs?

Answer 13

• follicular lymphoma
• chronic lymphocytic lymphoma/small lymphocytic leukemia
• mantle cell lymphoma
• mycosis fungoides/Sézary syndrome
• Burkitt lymphoma
• acute lymphoblastic leukemia/lymphoma
• large cell lymphoma

Question 14

what’s the defining cell of Hodgkin lymphoma?

Answer 14

the Reed-Sternberg cell, which is a very large cell with big nuclei and an “owl’s-eye” appearance

Question 15

what is leukemia?

Answer 15

all leukemias are malignant proliferations of hematopoietic cells in the bone marrow

Question 16

what are the two main types of leukemia?

Answer 16

acute

chronic

both types can be composed of either lymphoid or myeloid cells

Question 17

what are acute leukemias?

Answer 17

they come on suddenly and have a devastating clinical course

acute leukemias are composed of very immature hematopoietic cells

Question 18

what are chronic leukemias?

Answer 18

they appear more insidiously and progress at a slower pace

may persist for years even without treatment

chronic leukemias are composed of cells at a more mature stage of development

Question 19

explain myeloid vs. lymphoid leukemias

Answer 19

leukemias may be composed of lymphoid cells or myeloid cells

myeloid means basically any cell outside the lymphoid lineage (so neutrophils, basophils, eosinophils, monocytes, red blood cells, and megakaryocytes)

Question 20

what are the four main groups of leukemias?

Answer 20

based on whether it’s acute/chronic and if it’s lymphoid/myeloid

1. Acute myeloid leukemia
2. Chronic myeloproliferative disorders
3. Acute lymphoblastic leukemia
4. Chronic lymphoproliferative disorders

Question 21

What are the first two questions you need to ask yourself when you’re looking at a leukemia?

Answer 21

ss it acute or chronic?

And, is it myeloid or lymphoid?

Question 22

A 50-year-old female presents with a 3-week history of worsening fatigue, fevers, and weight loss. A blood smear and bone marrow biopsy are performed, and the bone marrow and blood are full of immature myeloid cells. what’s the most likely diagnosis?

Answer 22

acute myeloid leukemia

Question 23

On
predominance. The peripheral smear shows mostly mature cells, as does the bone marrow biopsy. A biopsy of an inguinal lymph node shows evidence of malignant and mature cells. whats the most likely diagnosis?

Answer 23

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)

the patient has mature-appearing, malignant cells of lymphoid origin in his blood, bone marrow, and lymph nodes

Question 24

Myeloid malignancies are malignant proliferations of cells arising from myeloid stem cells. Which of the following cells would NOT be classified as myeloid?

A. Basophil
B. Erythrocyte
C. Megakaryocyte
D. Plasma Cell

Answer 24

plasma cell