Heme Onc Flashcards
affected cells: aml
myeloblasts t/f their daughters i.e. granulocytes
isolated? hodgkin’s
usually, 1-2 nodes; in ic patients can be diffuse
what is a sanctuary site and in which cancer is it especially relevant?
immunoprotected tissue e.g. cns or testis in which cancer hides out; A.L.L.
fast or slow? follicular lymphoma
slow
tx all
prolonged maintenance therapy on anti-lymphocytic drugs e.g. vinca, steroid
complications follicular lymphoma
slow, so time to develop anti-cancer but more so autoimmune disease e.g. autoimmune hemolytic anemia. (this is a complication in most indolent lymphomas)
histology burkitt’s
“starry sky”. dense B cells with some larger, whitish cells throughout
tx muliple myelomas
bisphosphonates, thalidomide, lenalidomide, emerging tx like anti-cd38 and car-t
mutation: polycythemia vera
usually jak2
which cancer/myeloprolif: bcr-abl
cml
tx: polycythemia vera
phlebotomy, iron deficiency
tx apml
atra (all-trans retinoic acid)
which cancer mediastinal mass?
most often Hodgkin’s, can be seen in others
histology hodgkin’s
Reed-Sternberg cells, nodular sclerosis
hodgkin’s lymphoma; note nodular sclerosis
myeloproliferative or cancer? cml
myeloproliferative; differentiation intact (can progress to acute blast crisis)
demographics aml
old ppl, male 2:1
what is bcr-abl
constitutively active tyrosine kinase
symptoms aml
anything d/t reduced granulocyte fx and proliferative takeover of bone marrow
neutropenia: infections
anemia: fatigue, pale complexion…
thrombocytopenia: bleeding
bone marrow problems: bone pain
hepatosplenomegaly
cml
multiple myeloma histology
“punched out” bone marrow (osteolysis) with many (>30%) clonal B cells
multiple myeloma symptoms
pancytopenias (neutropenia, thrombopenia, anemia)
CRAB d/t bone resorption: high Calcium, Renal impairment, Aplastic anemia, Bone pain
aml or apml; note auer rod
histology diffuse large B cell lymphoma
lymph node takeover by large, immature B cells (hence “diffuse” “large”)
diffuse large b cell lymphoma; note dense (“diffuse”) infiltrate of large b cells (far-apart nuclei)
hodgkin’s lymphoma; note reed-sternberg cell
most likely cell to be affected in all
b cells
polycythemia vera
causes burkitt’s
ebv, almost always in ic patients b/c they are most susceptible to ebv and to immune evasion
which cancer/myeloprolif: constant erythropoiesis
polycythemia vera
what is M protein
clonal proteins found in multiple myeloma; usually igg (~50%), can be iga, light chain
m spike is diagnostic
markers all
CD10+, other B cell markers, some T cell markers
histology follicular lymphoma
dense, nodular (“follicular”) lymph nodes, tightly packed cells, memory b takeover
cells affected: polycythemia vera
rbcs; others are unaffected
mutation burkitt’s
translocation of cmyc to IgH region. igh is constitutively active in B cells so now cmyc survival signal is on.
myeloproliferative or cancer? aml
cancer. differentiation, maturation, function very much not intact
multiple myeloma; not always seen but charge on m proteins can make rbcs sticky, called rouleaux formation
causes of polycythemia vera
primary: bad clone; secondary: hypoxia, high epo, etc
cml drug
imatinib
histology apml
even more likely to form auer rods and Azur granules than in general aml
aml or apml
which cancer: philadelphia chromosome
CML (and about 30% of adult ALL cases)
histology aml
auer rods, azur granules, open chromatin
fast or slow? burkitt’s
super duper fast. fastest of all neoplasms
causes aml
key one are environmental toxins, e.g. occupational, chemo, radiation, esp. benzene, anything inducing dna breakage
burkitt’s lymphoma; note “starry sky”
sx apml
coagulopathy and hemorrhage (DIC)
multiple myeloma; note “punched out” appearance
follicular lymphoma; note nodules/follicles
all
mutations apml
t(15:17), t(11:17)
affected cell follicular lymphoma
usually memory b
hsct? cml
yes if imatinib fails
most likely cell to be affected in childhood all
committed pre-b cell
isolated? diffuse large B cell lymphoma
usually isolated, metastatic potential; name “diffuse” comes from lymph node appearance not metastasis
