Hemepath Flashcards
Acute Lymphoblastic Leukemia/Lymphoma
pre B cell ALL
Tdt + CD 10, 19,20 Favorable: t(12;21) Unfavorable: t (9;22) young (10)
Acute Lymphoblastic Leukemia/Lymphoma
pre T cell ALL
Mediastinal Mass(may cause dysphagia or vena cava syndrome) Associated with Down syndrome TdT+ CD2-8 Adolescent male, thymic involvement
Acute Myelogenous Leukemia
Older (esp>60) Myeloblasts >20% (don't forget about Myelodysplastic syndrome-nuclear irregularity, nuclear budding, multinucleation, separated nuclear lobes) MPO + Alpha naphthyl butyrate esterase CD 13, 33, 34, 117 Auer rods Favorable: t (8;21) t (15;17)=Acute promyelocytic leukemia--transposition of retinoic receptor gene-tx-all trans retinoic acid-crystal aggregates of MPO-auer rods-->DIC Inv(16) NPM Unfavorable T (11q23;v) FLT3
Chronic Leukemia:
Chronic lymphocytic leukemia/Small lymphocytic lymphoma (CLL/SLL)
>60y B-cell CD 5 (pan t-cell marker), CD 20, CD23 Smudge cells Hypoglobulinemia Autoimmune Hemolytic anemia CLL with increasing lymph node/spleen may develop to Richter syndrome: large B cell lymphoma
Chronic Leukemia:
Hairy cell Leukemia
Middle aged man with pancytopenia, splenomegaly of red pulp, and infections
- mature B cells w/ filamentous hair-like projections
- TRAP+
- Dry tap on BM aspiration
- Tx: cladribine (2-CDA)–>inhibits adenosine deaminase
- good prognosis
Chronic Leukemia
Adult T cell Leukemia/Lymphoma
tumor of CD4+ T cells due to HTLV-1 infection
- especially Japan
- punched out bone lesions, hypercalcemia, hepatosplenomegaly, LAD
- floret-like lymphocytes
- usually fatal
Hodgkin Lymphoma
bimodal age involvement low grade fever, night sweats, weight loss Classical Types 1. Lymphocyte rich (best prognosis) 2. Mixed cellularity 3. Lymphocyte depleted 4. Nodular sclerosis (CD 15, CD 30) 5. Nodular lymphocyte(CD 20, 45)
more RS–>worse prognosis
RS secrete cytokines–>stimulate reactive cells that make up majority of the tumor mass
Lymphocyte rich subtype
Reactive small lymphocytes predominate, few mononuclear or classic Reed-Sternberg cells
CD 15, 30
Mixed cellularity
Reed-Sternberg cells and variants on a mixed cellular background including eosinophils, plasma cells, T-lymphocytes, histiocytes
CD 15, 30
Lymphocyte depleted type
Paucity of lymphocytes and relative abundance of Reed-Sternberg cells
CD 15, 30
Nodular sclerosis
fibrous nodular pattern, lacunar cells
CD 15, 30
Nodular lymphocyte predominant subtype
nodularity with predominance of mature lymphocytes and popcorn cell or L & H variant of RS cells
CD 20, 45
Non-Hodgkin Lymphoma
Diffuse Large B cell Lymphoma
Large Cell
- most common non hodgkin lymphoma in adults
- usually older adults
- clinically aggressive
- Germinal center B cell or activated b cell(worse)
- 30% arise from follicular lymphoma t (14:18)
((14;18) or Bcl6) + Myc –>double hit
Non-Hodgkin Lymphoma
Burkitt Lymphoma
Medium Cell
t(8;14) –>over expression of c-myc–>increased proliferation
Sporadic: abdomen or pelvis
Endemic: Mandible, Africa, latent EBV
Rapid growth–>cell death–>macrophages “tingible bodies” clean up—>starry sky pattern
Non hodgkin Lymphoma
Follicular Lymphoma
Small Cell
40% of adult NHL
CD 20+ B cells
T(14;18) –>bcl2 over amplification–>anti apoptotic
waxing and waning painless lymphadenopathy
Treatment=rituximab *anti-CD20
-may transform to DLCL in 30% to 50% of cases (