INTRODUCTION TO HEMATOLOGIC MALIGNANCIES Flashcards
A disease, usually
of leukocytes, in the blood and
bone marrow
LEUKEMIA
Leukemia is a disease usually of WHAT?
Leukocytes
Leukemia is a disease, usually
of leukocytes, located where?
in the blood and
bone marrow
What are the 2 Forms of Leukemia?
- Acute leukemia
- Chronic Leukemia
short duration
acute leukemia or chronic leukemia
acute leukemia
long duration
acute leukemia or chronic leukemia
Chronic leukemia
Many immature cell forms in
the bone marrow and/or
peripheral blood
acute or chronic leukemia
Acute leukemia
Mostly mature cell forms in the
bone marrow and/or peripheral
blood
Acute or chronic leukemia
Chronic leukemia
Elevated total leukocyte count
Acute or chronic leukemia
acute leukemia
Total leukocyte counts that
range from extremely elevated
to lower than normal
Acute or chronic leukemia
Chronic leukemia
is a general term
for malignancy that starts in the
lymph system, mainly in the
lymph nodes.
Lymphomas
Lymphomas is a general term
for malignancy that starts where?
lymph system, mainly in the
lymph nodes.
What are the 2 Types of Lymphomas?
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
Proliferation of malignant
lymphocytes
Hodgkin or Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Proliferation of malignant
lymphocytes
Hodgkin or Non-Hodgkin Lymphoma
Hodgkin Lymphoma
have a
basophilic vacuolated cytoplasm
with starry sky pattern
Hodgkin or Non Hodgkin
Hodgkin
basophilic vacuolated cytoplasm
with starry sky pattern is due to what?
due to numerous tangible body
MACROPHAGE that are arrested at
certain stages of maturation
What is the hallmark of Hodgkin Lymphoma?
presence of Reed-Sternberg cell
Reed-Sternberg cell resembles what appearance?
owl’s eye appearance
These are large binucleated or
multinucleated cell resembles owl’s
eye appearance with each nucleus
bearing a very large nucleolus.
Reed-Sternberg cell
Presence of Reed-Sternerg cells
Hodgkin or Non Hodgkin
Hodgkin
Diffuse large B-cell lymphoma
Hodgkin or Non Hodgkin
Non Hodgkin
Reed-Sternberg is absent
Hodgkin or Non Hodgkin
Non Hodgkin
mixed population of
lymphocytes, histiocytes,
eosinophils and some plasma
cells are present
Hodgkin or Non Hodgkin
Non Hodgkin
In Non Hodgkin Lymphoma, mixed population of what cells are present?
HELP
- Histiocytes
- Eosinophils
- Lymphocytes
- Plasma cells
a form of cancer
of the plasma cells.
Myelomas
In myeloma, cells shrink
True or False
In myeloma, cells overgrows
FALSE
The mass or tumor in myelomas is located where?
Bone marrow
This is the form of cancer wherein the cells overgrows,
forming a mass or tumor that is
located in the bone marrow
Myelomas
Overproduction of
various types of immature
or mature leukocytes in
the bone marrow and/or
peripheral blood, in most
types of leukemias
Leukemia
Solid malignant tumors of
the lymph nodes
Lymphoma
Overproduction of plasma
cells in the bone marrow
with concurrent
production of abnormal
proteins
Myeloma
Cell Type: Plasma cells
Myeloma
Cell type: Lymphocyte is the
distinctive
cell type. Reed-Sternberg
cells are diagnostic for this.
Lymphoma
Cell type: Usually involves
leukocytes of the
myelogenous or
lymphocytic cell types
Leukemia
Site of malignant cells: Malignant cells are
initially confined to the
organs containing
mononuclear phagocyte
cells such as the
lymph nodes, spleen,
liver, and bone marrow.
Lymphomas
What are the organs containing
mononuclear phagocyte
cells?
- Lymph nodes
- Spleen
- Liver
- Bone marrow
Site of malignant cells: Malignant cells freely
trespass the blood brain
barrier
Leukemia
Site of malignant cells: Plasma cells form a mass
or tumor that is located in
the bone marrow.
Myeloma
Where is the site of malignant cells in Myelomas?
Bone marrow
Where is the site of malignant cells in Lymphomas?
confined to the organs containing mononuclear phagocyte cells such as the lymph nodes, spleen,
liver, and bone marrow.
Where is the site of malignant cells in Leukemia?
freely trespass the blood brain
barrier
Lymphomas can spill over into the circulating blood and present a leukemic appearing picture on a
peripheral blood smear
True or False
TRUE
French-American-British (FAB) Classification
What are the 3 broad Leukocyte groups?
LMM
- Myelogenous
- Monocytic
- Lymphocytic
Major types of leukocytic leukemias can be classified as what?
- Acute
- Chronic
Major types of leukocytic leukemias can be classified as acute or
chronic according to the leukocyte groups. Give 4 examples of these.
- Acute or chronic Myelogenous
- Acute or chronic monocytic
- Acute or chronic Myelomonocytic
- Acute or chronic Lymphocytic Leukemia (CLL)
The World Health Organization (WHO)
Classification is based on these 3 aspects?
BIG
- Based on MORPHOLOGY
- Immunophenotyping
- Genetic studies
According to the World Health Organization (WHO)
Classification, morphology information is combined with what?
- Immunophenotyping
- Genetic studies
Immunophenotyping and Genetic studies are done on what samples?
- peripheral blood
- Bone marrow
- Lymph nodes
This leukemia must be distinguished from
acute lymphoblastic leukemia (ALL), myelodysplastic
syndrome (MDS), or AML arising in the presence of MDS
Acute Myeloid Leukemia (AML)
Acute myeloid leukemia (AML) must be distinguished from WHAT 3 LEUKEMIAS?
- Acute LymphoBLASTIC leukemia (ALL)
- Acute MYELODYSPLASTIC syndrome (AMS)
- AML arising in the presence of MDS
Why must Acute myeloid leukemia (AML) must be distinguished from
acute lymphoblastic leukemia (ALL), myelodysplastic
syndrome (MDS), or AML arising in the presence of MDS?
because therapeutic strategies and the prognosis vary
This leukemia is characterized by the presence of blasts
and immature leukocytes in the peripheral blood and bone
marrow
Acute Leukemia
Acute leukemias are characterized by the presence of what?
presence of blasts
and immature leukocytes
Anemia is present in acute leukemia?
True or False
TRUE
What are the 2 reasons why anemia is present in Acute Leukemia?
- caused by bleeding
- the replacement of normal marrow
elements by leukemic blasts.
What type of leukemia has a total leukocyte count that is usually elevated, some patients
may demonstrate normal or decreased leukocyte count.
Acute or chronic
Acute leukemia
What are the 2 synonyms for AML?
- Acute Myelogenous Leukemia
- Acute Non Lymphocytic Leukemia (ANLL)
This type of leukemia remains a lethal disorder, which kills the majority of
afflicted adults
AML/ANLL
Acute Leukemia is divided into 2 Major Division. What are these?
- Acute Myeloid Leukemia (AML)
- Acute Lymphoid Leukemia (ALL)
Acute Lymphoid Leukemia is subdivided into 3 categories. What are those?
- L1
- L2
- L3
L for Lymphoid
Acute Lymphoid Leukemia is subdivided into 3 categories. What are those?
- L1
- L2
- L3
L for LympoBLASTIC
Acute Myeloid Leukemia is subdivided into 7 categories. What are those?
- M1
- M2
- M3
- M4
- M5
- M6
- M7
M for Myeloid
The WHO’s classification of AML is based on what?
McCyto GenIm
- Morphology
- Clinical features
- Cytochemistry
- Genetics
- Immunophenotype
This is the most common leukemia subtype
Acute Myeloid Leukemia (AML)
This leukemia is recognized as a heterogenous clonal disorder
Acute Myeloid Leukemia (AML)
Acute Myeloid Leukemia is characterized by what? (2)
- Maturation block
- Accumulation of acquired somatic genetic alterations
In AML, what are the normal mechanisms altered by the accumulation of acquired somatic
genetic alterations in hematopoietic progenitor cells?
- Self-renewal
- Proliferation
- Differentiation
AML according to the FAB classification, M0, M1, and M2 are classified as what?
myeloid
AML according to the FAB classification, M3 is classified as what?
Promyelocytic
AML according to the FAB classification, M4 is classified as what?
Myelomonocytic
AML according to the FAB classification, M5 is classified as what?
Monocytic
AML according to the FAB classification, M6 is classified as what?
Erythroleukemia
AML according to the FAB classification, M7 is classified as what?
Megakaryocytic
Classify the 7 classification of AML according to the FAB classification
- M0 (myeloid)
- M1 (myeloid)
- M2 (myeloid)
- M3 (Promyelocytic)
- M4 (Myelomonocytic)
- M5 (Monocytic)
- M6 (Erythroleukemia)
- M7 (Megakaryocytic)
Under what classification has undifferentiated blasts according to the FAB classification?
M0
What is the WHO classification of M0 in AML?
not otherwise categorized
What is the WHO SYNONYM for M1 in AML?
acute myeloBLASTIC leukemia
WITHOUT maturation
Under what classification has blasts and promyelocytes predominate without further maturation of myeloid cells?
M1
What is the WHO synonym for M2 in AML?
Acute MyeloBLASTIC leukemia WITH maturation
Under what classification has myeloid cells demonstrate maturation beyond the blast
and promyelocyte stage according to the FAB classification?
M2
Under what classification has promyelocytes predominate in
the bone marrow, according to the FAB classification?
M3
Under what classification has BOTH MYELOID and MONOCYTIC cells are present to the extent of
at least 20% of the total leukocytes, according to the FAB classification?
M4
In M4, both MYELOID and MONOCYTIC cells are PRESENT to the extent of at least how many percent of the total leukocytes?
at least 20% of the total
leukocytes
This classification according to the FAB classification is referred to as Naegeli type
monocytic leukemia.
M4
M4 is referred to as what type of monocytic leukemia?
Naegeli Type
What is the WHO synonym of M4 in AML?
Acute Myelomonocytic Leukemia
This has a WHO synonym termed as acute
myelomonocytic leukemia
M4
In M5, most cells are monocytic
True or False
TRUE
This classification of AML according to the FAB classification is subdivided into subtypes A and B
M5
What are the 2 subtypes recognized in M5?
- FAB M5a
- FAB M5b
common in young adults
FAB M5a or FAB MM5b
FAB M5a
common during middle age
FAB M5a or FAB M5b
FAB M5b
characterized by large
blasts in bone marrow and
peripheral blood
FAB M5a or FAB M5b
FAB M5a
differentiated type by
monoblasts, promonocytes, and
monocytes
FAB M5a or FAB M5b
FAB M5b
FAB M5b is differentiated by what cells?
Mono Mono Promono
- MonoBLASTS
- MonoCYTES
- PromonoCYTES
M5 is referred to as what type of monocytic leukemia?
Schilling’s Type
What are the WHO synonyms for M5?
- Acute MonoBLASTIC leukemia
- Acute MonoCYTIC leukemia
What is the WHO synonym of FAB M5a?
Acute MonoBLASTIC leukemia
What is the WHO synonym for FAB M5b?
Acute MonoCYTIC leukemia
This classification has WHO synonyms that are acute
monoblastic leukemia and acute monocytic
leukemia.
M5
This classification is referred to as Erythemic Myelosis
M6
M6 is also referred to as what?
Erythemic Myelosis or Di Guglielmo Syndrome
Erythemic Myelosis also termed as
DGS
Di Guglielmo Syndrome
Under what classification has abnormal proliferation of both erythroid and granulocytic precursors, according to the FAB classification?
M6
M6 may include abnormal
megakaryocytic and monocytic
proliferations
True or False
TRUE
What is the WHO synonym for FAB M6a and FAB M6b?
Acute Erythroid Leukemia
This classification has a WHO synonym of Acute Erythroid Leukemia?
FAB M6a and FAB M6b
M7 has large and small megakaryoblasts with a low nuclear cytoplasmic ratio
True or False
High nuclear cytoplasmic ratio
FALSE
M7 has large and small megakaryoblasts with a low nuclear cytoplasmic ratio
True or False
High nuclear cytoplasmic ratio
FALSE
Under what classification has pale and an agranular cytoplasm, according to the FAB classification?
M7
M7 has a granular cytoplasm
True or False
Agranular cytoplasm
FALSE
What is the WHO synonym for M7?
Acute MyeloBLASTIC leukemia
Si M7 ay MyeloCYTIC pero BLASTIC kay WHO
What is the WHO synonym for M7?
Acute MyeloBLASTIC leukemia
Si M7 ay MyeloCYTIC pero BLASTIC kay WHO
AML under what classifcation is with certain genetic abnormalities
FAB or WHO
WHO classification
AML under what classifcation is with certain genetic abnormalities
FAB or WHO
WHO classification
In the WHO classification, what are the 4 AML’s with certain genetic abnormalitis?
AML, AML, AML, APL
- AML with t(8;21)
- AML with inv (16) or t(16;16)
- AML with t(9;11)
- APL with t(15;17)
In the WHO classification, what are the 8 AML’s that are “Not Otherwise Specified”?
M0 - M2, M4-M7 + ABL
- AML with MINIMAL DIFFERENTIATION (M0)
- AML without maturation (M1)
- AML with maturation (M2)
- Acute Myelomonocytic Leukemia (M4)
- Acute MonoBLASTIC/monoCYTIC leukemia (M5)
- Acute Erythroid Leukemia (M6)
- Acute Megakaryoblastic Leukemia (M7)
- Acute Basophilic Leukemia
In the WHO classification, what are the ACUTE LEUKEMIAS of AMBIGUOUS LINEAGE?
1 Acute 4 Mixed
- Acute undifferentiated leukemia
- Mixed phenotype acute leukemia -> t(9;22)
- Mixed phenotype acute leukemia -> t(v;11q23)
- Mixed phenoytpe acute leukemia -> B lymphocytes-myeloid cells
- Mixed phenotype acute leukemia -> T-myeloid
This leukemia is the most common cancer in children
Acute LymBLASTIC Leukemia (ALL)
ALL represents how many percent of cancer diagnoses among children?
23%
ALL represents 23% of cancer diagnoses among children of what age?
children younger than 15 years of age
ALL is divided into 3 subtypes. What are those?
- L1
- L2
- L3
This ALL subtype is common in CHILDREN
L1
This ALL subtype is common in OLDER CHILDREN and ADULTS
L2
This ALL subtype is common in patient’s with leukemia secondary to Burkitt lymphoma
L3
ALL subtype L3 is common in what?
in patients with leukemia secondary to Burkitt lymphoma
ALL subtype L1 is common in what?
children
ALL subtype L2 is common in what?
Older children and adults
- Size of Blasts: Small
- Nuclear shape: Indistinct
- Nucleoli: Scant
- Cytoplasm: Invisible
Identify what FAB Type
L1
- Size of Blasts: Large, heterogenous
- Nuclear shape: Indented, prominent
- Nucleoli: Large, abundant
- Cytoplasm: Moderately clefted
Identify what FAB Type
L2
- Size of Blasts: Large
- Nuclear shape: Regular oval to round
- Nucleoli: Prominent, basoophilic
- Cytoplasm: Prominent, vacuoles
Identify what FAB Type
L3
DETERMINE THE CHARACTERISTICS
- Size of Blasts:
- Nuclear shape:
- Nucleoli:
- Cytoplasm:
L3 FAB Type
- Size of Blasts: Large
- Nuclear shape: Regular oval to round
- Nucleoli: Prominent, basophilic
- Cytoplasm: Prominent, vacuoles
DETERMINE THE CHARACTERISTICS
- Size of Blasts:
- Nuclear shape:
- Nucleoli:
- Cytoplasm:
L1 FAB Type
- Size of Blasts: Small
- Nuclear shape: Indistinct
- Nucleoli: Scant
- Cytoplasm: Invisible
DETERMINE THE CHARACTERISTICS
- Size of Blasts:
- Nuclear shape:
- Nucleoli:
- Cytoplasm:
L2 FAB Type
- Size of Blasts: Large, heterogenous
- Nuclear shape: Indented, Prominent
- Nucleoli: Large, abundant
- Cytoplasm: Moderately clefted
This FAB Type has SMALL blasts
L1
This FAB Type has an INVISIBLE cytoplasm
L1
This FAB Type has a SCANT nucleoli
L1
This FAB Type has an INDISTINCT nuclear shape
L1
This FAB Type has LARGE, HETEROGENOUS blasts
L2
This FAB Type has an INDENTED, PROMINENT nuclear shape
L2
This FAB Type has an INDENTED, PROMINENT nuclear shape
L2
This FAB Type has LAGE, ABUNDANT nucleoli
L2
This FAB Type has a MODERATELY CLEFTED cytoplasm
L2
This FAB Type has LARGE blasts
L3
This FAB Type has a REGULAR OVAL TO ROUND nuclear shape
L3
This FAB Type has PROMINENT, BASOPHILIC nucleoli
L3
This FAB Type has a PROMINENT, VACUOLES in the cytoplasm
L3
The WHO classification that is synonymous with the FAB L1 and L2 classification is:
- Precursor B lymphoblastic leukemia/lymphoblastic lymphoma
- Precursor T lymphoblastic leukemia/lymphoblastic lymphoma
What is the precursor cell of the precursor B lymphoblastic leukemia/lymphoblastic lymphoma?
Precursor B-cell ALL
What is the precursor cell of the precursor T lymphoblastic leukemia/lymphoblastic lymphoma?
Precursor T-cell ALL
What is the precursor cell of the precursor T lymphoblastic leukemia/lymphoblastic lymphoma?
Precursor T-cell ALL
The precursor B lymphoblastic leukemia/lymphoblastic lymphoma’s neoplasm of lymphoBLASTS are committed to what lineage?
B-cell lineage
The precursor T lymphoblastic leukemia/lymphoblastic lymphoma’s neoplasm of lymphoBLASTS are committed to what lineage?
T-cell lineage
L1 is heterogenous
True or False
Homogenous
FALSE
What FAB Type in Acute Leukemia has one population of cells within
the case?
L1
What are the predominant cells in L1?
small cells
L1 in acute leukemia according to the FAB classification has a regular nuclear shape
True or false
TRUE
L1 in acute leukemia according to the FAB classification has an occasional cleft
True or false
TRUE
L1 in acute leukemia according to the FAB classification has a homogenous chromatin pattern
True or False
TRUE
L1 in acute leukemia according to the FAB classification has a RARELY VISIBLE nucleoli
True or False
TRUE
L1 in acute leukemia according to the FAB classification has a MODERATELY BASOPHILIC cytoplasm
True or False
TRUE
L2 is homogenous
True or False
hetergenous
FALSE
L1 in acute leukemia according to the FAB classification has LARGE and HOMOGENOUS cells in size
True or False
L3
FALSE
L2 in acute leukemia according to the FAB classification has LARGE CELLS
True or False
TRUE
L2 in acute leukemia according to the FAB classification has an IRREGULAR nuclear shape
True or False
TRUE
L2 in acute leukemia according to the FAB classification have CLEFTS in the NUCLEUS that are common
True or False
TRUE
L2 in acute leukemia according to the FAB classification have one or more large nucleoli that are invisible
True or False
VISIBLE
FALSE
L2 in acute leukemia according to the FAB classification has a cytoplasm that varies in color
True or False
TRUE
L2 is also referred to as the Burkitt Lymphoma Type
True or False
L3
FALSE
L3 in acute leukemia according to the FAB classification are LARGE and HOMOGENOUS in size
True or False
TRUE
L2 in acute leukemia according to the FAB classification have a nuclear
shape that is ROUND or OVAL
True or False
L3
FALSE
L2 in acute leukemia according to the FAB classification have one to three PROMINENT NUCLEOLI
True or False
L3
FALSE
L3 in acute leukemia according to the FAB classification have a cytoplasm that is deeply basophilic with vacuoles often prominent
True or False
TRUE
Symptoms of ALL can vary from a few weeks to a few months
True or False
FROM FEW DAYS TO FEW WEEKS
FALSE
Symptoms of ALL can vary from a few weeks to a few months
True or False
FROM FEW DAYS TO FEW WEEKS
FALSE
Symptoms of ALL include pain in the extremities, particularly in what part?
Legs
Symptoms of pain in extremities, particularly in the legs in ALL is produced byan infiltration of what?
infiltration of leukemic cells into the tissues.
In ALL, these are present in 75% of
patients
- Lymphadenopathy
- hepatomegaly
Lymphadenopathy and hepatomegaly are present in what percent of ALL patients?
75%
In ALL patients, these conditions are caused by
nerve infiltration by leukemic blasts, which are quite common in ALL patients
- Leukemic meningitis
- cranial nerve palsies
Leukemic meningitis and cranial nerve palsies caused by what?
caused by
nerve infiltration by leukemic blasts
In ALL, the total leukocyte count is ELEVATED in what percent of patients?
60% to 70% of patients
60% to 70% of ALL patints have an ELEVATED total leukocyte count of what?
ranging from 50 to 100 × 10^9/L
In ALL, what percent of patients exhibit EXTREME LEUKOCYTOSIS?
< 15% of patients
< 15% of ALL patients exhibit EXTREME LEUKOCYTOSIS with a total leukocyte count of what?
TL > 100 × 10^9/L
In ALL, approx. 25% of patients exhibits what?
leukocytopenia
In ALL, approx. what percent of patients exhibits leukocytopenia?
25%
In ALL, a PBS display what? (2)
- predominance of blast cells
- close to 100% lymphoblasts, lymphocytes & smudge cells
Leukemic cells can infiltrate many areas of the body
True or False
TRUE
