Lecture 10: Leukemia and Lymphoma Cases

Question 1

What is Myelodysplastic Syndrome?

Answer 1

• age-related acquired genetic damage to hematopoietic cells marked by cytopenias and dysmorphic RBCs
• considered pre-leukemic

Question 2

What are Gram (+) cocci and Gram (-) rods we should be concerned about getting an infection from if in a hospital? What is a common fungal infection and what stain is used to see it?

Answer 2

Gram (+) - staphylococcus/streptococcus

Gram (-) - E. Coli/pseudomonas

Fungus –> Candida (silver stain)

Question 3

How is Candida Sepsis treated?

Answer 3

voriconazole and amphotericin B

• replace any central caths that caused the infection

Question 4

What is a diagnostic finding and a confirmatory finding of Acute Promyelocytic Leukemia?

Answer 4

diagnostic - Auer Rods (in circulating blasts)

confirmatory - positive for t(15;17)

Question 5

What molecules are expressed by Acute Promyelocytic Leukemia cells?

Answer 5

express Tissue Factor (activates Factor X) and Annexin II receptors (convert plasminogen into plasmin)

• both HIGHLY expressed on APL cells

Question 6

What is the specialized chemotherapy treatment given to patients who suffer from Acute Promyelocytic Leukemia?

Answer 6

ATO - arsenic trioxide

ATRA - all-trans retinoic acid (Vitamin A derivative)

Question 7

What are two life-threatening outcomes of APL?

Answer 7

massive cerebral and pulmonary hemorrhage

Question 8

What does the LAP score tell us about WBCs?

Answer 8

positive LAP staining (red/blue) is seen in REACTIVE conditions = Leukemoid RXN

absent LAP staining = abnormal myelocyte population –> NEOPLASM

Question 9

What are Pseudo-Gaucher Cells?

Answer 9

• macrophages that blue-green cytoplasm typically seen in CML

Question 10

What does Imatinib (Gleevec) do?

Answer 10

• tyrosine kinase inhibitor (controls ATP-dependent processes by binding where ATP should and blocks it from activating the kinase)
• pts. with Philadelphia chromosome t(9;22) have this tyrosine kinase problem

Question 11

How can we test for the Philadelphia chromosome?

Answer 11

Cytogenics, FISH, PCR

• PCR is the most sensitive (shows 1 in 100.000 cells vs 1/20 for cytogenics and 1/200 in FISH)

Question 12

Hematologic Response vs Molecular Response

Answer 12

HR - where white cell count begins to normalize

MR - negative for BCR-ABL PCR

Question 13

Why is monitoring CML so important?

Answer 13

CML can progress to Accelerated phase (10-19% blasts, thrombocytopenia, basophilia)

AP can progress to Blast phase (circulating blasts are 20% or higher)

Question 14

What are 4 common findings with Chronic Myeloid Leukemia?

Answer 14

1. HIGH WBC count (mature granulocytes/LAP negative)
2. Splenomegaly
3. Hypercellular bone marrow
4. Philadelphia chromosome

Question 15

What are 3 things that are suspicious for metastatic lymph node cancer?

Answer 15

1. subclavian LAD
2. fixed and hard LAD
3. lymph node is > 4cm

Question 16

What is the only biopsy method that can diagnose Hodgkins lymphoma? What is the diagnostic cell that we are looking for?

Answer 16

Excision Biopsy (also best way to diagnose lymphoma)

• looking for Reed-Sternberg cells (look like owls)
• fine needle aspiration/needle biopsy not enough

Question 17

What is Tumor Lysis Syndrome and what problems can it cause?

Answer 17

• when bulky tumors breakdown due to chemotherapy and dump their metabolic products
• efflux of potassium and uric acid crystal buildup can lead to arrythmias and acute renal failure

Question 18

What lymphoma is likely to have a rapidly enlarging mass?

Answer 18

Burkitt Lymphoma

• CNS and bone marrow involvement MORE likely with this lymphoma than other NHL
• CNS involvement = INTRATHECAL chemotherapy (get chemotherapeutics into CSF via Lumbar Puncture)

Question 19

What is Hodgkins Lymphoma?

Answer 19

neoplastic lymphoid proliferation with scattered B-derived Reed Sternberg cells in an ABUNDANT background of T lymphocytes, eosinophils, and other inflammatory cells

• chemotherapy VERY effective

Question 20

What are the 3 typical ways that Hodgkins Lymphoma presents?

Answer 20

lymphadenopathy, constitutional symptoms (“B” symptoms), or incidentally on chest x-ray

Question 21

What is Chronic Lymphocytic Leukemia also known as and how does it typically manifest?

Answer 21

also known as Small Lymphocytic Lymphoma

• peripheral disease is typically what manifests (monoclonal B cells) –> typically diagnostic of what is happening in LNs