Leukemia/Lymphoma

Question 1

Hodgkin’s: nodal distribution

Answer 1

localized, single group, continguous spread

STAGE is strongest predictor of prog

Question 2

Hodgkin’s: age distribution

Answer 2

Bimodal
young adult
>55

Question 3

Hodgkin’s: Symptoms and associations

Answer 3

low grade fever, night sweats, weight loss
50% associated with EBV
Reed Sternberg cells -bilobed nuclei with two inclusions

Nodular sclerosis is most common, best prog

Question 4

Non-Hodgkin’s: nodal distribution

Answer 4

Multiple, peripheral nodes
extranodal involvement common
noncontiguous

Question 5

Non-Hodgkin’s: age distribution

Answer 5

20-40

Question 6

Non-Hodgkin’s: symptoms and associations

Answer 6

fewer constitutional symptoms than Hodgkins

May be assoc. with HIV/immunosuppression

Question 7

Burkitt’s Lymphoma

Answer 7

B cell
ADOLESCENTS/YOUNG ADULTS
t8;14, c-myc (8) and heavy chain Ig (14)
Starry sky, sheets of lymphocytes
Jaw lesion-endemic african
abd/pelvic mass-sporadic

EBV assoc

Question 8

Diffuse Large B-Cell Lymphoma

Answer 8

B cell
OLDER ADULTS (20% in kids)
Most common in adults (20% may be T cell)

Question 9

Mantle Cell Lymphoma

Answer 9

b cell
OLDER MALES
t11;14 - cyclin D1 (11), heavy chain (14)
Poor prognosis
CD5+

Question 10

Follicular Lymphoma

Answer 10

b cell
adults
t14;18-heavy chain (14), bcl-2(18)
indolent, hard to cure, bcl-2 inh. apoptosis

Question 11

Adult T cell lymphoma

Answer 11

Adults
Cutaneous lesions, esp. Japan, west africa, caribbean
Aggressive
caused by HTLV-1

Question 12

Sezary Syndrome

Answer 12

Mycosis fungoides
Adults
cutaneous patches
CD4+

Question 13

Leukemia: signs/symptoms

Answer 13

anemia, infections, hemorrhage

Question 14

ALL

Answer 14

<15 years
T-ALL may present at mediastinal mass
Lots of lymphoblasts on smear
TdT+, CALLA+
Most responsive to therapy
may spread to CNS/Testes
t12;21 - better prognosis

Question 15

SLL/CLL

Answer 15

>60yrs, oft asympto
Smudge cells (fragile b cells)
autoimmune hemolytic anemia

Richter Transformation: SLL –> Diffuse Large B Cell

Question 16

Hairy Cell Leukemia

Answer 16

Adults
Mature B cell tumor of elderly
Cells with filamentous projections
stains TRAP (tartrate-resistant acid phos)

Rx: Cladribine, adenosine analog

Question 17

AML

Answer 17

Age: ~65 yrs
Auer rods (peroxidase + cytoplasmic inclustions)
Lots of myeloblasts
t15;17–> PML rara, all trans retinoic acid, induces differentiation, may present as DIC if auer rods are released

Question 18

CML

Answer 18

30-60 years
Philadelphia t9;22 bcr-able (PMNs, metamyelocytes, basophils)
Splenomegaly
BLAST CRISIS - transform to AML/ALL (>30% blasts)
very low leukocyte alkaline phosphatase

Rx: imatinib

Question 19

Ages of ALL, CLL, AML, CML, Hairy Cell

Answer 19

All Hairy Camels Amble Closely
ALL, Hairy, CML, AML, CLL/SLL
ALL - >15
Hairy/CML - 30-60
AML/CLL/SLL - 65+