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Leukemia, Lymphoma Flashcards

1
Q

Pancytopenia
Without organomegally

Dx?

A

Aplastic Anemia

until proven otherwise

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2
Q

Pancytopenia

With organomegaly

A

Leukemia

Until proven otherwise by bone marrow aspiration

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3
Q

Confirms diagnosis of leukemia

A

BMA

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4
Q

Leukemia only present in adults

A

CLL

Chronic Lymphocytic Leukemia

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5
Q

Use of antigen and antibody (similar to blood typing)

Important in distinguishing SUBTYPE of leukemia

They are the clusters of differentiation (CD)

A

Flow cytometry

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6
Q

CD 13

CD 33

A

AML

Acute Myelogenous Leukemia

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7
Q

CD 10

CALLA

A

Pre B ALL

Very good prognosis

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8
Q

CD 19
CD 20
CD 22

A

B Acute Lymphocytic Leukemia

B ALL

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9
Q

CD 3
CD 5
CD 7

A

T Acute Lymphocytic Leukemia

T ALL

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10
Q

Differentiates from myeloid to lymphoid

A

Immunohistochemistry

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11
Q

Myelofibroblast

IHC

A

Myeloperoxidase
Sudan Black B
Specific esterase

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12
Q

Monoblast IHC

A

Non specific esterase

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13
Q

Lymphoblast IHC

A

Periodic Acid Schiff

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14
Q

Herald of leukemia

A

blast

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15
Q

Metastatic pattern of acute leukemia

A 
Spinal fluid CNS 7/10 
Liver
Spleen 
Lymph node
Testicles
Extramedullary tumors in AML
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16
Q

Areas that systemic chemotherapy can’t reach hence give directed therapy

A

Sanctuary sites CNS

Direct therapy intrathecal

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17
Q

Ecchymosis, bruises, petechiae
History of infection or fever 2 weeks prior to consult

Isolated thrombocytopenia

A

ITP

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18
Q

Transient Myeloproliferative Disease is most commonly seen in

A

Down Syndrome

Anemia, thrombocytopenia and high WBC with blast - 75% resolves

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19
Q

40% of patients with Down will later develop

A

AML

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20
Q

Radiation is contraindicated to age

A

3 and below

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21
Q

Anti emetic post chemotherapy

5HT3 antagonist

A

Ondansentron

22
Q

If patients are not properly hydrated or prepared before initiation of chemotherapy, this occurs

A

Tumor lysis syndrome

23
Q

Destruction of lymphoblast

Release of K -> Hyperkalemia, cardiac arrhythmia

Release of nucleic acid -> Purine catabolism, hyperuricemia, uric acic crystals, acute renal failure

Hyperphosphatemia -> Calcium-phosphate imbalance

A

Tumor lysis syndrome

24
Q

Peak at 2-3 years of age
Boys

Common in Down syndrome, Bloom
Syndrome, Ataxia-telangiectasia, Fanconi anemia

Radiation exposure

B-cell and EBV

A

Acute Lymphoblastic Leukemia

25
``` Recurrent fever (lagnatin) 61% Easy bruisability (pasain) Limping (bone and joint pain) ``` CLADS, hepatomegaly Bone marrow failure (pallor, fatigue, exercise intolerance, bruising, epistaxis) from infection or disease URTI 1-2 months prior Purpuric, petechial lesions, mucous membrane hemorrhage
Acute Lymphocytic Leukemia | ALL
26
ALL subtypes
L1 - homogenous, 85% children L2 - varied structure, 14% children L3 - burkitt, 1-2% children
27
Large blasts, prominent nucleoli Stippled homogenous chromatin structure Abdundant cytoplasmic vacuolation (bubble type)?
ALL L3 | Burkitt’s leukemia
28
Philadelphia chromosome
T (9;22) BCR-ABL ALL CML
29
Good risk factor for ALL
Age 1-9 years at diagnosis | Initial WBC <5,000
30
Peak at 15-19 years Hypercellular marrow consisting of a monotonous pattern of cells Subcutaneous nodules, blueberry muffin lesions Infiltration of gingiva Discrete masses chloromia in orbit and epidural spaces, granulocytic sarcoma in absence of bone marrow involvement DIC
Acute Myelogenous Leukemia
31
AML management needs bone marrow transplant except subtype
M3 Promyelocytic Leukemia Acute Promyelocytic Leukemia
32
M3 Acute Promyelocytic Leukemia can be treated with
All-trans-retinoic acid (ATRA) targeted therapy Anthracycline Cytarabine p
33
T (15,17) | PML RARA receptor for ATRA
M3 Acute Promyelocytic Leukemia
34
Mutation with this gene has Very poor prognosis but has available targeted therapy (AML)
FLT 3 mutation
35
L UQ pain Priapism Splenomegaly WBC 184,000 (Leukocytosis) BMA numerous granulocytes (granulocytic hyperplasia) myeloid cells at all stages of differentiation c t (9;22)
Chronic Myelogenous Leukemia
36
Differentiates myeloproliferative disease from infection
LAP Leukocyte Alkaline Phosphatase score High LAP - infection
37
Low LAP
Leukemia
38
Drug for CML
Imatinib (Cleevec) 80% 10 year disease event free survival
39
Tyrosine kinase inhibitor targetting the BCR-ABL tyrosine kinase in CML
Imatinib (Cleevec)
40
Temporarily decreases WBC in CML Treats symptomatic patients by decreasing platelet and WBC Prevents hyperviscosity but does not cure
Hydroxyurea - cytoreductase chemotherapy
41
Ablates the philadelphia chromosomes | Flu-like symptoms
Interferon IV
42
Phases of CML
Chronic - stable Accelerated - increase in blasts Blastic - blast >20%, may be AML (80%) or ALL (20%)
43
Most common cancer in adolescents
Lymphoma
44
``` On and off fever Painless, firm, rubbery cervical lymph node Unexplained weight loss >10% Nigh sweats, unresponsive to antibiotic Negative TB, skin test, CXR Widened mediastinum ``` Lymph node biopsy: Reed Sternberg Cells
Hodgkin Lymphoma
45
Bimodal peak 15-35, after 50 EBV, HSV 6, CMV Ann-arbor Staging Painless cervical lymphnode Night sweats+ Weight loss BMA: Normal CXR: Mediastinal widening CT: Enlarged abdominal LN Better prognosis
Hodgkin Lymphoma
46
Hodgkin Pathognomonic of
Reed Sternberg Cells
47
More common lymphoma in aged 2-4 years
Non-Hodgkin Lymphoma
48
Non-hodgkin Subtypes
Lymphoblastic lymphoma - intrathoracic or mediastinal supradiaphragmatic mass, CNS and BM Burkitt - abdominal, head and neck, BM and CNS Diffuse large B cell - abdominal or mediastinal Anaplastic large cell - primary cutaneous, sytemic disease B symptoms - fever, night sweat, weight loss
49
``` Contiguous Lymph nodes Reed - Sternberg Ann-arbor staging Easier to treat Adolescent ```
Hodgkin
50
Affects any lymph nide Starry sky appearance St. Jude Staging/Murphy staging More common in children 2-4 years old
Non-Hodgkin Lymphoma
51
+ blasts Aurer rods in promyelocyte Myeloperoxidase + Sudan black
Acute promyelocytic leukemia

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