Leukemia, Lymphoma, Multiple Myeloma

Question 1

Diagnostic studies for Multiple Myeloma

Answer 1

Hallmark = Monoclonal spike on protein electrophoresis (SPEP or UPEP)

Bence-Jones proteins in urine

Xrays of axial skeleton showing: Lytic lesions, and/or generalized osteoporosis

Anemia: Normal cell morphology but Rouleaux formation (RBC’s stack up like coins)

Question 2

Hodgkin Lymphoma is characterized by enlargement of what

Answer 2

• lymph nodes
• spleen
• liver
• Reed-Sternberg cells:
• multinucleated B cells
• arrested development
• biopsy of lymph node tissue

Question 3

Hodgkin lymphoma clinical features

Answer 3

Painless lymphadenopathy

–Cervical

–Supraclavicular

–Mediastinal (60% have mediastinal involvement at dx)

• Most have stage I-II at diagnosis
• Pruritus (without rash)
• Alcohol-induced pain of affected lymph node(s)

Question 4

Non Hodgkin Lymphoma clinical features

Answer 4

Painless, persistent lymphadenopathy

Stem from B lymphocytes

•B symptoms

–Fevers

–Weight loss

–Night sweats

Question 5

acute myelogenous leukemia epidemiology

Answer 5

Most common acute leukemia in adults •~80% of acute leukemia in adults •Median age at diagnosis ~65 years •Incidence increases with age •M:F ratio ~5:3 •Incidence highest in Caucasians

Question 6

acute myelogenous leukemia (AML)

Answer 6

–Accumulation of leukemic blasts •Bone marrow (up to 5% OK) •Peripheral blood –Always abnormal –Should prompt bone marrow biopsy –Reduced production of normal cells •Neutrophils •Erythrocytes •Platelets

Question 7

Auer rods

Answer 7

Elongated needles in malignant neutrophils •Clumps of azurophilic granule material •Can also be seen in disorders other than AML -HUGE indicator of AML, assume linkage

Question 8

chronic myeloid leukemia is caused by

Answer 8

trans-location of chromosomes t(9:22) to produce the “Philadelphia chromosome” which leads to the creation of the protein that leads to the leukemic cells which cause the dz

Question 9

Acute Lymphocytic Leukemia (ALL)

Answer 9

• Most common cancer in children & teens •60% dx’d F •Caucasians > Hispanics > African Americans •More common in certain genetic conditions –Down syndrome –Neurofibromatosis type 1 –Bloom syndrome •Cure rate more favorable in children than adults

Question 10

Chronic Lymphocytic Leukemia: Epidemiology

Answer 10

• Most prevalent leukemia in adults in Western countries •35% of leukemia in US •Median age at dx 72 yrs •M:F 2:1 • Genetic –First degree relatives have RR of 4.5-7% –8% of those dx’d have a family hx –Highest inheritability of any malignancy

Question 11

what is Hodgkin lymphoma

Answer 11

Ca of the lymphocytes

Question 12

Reed Sternberg cells are also described as

Answer 12

“Popcorn cells”

Question 13

Hodgkin Lymphoma Epidemiology

Answer 13

Hodgkin Lymphoma Epidemiology

•Most common between ages 15-34 yrs

–Peaks in 20s

–Peaks again after age 50

–Rare in children <5 yrs

• Epstein–Barr virus
  * Found in 40-50% of cases
• HIV
• Smoking
• Obesity

Question 14

Ann Arbor Staging System

Answer 14

Ann Arbor Staging System
•Stages I-IV
–Early stages (I-II) favorable prognosis
•B symptoms (worse prognosis)
–1/3 present with these
–Fever
–Night sweats
–Weight loss
•E = Extension to distant site (worse prognosis)
•X = Bulky disease (worse prognosis)
–Lymph Node >10 cm or
–Mediastinal mass >1/3 diameter of thorax

Question 15

what confirms the dx of Hodgkin lymphoma

Answer 15

Reed sternberg cells from lymph node/bone marrow biopsy