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Leukemias/lymphomas Flashcards

1
Q

Mantle cell lymphoma demo?

A

Older males (like Micky Mantle)

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2
Q

Age of onset for most chronic leukemias?

A

Older adults

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3
Q

CD markers in CLL/SLL?

A

CD5 (T cell marker, though not a T cell), CD20 (B cell marker), CD23 (not expressed in mantle cell lymphoma)

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4
Q

What disease?

A

Primary Myelofibrosis

+ Reticulin stain in bone marrow shows fibrosis

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5
Q

All myeloproliferative disorders can (uncommonly) progress to what cancer?

A

Acute leukemia

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6
Q

ALL age group?

T-ALL sex?

A

Children

Males

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7
Q

What disease?

A

Myelodysplastic syndrome (pre-leukemic, predisposes to AML)

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8
Q

What stain is this?

What dz a/w?

A

Alpha-naphtyl butyrate esterase

+ AML

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9
Q

What disease?

A

Nodular sclerosis Hodgkin’s lymphoma

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10
Q

Compare/contrast HL vs NHL

A
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11
Q

What disease?

A

Follicular lymphoma (spleen)

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12
Q

What disease?

A

Essential thrombocytosis

Increased large abnormal megakaryocytes and peripheral blood smear shows abnormally large platelets

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13
Q

Translocation in Burkitt lymphoma?

A
  • MYC is located on chromosome 8 and translocated to immunoglobulin heavy chain locus IGH, t(8;14), or light chain loci
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14
Q

What disease?

A

Primary myelofibrosis

Note the teardrop cells in different directions

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15
Q

What disease?

A

Follicular lymphoma

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16
Q

Most common adult leukemia in western world?

A

CLL/SLL

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17
Q

What 3 mutations drive (primary) myelofibrosis?

A

JAK2 mutations (50% to 60% of cases), CALR mutations (30-40% of cases), and MPL mutations (1% to 5% of cases)

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18
Q

What can CLL/SLL progress to?

A

Some patients transform to a higher grade process: Prolymphocytic leukemia or diffuse large cell lymphoma (Richter syndrome or transformation)

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19
Q

What c’some # abnormalities are seen in myeldysplastic syndrome?

A

Chromosomes 5 & 7

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20
Q

What dz?

A

CML

Increased PMNs, PMN-precursors (also would see basophilia, thrombocytosis)

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21
Q

CD markers for AML?

A

CD13, CD33, CD117 tells you it is myeloid, CD34 tells you it’s immature

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22
Q

What disease?

A

CLL/SLL

Note clumped chromatin w/scant cytoplasm in cells w/large nucleus

Smudged cells are seen in CLL because the cells are more fragile, so they burst when you make the smear (artifact)

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23
Q

Translocation on follicular lymphoma?

A
  • t(14;18) [BCL2/IGH fusion]
    • causing BCL2 over-amplification (anti-apoptotic)
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24
Q

What disease?

A

Hairy cell leukemia

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25
What disease?
Follicular lymphoma ## Footnote •Two types of cells are seen: Small cells with cleaved or irregular nuclei (**centrocytes**) and larger cells with open nuclear chromatin and several nucleoli (**centroblasts**)
26
What disease?
Nodular lymphocyte-predominant Hodgkin's lymphoma (outlier) ## Footnote **Popcorn cells**, or **L&H variant** of RS cells (smaller nucleoli)
27
* What are the lineage-defining B cell markers? (2) * T cell markers? * What are some other T cell markers? * Myeloid markers? * What are some other myeloid markers?
**Bold = lineage-defining** * B cell markers: **CD19, CD20** * T cell markers: CD2, **CD3**, CD4, CD5, CD7, CD8 * Myeloid markers: CD13, CD33, **Myeloperoxidase**
28
What disease?
CLL/SLL •Two cell types: Predominantly small round lymphocytes (6-12 um), condensed, clumped chromatin and scant cytoplasm and fewer larger cells (prolymphocytes/ paraimmunoblasts)
29
What disease?
Diffuse large B cell lymphoma | (**fish flesh**)
30
What CD marker do most diffuse large B cell lymphomas express?
**CD20**
31
What age group is typically affected by Hodgkin lymphomas?
Young adults/adolescents (+ older adults)
32
Favorable prognostic indicators in ALL?
–hyperdiploidy (\>50 chromosomes) is common –**t(12;21)** [TEL1-AML1 (ETV6-RUNX1)] --age 2-10
33
What demo is affected in hairy cell leukemia?
Middle-aged men
34
What CD markers are used for dx of T-ALL? B-ALL?
* T (CD1, 2, 3, 4, 5, 7, 8) * B (CD19, 20, 22) cell markers * (TdT) Terminal deoxynucleotidyl transferase –Found in immature cells only
35
What disease?
PML Note auer rods
36
Follicular lymphoma age group?
Late adulthood
37
Translocation most a/w acute PML (pro-myelocytic, subset of AML)? Prognosis?
t(15;17) -retanoic acid receptor from c'some 17 --\> 15 Good prognosis (tx is all-trans retanoic acid)
38
Translocation in mantle cell lymphoma?
* **t(11;14)** [Cyclin D1--IGH fusion] * Causing _Cyclin D1_ over-amplification (increased proliferation) (Mantle played for the Cyclins)
39
What disease?
Multiple Myeloma
40
What disease?
* DLBL (diffuse large B cell lymphoma) * Larger cells * Often hear _vesicular chromatin, bubbly-feel appearance_ * Multiple nuclei typically seen (sometimes single) * Mitotic figures (active)
41
CD markers of mantle cell lymphoma?
**CD5, CD19, CD20**
42
Unfavorable prognostic indicators of ALL?
* Age 2-10 * –t(9;22) [BCR-ABL; Philadelphia chromosome] * Also in CML
43
What disease?
Burkitt lymphoma * Increased number of _histiocytes_ surrounded by clear space gives an impression of “**starry sky** pattern” * Tumor cells are round, smaller than DLCL but larger than CLL--intermediate size
44
CD markers in Burkitt lymphoma?
B-cell neoplasm (positive for **CD20, CD19**); also expresses **CD10, BCL6** (germinal center cell origin)
45
What stain is this? What dz a/w?
MPO + AML
46
Drug therapy for follicular lymphoma?
Anti-CD20
47
What mutation drives polycythemia vera?
JAK2 kinase
48
What mutations drive essential thrombocytosis?
Caused by activating point mutations in **JAK2** (50% of cases), **CALR** (40%) or **MPL** (5-10% of cases) (same as in myelofibrosis)
49
What disease?
Peripheral T-Cell Lymhoma (PTCL) * Polymorphic appearance * Small cells, large cells, rounded cells, reactive cells (eosinophils), lots of variation b/w cases
50
What disease?
Primary myelofibrosis ## Footnote Note the fibrosis of the bone marrow in the parenchyma
51
CD markers for follicular lymphoma?
**CD10, CD19, CD20**
52
What's the best tx for CML, currently?
**Imatinib** (Gleevec) is an _ABL specific, tyrosine kinase inhibitor_ ## Footnote (marrow xplant and IFN-alpha also used, less efficacious)
53
What age range is typically affected in myeloproliferative disorders?
Late adulthood
54
What disease?
Classical Hodgkin's lymphoma ## Footnote Typical **Reed-Sternberg cell** (also mononuclear variants seen)
55
What disease?
CML Hypercellular bone marrow, not much fat (might need more info to r/o others)
56
Ages affected by Burkitt lymphoma?
Children + young adults
57
What disease?
Multiple myeloma ## Footnote Lytic, "punched out" lesions
58
What disease?
ALL ## Footnote Lymphoblasts usually show scant basophilic cytoplasm (almost entire cell is the nucleus) and fine nuclear chromatin (not clumpy- sign of mature cell), often nuclear convolutions
59
CLL/SLL prognosis is favorable for those pts w/what gene (name of the protein)
Ig heavy chain
60
AML What demo is typically affected?
Adults (peaks after age 60)
61
What CD markers are seen in classical Hodgkin's lymphoma? What about in the nodular lymphocyte predominant form?
* Classical: **CD15, CD30** * Outlier: **CD20, CD45**
62
What translocation is a/w CML?
* **t(9;22)**; _BCR-ABL_ fusion gene (Philadelphia chromosome) w/_Tyr kinase activity_ * ABL on c'some 9 and the BCR on c'some 22
63
What disease?
Nodular sclerosis (classical Hodgkin's lymphom) ## Footnote **Lacunar cells** (artifact)
64
What disease?
**Floret cell** of adult T cell leukemia/lymphoma (ATLL)
65
What disease?
LN in CLL/SLL
66
What CD marker is seen in Peripheral T-Cell Lymhoma (PTCL) NOS
**CD3+**, but CD4/CD8 may *not* be seen
67
What disease?
CML - Note thrombocytosis, basophilia (purple granules)

MHD (20 decks)

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