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MHD > Leukemias/lymphomas > Flashcards

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
Q

What disease?

A

Follicular lymphoma

•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)

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26
Q

What disease?

A

Nodular lymphocyte-predominant Hodgkin’s lymphoma (outlier)

Popcorn cells, or L&H variant of RS cells (smaller nucleoli)

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27
Q
  • 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?
A

Bold = lineage-defining

  • B cell markers: CD19, CD20
  • T cell markers: CD2, CD3, CD4, CD5, CD7, CD8
  • Myeloid markers: CD13, CD33, Myeloperoxidase
28
Q

What disease?

A

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
Q

What disease?

A

Diffuse large B cell lymphoma

(fish flesh)

30
Q

What CD marker do most diffuse large B cell lymphomas express?

A

CD20

31
Q

What age group is typically affected by Hodgkin lymphomas?

A

Young adults/adolescents (+ older adults)

32
Q

Favorable prognostic indicators in ALL?

A

–hyperdiploidy (>50 chromosomes) is common

–t(12;21) [TEL1-AML1 (ETV6-RUNX1)]

–age 2-10

33
Q

What demo is affected in hairy cell leukemia?

A

Middle-aged men

34
Q

What CD markers are used for dx of T-ALL? B-ALL?

A
  • T (CD1, 2, 3, 4, 5, 7, 8)
  • B (CD19, 20, 22) cell markers
  • (TdT) Terminal deoxynucleotidyl transferase

–Found in immature cells only

35
Q

What disease?

A

PML

Note auer rods

36
Q

Follicular lymphoma age group?

A

Late adulthood

37
Q

Translocation most a/w acute PML (pro-myelocytic, subset of AML)?

Prognosis?

A

t(15;17)

-retanoic acid receptor from c’some 17 –> 15

Good prognosis (tx is all-trans retanoic acid)

38
Q

Translocation in mantle cell lymphoma?

A
  • t(11;14) [Cyclin D1–IGH fusion]
    • Causing Cyclin D1 over-amplification (increased proliferation)

(Mantle played for the Cyclins)

39
Q

What disease?

A

Multiple Myeloma

40
Q

What disease?

A
  • 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
Q

CD markers of mantle cell lymphoma?

A

CD5, CD19, CD20

42
Q

Unfavorable prognostic indicators of ALL?

A
  • Age 2-10
  • –t(9;22) [BCR-ABL; Philadelphia chromosome]
    • Also in CML
43
Q

What disease?

A

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
Q

CD markers in Burkitt lymphoma?

A

B-cell neoplasm (positive for CD20, CD19); also expresses CD10, BCL6 (germinal center cell origin)

45
Q

What stain is this?

What dz a/w?

A

MPO

+ AML

46
Q

Drug therapy for follicular lymphoma?

A

Anti-CD20

47
Q

What mutation drives polycythemia vera?

A

JAK2 kinase

48
Q

What mutations drive essential thrombocytosis?

A

Caused by activating point mutations in JAK2 (50% of cases), CALR (40%) or MPL (5-10% of cases)

(same as in myelofibrosis)

49
Q

What disease?

A

Peripheral T-Cell Lymhoma (PTCL)

  • Polymorphic appearance
    • Small cells, large cells, rounded cells, reactive cells (eosinophils), lots of variation b/w cases
50
Q

What disease?

A

Primary myelofibrosis

Note the fibrosis of the bone marrow in the parenchyma

51
Q

CD markers for follicular lymphoma?

A

CD10, CD19, CD20

52
Q

What’s the best tx for CML, currently?

A

Imatinib (Gleevec) is an ABL specific, tyrosine kinase inhibitor

(marrow xplant and IFN-alpha also used, less efficacious)

53
Q

What age range is typically affected in myeloproliferative disorders?

A

Late adulthood

54
Q

What disease?

A

Classical Hodgkin’s lymphoma

Typical Reed-Sternberg cell (also mononuclear variants seen)

55
Q

What disease?

A

CML

Hypercellular bone marrow, not much fat (might need more info to r/o others)

56
Q

Ages affected by Burkitt lymphoma?

A

Children + young adults

57
Q

What disease?

A

Multiple myeloma

Lytic, “punched out” lesions

58
Q

What disease?

A

ALL

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
Q

CLL/SLL prognosis is favorable for those pts w/what gene (name of the protein)

A

Ig heavy chain

60
Q

AML

What demo is typically affected?

A

Adults (peaks after age 60)

61
Q

What CD markers are seen in classical Hodgkin’s lymphoma?

What about in the nodular lymphocyte predominant form?

A
  • Classical: CD15, CD30
  • Outlier: CD20, CD45
62
Q

What translocation is a/w CML?

A
  • 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
Q

What disease?

A

Nodular sclerosis (classical Hodgkin’s lymphom)

Lacunar cells (artifact)

64
Q

What disease?

A

Floret cell of adult T cell leukemia/lymphoma (ATLL)

65
Q

What disease?

A

LN in CLL/SLL

66
Q

What CD marker is seen in Peripheral T-Cell Lymhoma (PTCL) NOS

A

CD3+, but CD4/CD8 may not be seen

67
Q

What disease?

A

CML

  • Note thrombocytosis, basophilia (purple granules)

MHD (20 decks)

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