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dit topics > luekemia + lymphoma + multiple myeloma > Flashcards

luekemia + lymphoma + multiple myeloma Flashcards

1
Q

tumor cells in bone marrow +/- peripheral blood

A

leukemia

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2
Q

tumor cells in lymph node

A

lymphoma

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3
Q

types of lymphoma

A

Hodgkin (1 type)

Non-Hodgkin (39 types)

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4
Q

Reed-sternberg cells: large cell, bi-lobed nucleus, prominent nucleoli with clearing “owl eyes”, clearing around whole cell (white)
MORE = WORSE prognosis

A

hodgkin lymphoma

will be on test!

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5
Q 
localized, single group of nodes
PAINLESS LAD (neck usually)
mediastinal LAD (CT or CXR)
firm, rubbery lymph nodes
B symptoms: low grade fever, night sweats, weight loss (also in TB)
pruritis
associated with EBV: 50%
A

hodgkin lymphoma

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6
Q 
bimodal age distribution
1st peak: 20 yo
2nd peak: 65 yo
more common in men
except nodular sclerosing type
A

hodgkin lymphoma

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7
Q

most are B cell lymphomas

A

Non-Hodgkin lymphoma

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8
Q

widespread lymph nodes + other tissues: GI, thyroid, CNS
fewer B symptoms
varying age
some associated with HIV and immunosupression

A

Non-Hodgkin lymphoma

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9
Q

types of hodgkin lymphomas

A

lymphocyte-predominant type
nodular sclerosing type
mixed cellularity type
lymphocyte-depleted type

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10
Q

hodgkin lymphoma
least common, BEST prognosis (mostly lymphocytes, not many Reed sternberg cells)
younger males

A

lymphocyte-predominant type

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11
Q

hodgkin lymphoma
most common
great prognosis (not many Reed sternberg cells)
F=M
young adults
bx: bands of collagen, sclerosis, fibrosis + nodules

A

nodular sclerosing type

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12
Q

hodgkin lymphoma
2nd most common
mix of lymphocytes + RS cells worse prognosis

A

mixed cellularity type

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13
Q

hodgkin lymphoma
lots of RS cells
very poor prognosis

A

lymphocyte-depleted type

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14
Q

types of non-hodgkin lymphoma (B cell)

A 
diffuse large B cell lymphoma
lymphoblastic 
follicular lymphoma
burkitt lymphoma
mantle cell lymphoma
small lymphocytic lymphoma 
marginal cell lymphoma
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15
Q

most common type of NHL in adults
most common type of lymphoma in US
elderly
t (14;18): 30%

A

diffuse large B cell lymphoma

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16
Q

most common type of NHL in children

A

lymphoblastic lymphoma

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17
Q

NHL

t(14;18): 90%

A

follicular lymphoma

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18
Q

NHL
t(8;14): activates c-myc oncogene
“starry sky”: lymphocyte sheets (stars), some macrophages (sky) that have ingested apoptotic tumor cells

A

BurkiTT lymphoma (spells 8…14)

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19
Q

types of burkitt lymphoma

A

endemic: associated with EBV - Africa - jaw lesion
sporadic: pelvis or abdomen
immunodeficiency-associated: HIV

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20
Q

NHL
NHL
t (11;14): disrupts regulation of cyclin D →go into S phase quickly

A

mantle cell lymphoma

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21
Q

NHL
lymphoma equivalent of CLL
difference: tumor cells in lymph nodes

A

small lymphocytic lymphoma

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22
Q

NHL
arises in chronically inflamed tissue (outside lymph nodes)
associated with sjogren syndrome, hashimoto thyroiditis, H. pylori

A

marginal cell lymphoma

H. pylori = MALToma

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23
Q

types of non-hodgkin lymphoma (T-cell)

A

adult T cell lymphoma
mycosis fungoides/sezary syndrome
intestinal (enteropathy-associated) T cell lymphoma

24
Q

NHL
caused by HTLV-1 (associated with IVDU)
cutaneous lesions

A

adult T cell lymphoma

25
Q

NHL
cutaneous lesions
if malignant T cells leave skin lesions → blood: sezary syndrome

A

mycosis fungoides/sezary syndrome

26
Q

NHL

associated with long term celiac disease (lymphocytes chronically in crypts)

A

intestinal (enteropathy-associated) T cell lymphoma

27
Q

leukemia classifications

A

acute vs chronic

lymphoid (lymphocytes) vs myeloid (granulocytes: NEB) tumor cells

28
Q

creates mutation bcr-abl (oncogene: mutated gene that encodes cancer, constitutively (always on) activated tyrosine kinase)

A

t(9;22): philadelphia chromosome

29
Q

drug inhibits bcr-able tyrosine kinase

A

imatinib

30
Q

activation of c-myc caused by

A

t(8;14)

31
Q

t(9;22) seen in

A

CML-always
ALL- sometimes
AML - rare

32
Q

t(8;14) seen in

A

BurkiTT lymphoma

33
Q

t(15;17) seen in

A

M3 type of AML: has lots of Auer rods

34
Q

drug to treat t(15;17) in M3 type of AML

A

all-trans retinoic acid

35
Q

t(18;21) seen in

A

AML (trisomy 21: extra copy of 21, greater risk of translocation)

36
Q

t(11;14) seen in

A

mantle cell lymphoma

37
Q

t(14;18) seen in

A

follicular lymphoma

38
Q

bcl-2 activation caused by

A

t(14;18)

39
Q

cyclin D1 activation caused by

A

t(11;14)

40
Q 
↑ WBC count (>30-40,000) as result of stressor (infection!, down syndrome, tetrology of fallot, maligancy, kawasaki disease, heat stroke)
mostly neutrophils
left shift (5-10% immature bands)
A

leukemoid reaction

41
Q

dysplasia of hematopoietic cells in myeloid tissue (like HPV)
pre-luekemic state: risk of transformation to AML
asymptomatic
↓CBC → bone marrow bx: dysplasia, disorderd hematopoiesis
“Pseudo-pelger-huet anomaly”: 2-lobed nuclei connected by thin strand
tx: monitor, give GF or transfusions as needed

A

myelodysplastic syndrome

42
Q

myeloproliferative disorders: neoplastic transformation of single myeloid precursors → monoclonal proliferation of MATURE myeloid cells

A

polycythemia vera
essential thrombocytosis
myelofibrosis
CML: neoplasm of mature myeloid cells

43
Q

from myeloid precursors

A 
monocytes
macrophages
granulocytes: NEB
erythrocytes
megakaryocytes/PLT
dendritic cells
44
Q

from lymphoid precursors

A

T cell
B cell
NK cell

45
Q

myeloid precursor cell acquires JAK2 mutation: constituitvely active janus kinase 2 → hematopoietic GF signaling to make more cells

A

polycythemia vera
essential thrombocytosis
myelofibrosis

46
Q 
JAK2 mutation in red cell precursor
↑ RBC mass + normal/low EPO
plethora: reddened face
pruritis after hot bath/shower
splenomegaly
hyperviscous blood: headache
erythromelalgia: hands/feet are painful, swollen due to episodic clots in vessels
A

polycythemia vera

47
Q

↑ PLT + low thrombopoietin

thrombosis or bleeding (defective PLTs)

A

essential thrombocytosis

48
Q

fibrosis + obliteration of marrow space

“tear drop” RBC

A

myelofibrosis

vs adipocytes = aplastic anemia

49
Q

most common tumor that arises in bone if > 50 yo

A

multiple myeloma

50
Q

malignancy of plasma cells that arises in BM
↑ IgG (usually) or IgA
lymph node bx: plasma cells (large eccentric nuclei, chromatin gives “clock face” appearance, cytoplasm outside nucleus cleared out “perinuclear hof”)
monoclonal Ab spike on serum protein electrophoresis (SPEP): Monoclonal M spike
Bence Jones proteins: Ig light chains in urine detected on urine protein electrophoresis (UPEP) - BUT no ↑ protein on UA
punched out lytic bone lesions on XRAY (swiss cheese)
smear: RBC stacked like coins (rouleaux formation)

A

multiple myeloma

51
Q

4 clues, >40-50 yo:
anemia: plasma cells interfere with production of other cell lines in BM
renal insufficiency: Ab casts in urine
back pain + hypercalcemia: secrete cytokines “local osteolytic factors” that stimulate osteoclasts, inhibit osteoblasts

A

multiple myeloma

52
Q

associations with multiple myeloma

A

↑ susceptibility: lymphocytes are defective/deficient

1° amyloidosis (AL): deposition of Ig light chains

53
Q 
M spike (IgM)
associated with amyloidosis +  hyperviscous symptoms
NO lytic bone lesions
A

waldenstrom macroglobulinemia

54
Q

solid tumor of plasma cells
2 types: solitary plasmacytoma of bone or extramedullary plasmacytoma (usually head/neck, esp nose)
NO lytic bone lesions

A

plasmacytoma

55
Q

monoclonal proliferation of plasma cells → production of monoclonal Ig (M spike)
No symptoms: no end organ damage yet
can progress to multiple myeloma (monitor)

A

monoclonal gammopathy of undetermined significance (MGUS)

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