lymph

Question 1

Acute myelogenous (myelocytic) leukemia

Answer 1

-same symptoms as all acute leukemia - fatigue, fever, bleeding, etc.

-dx- > 20% blast cells in bone marrow (normal is 1 – 2 % blasts) !!!!!!!!!!!!!!!

-Some types have Auer rods!!!! in cytoplasm of leukemic cells especially acute promyelocytic leukemia -> prone to DIC

Question 2

Chronic myelogenous leukemia

Answer 2

-hyperplasia of the bone marrow ==> 100% bone marrow cellularity = marrow is completely filled with hematopoietic cells, leaving no space for fat cells

-WNL- bone marrow cellularity = 30% to 70%
-All cell lines increased
-Significant splenomegaly

-association with Philadelphia chromosome t(9;22)!!!!!!!!!!

Question 3

Chronic lymphocytic leukema v. acute lymphoblastic leukemia

Answer 3

-SUDDEN ONSET
-ANEMIA, BLEEDING, FEVER
-Bone pain, adenopathy, hepatosplenomegaly
-CNS: headaches, vomiting, nerve palsies
-children > adults
-These can also occur in acute myelogenous leukemia (AML)

-CHRONIC
-Unexplained sustained (months) increased lymph count
-M>F, > 55 or 60 years old
-Lymphs look normal and are NOT blasts
-Progressive involvement of marrow, nodes, and other organs is the usual behavior
-Liver can become involved
-Translocations RARE, but trisomies and deletions common
-smuge cells

Question 4

Multiple myeloma: plasma cells, dx

Answer 4

-malignant proliferation of plasma cells (former B lymphocytes)
-can have leukemic phase, but BONE MARROW usual primary site of origin

-!!!!usually have MONOCLONAL GAMMOPATHIES- secret monoclonal proteins -> need serum protein electrophoresis (SPEP) to dx
-monoclonal SPIKE

-secrete heavy and light chains -> light chain in urine -> aka Bence-Jones protein

-plasma cell- oval cytoplasm, round nucleus off to side
-cartwheel/clockface chromatin
-prominent golgi or “Hoff”

Question 5

multiple myeloma: CRAB

Answer 5

-hyperCalemia
-Renal insufficiency
-Anemia
-Bone disease- osteopenia, lytic lesions, fractures, pain

Question 6

multiple myeloma x ray

Answer 6

-“punched-out lesions” or lytic lesions
-Small, round, well-defined areas of bone destruction without reactive bone formation
-circular, radiolucent (dark) defects scattered across the skull
-Diffuse osteopenia

-Unlike metastatic lesions, myeloma lesions lack bone repair responses, leading to purely lytic areas
-aggressive
-abnormal plasma cells replace healthy bone marrow -> increasing osteoclastic activity and reducing bone strength

Question 7

significance of Reed-Sternberg cells in Hodgkin lymphoma

Answer 7

-B cell lymphocyte origin
-Must have presence of Reed-Sternberg cell = a neoplastic giant cell (of B cell lineage), which has variants such as mononuclear variant, lacunar variant, L and H cell (aka “popcorn cell”)

-Nodular sclerosis HD - MC Hodgkin lymphoma
-Reed-Sternberg cells are usually lacunar variant
-Excellent prognosis

-Mixed Cellularity HD - represents 20 – 25% of HD
-The Reed-Sternberg cells are infected with EBV (Epstein-Barr virus) in 70% cases (not usual in nodular sclerosis HD)
-Still good prognosis

-Lymphocyte rich HD – uncommon, EBV associated in 40% of cases
-Very good to excellent prognosis

-Lymphocyte depleted HD – least common Hodgkin lymphoma (< 5% of HD)
-May occur in elderly or HIV patients
-Less favorable prognosis

-Non-classical type: Lymphocyte predominance HD – no EBV association
-Excellent prognosis

Question 8

myeloproliferative, leukemia, multiple myeloma

Answer 8

Myeloproliferative disorders involve the overproduction of mature myeloid cells and can progress to leukemia (particularly AML).

Leukemia is characterized by uncontrolled proliferation of immature or abnormal blood cells, affecting either myeloid or lymphoid lines.

Multiple myeloma is a malignancy of plasma cells, leading to high levels of monoclonal proteins and bone, renal, and hematologic complications.