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(DIT) Rapid Fire + 4/5 Stars > Lymphoma/leukemia > Flashcards

Lymphoma/leukemia Flashcards

1
Q

Reed-Sternberg cells

A

Large cells
Bilobed nucleus
Prominent nucleoli w/ clearing around nucleoli – owl eye
Shrinks on slide -> clearing around cell

Assoc with Hodgkin lymphoma

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2
Q

Hodgkin lymphoma

A

Reed-Sternberg cells

Single group of LN
Extranodal involvement rare

Painless, nontender LAD

  • neck
  • firm, rubbery

mediastinal LAD

Constitutional B Sx: low grade fever, night sweats, wt loss

Pruritis

Bimodal age: 20s and 65
Men > Women
Nodular sclerosing exception

Prognosis: more lymphocytes than RS cells good prognosis; more RS cells than lymphocytes, worse

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3
Q

Lymphocyte-predominant type of HL

A

Least common
Best prognosis – few RS cells
Young males

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4
Q

Nodular sclerosing type – HL

A

MC
Great prognosis – few RS cells

Bx: bands of collagen, sclerosis, fibrosis -> separates nodules

M=F
Young adults

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5
Q

Mixed cellularity type of HL

A

2nd MC

worse prognosis

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6
Q

Lymphocyte depleted type of HL

A

Lots of RS cells, not many lymphocytes

Very poor prognosis

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7
Q

Non-hodgkin lymphoma

A 
Most B cell lymphoma
LN and other tissues
Fewer constitutional sx
Variable age distribution
Certain types assoc w/ HIV and immunosuppression
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8
Q

Adult T cell lymphoma

A

Aggressive, cutaneous

HTLV1

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9
Q

Mycosis fungoides

A

Cutaneous
Lesions look like mushrooms
T cell lymphoma

T cells in blood – Sezary sn

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10
Q

Diffuse large B cell lymphoma

A

20%
MC in adults, MC in US
Elderly

t(14;18) 30%

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11
Q

Follicular lymphoma

A

T(14;18) – 90%

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12
Q

Burkitt lymphoma

A

T(8;14) – activates c-Myc

Starry sky appearance – solid lymphocytes w/o M0 ingested tumor cells

Endemic – Africa
-assoc w/ EBV, involves mandible

Sporadic – pelvis, abdomen
Immunodef – assoc w/ HIV

B=8 and tt turns into 14

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13
Q

Lymphoblastic lymphoma

A

MC in children

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14
Q

Mantle cell lymphoma

A

T(11;14) – disrupts regulation of cyclin D -> S phase quickly

Connect tops of 1s to make an M and extend the 4 down for the A

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15
Q

Small lymphocytic lymphoma

A

Lymphoma equivalent to CLL

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16
Q

Marginal cell MALToma

A

Assoc w/ Sjogrens, Hashimoto thyroiditis, H pylori

17
Q

Intestinal enteropathy assoc T cell lymphoma

A

Assoc w/ long term celiac dz

18
Q

AML-M3 translocation

A

T(15;17)

Tx all trans retinoic acid

19
Q

AML translocation

A

T(8;21)

20
Q

Myelodysplastic syndromes

A

Dysplasia of myeloid hematopoietic cells
Risk -> AML

Peiger Huet anomaly
-N0 nuclei – two lobes connected with thin strand

asx – incidental finding

BM bx: dysplaysia
Disorderd hematopoiesis

21
Q

Acute leukemia

A

Rapid onset and rapidly progressive

Over 20% myeloblasts (AML) or lymphoblasts (ALL) in bone marrow

Numerous blast (immature) cells more than 20% in blasts in blood

Often associated pancytopenia (anemia, bleeding tendency, infection)

22
Q

ALL

A

Philadelphia chromosome may be seen – poor prognosis

MC in CHILDREN and young adults

M>F, W>AA

B cell types more common than T cell
3 morphologic variants and 5 phenotypic variants

Bone pain common

Very good prognosis in kids – up to 90% remission

Most have enzyme terminal deoxynucleotidyl transferase (TdT) +
PAS +

Difficult to dx on blood smear

Down Sn assoc

23
Q

AML

A

ML-midlife
T(8;21)

Philadelphia chromosome RARELY seen

Auer rods – thin red/pink rods in cytoplasm of myeloblasts

M3 – acute promyelogenic leukemia t(15;17)

8 different morphological classifications

Most CD13/33+

Usually nonspecific esterase + myeloid cells

Median age of onset 65

PAS –
Assoc w/ numerous risk factors

24
Q

AML risk factors

A

Radiation, benzene, or alkylating agents – HL tx

Myeloproliferative disease, myelodysplastic sn, or aplastic anemia

Down sn, Fanconi anemia, or Bloom Sn

25
Q

Chronic leukemia

A

Insidious onset and gradual progression – months to years

Mature cells rather than blasts (less than 5% blasts)

Can be myeloid CML or lymphoid CLL

Assoc w/ HSM and LAD

Prominent infiltration of BM by leukemic cells

Peripheral WBC count may be high

26
Q

CLL

A

MC adult leukemia seen in western countries

M>F, W>AA

ELDERLY adults – median age 70

95% B cell markers rather than T cell
10% progress to ALL

SMUDGE CELLS

Autoimmune hemolytic anemia – warm and cold agglutinins

Tends to be indolent

Monitor for progression, same as small lymphocytic lymphoma

27
Q

CML

A

May progress to AML 80% (blast crisis) or ALL 20%

Numerous basophils and PMNs are LAP –

Adults 25-60 yo, avg 55

Hyperplasia of all 3 cell lines (granulocytic, erythroid, megakaryocytic) but granulocyte precursors predominate

T(9;22) ALWAYS present

Fatigue, abd pain, splenomegaly, bleeding tendency

28
Q

Philadelphia Chromosome

A

T(9;22)
BCR-ABL -> constitutively activated tyrosine kinase

“Philadelphia CreaM cheese”

imatinib targets BCR-ABL tyrosine kinase

29
Q

Multiple myeloma

A

MC arises w/in bone about 50 yo
Monoclonal plasma cell cancer
-IgG, sometimes IgA

Anemia – plasma cells packed into BM interfere w/ other cell production

Renal insufficiency – excessive Ab form casts in urine
-Myeloma kidney

Bone pain – esp back: local osteolytic factors – aggressive bone resorption
Hypercalcemia

M spike – monoclonal Ab spike on serum protein electrophoresis (SPEP)

Bence Jones protein – Ig light chains in urine detected on urine protein electrophoresis (UPEP)
-no increase protein on regular UA

Increased susceptibility to infection

Amyloidosis

Xray: “punched out” lytic bone lesions

Peripheral smear: Rouleaux formations – stacked RBCs

30
Q

Walderstrom macroglobinemia

A

No lytic bone lesions
IgM monoclonal proliferation
Assoc w/ amyloidosis and hyperviscosity

31
Q

Plasmacytoma

A

Solid tumor of plasma cells

Types:

  • solitary plasmacytoma of bone
  • extramedullary plasmacytoma -> head and neck region – nose

Do NOT cause lytic bone lesions

32
Q

Monoclonal Gammopathy of undetermined significance (MGUS)

A

Monoclonal proliferation of plasma cells -> monoclonal Ig production

No sx – no end organ damage yet!
-> multiple myeloma eventually

33
Q

Myeloproliferative neoplasms

A

Neoplastic transformation of a single myeloid precursor -> monoclonal proliferation of mature myeloid cells

34
Q

JAK2 mutations

A

Polycythemia vera – RBC precursor
-increased RBC mass w/o elevated EPO

Essential thrombocytosis – thrombosis of bleeding
-elevated platelets, low thrombopoietin

Myelofibrosis – fibrosis and obliteration of marrow space
-teardrop shaped red cells

35
Q

Polycythemia vera

A

JAK2 mutation

Plethora (red face)
Pruritis after hot bath/shower
Splenomegaly
Hyperviscosity of blood – HA, erythromelalgia – painful hands

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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