Malignancies 2

Question 1

malignancies from the lymphoid line

Answer 1

b cell neoplasms: lymphoma, myeloma
t cell neoplasms
amyloidosis

Question 2

most common type of lymphoid neoplasm

Answer 2

non hodgkin lymphoma –> diffuse large b cell lymphoma, indolent follicular lymphoma

Question 3

most common cancer in children

Answer 3

acute lymphoblastic leukemia

Question 4

clinical picture of lymphoid malignancies

Answer 4

lymphadenopathy
splenomegaly
constitutional symptoms: weight loss, night sweats, irritable
anemia, thrombocytopenia

Question 5

infectious agents associated with lymphoid malignancies

Answer 5

ebv, htlv-1, hiv, hepatitis c virus, h. pylori, hhv 8

Question 6

associated syndromes with all

Answer 6

trisomy 21
bloom syndrome
fanconi anemia

Question 7

common causes of all

Answer 7

idiopathic!!
ionizing radiation
chemicals, drugs

Question 8

clinical manifestations of all

Answer 8

lymphadenopathy and organomegaly
cns involvement
testicular seeding

Question 9

special chemo technique used in all

Answer 9

intrathecal chemo

Question 10

reason why males have to be treated longer for all

Answer 10

testicular seeding: chemo cannot penetrate testis

Question 11

diagnosis for all

Answer 11

morphology
cytochemical analysis
(-) myeloperoxidase
immunophenotyping
flow cytometry, cytogenetics, fish markers

Question 12

induction phase for all treatment

Answer 12

use heavy chemo to induce remission

Question 13

consolidation and maintenance phase of all treatment

Answer 13

to prolong remission or achieve cure

if refractory: bone marrow transplant, tki

Question 14

length of all treatment

Answer 14

2-3 years, longer for males

Question 15

clinical presenting features of all

Answer 15

fever!!
bleeding
bone pain
lymphadenopathy
splenomegaly
hepatosplenogmegaly!!

Question 16

lab findings for all

Answer 16

leukocyte <10,000
hgb <7
platelet <20,000
lymphoblast L1 > L2 > L3

Question 17

patho of chronic lymphocytic leukemia

Answer 17

proliferation of mature lymphocytes

Question 18

characteristics of cll

Answer 18

no lymphoblasts
patients are in immunodeficient state
indolent course = can just observe

Question 19

peripheral smear in cll

Answer 19

mature lymphocytes (chromatin does not show)
scattered among lymphocytes are basket cells/smudge cells

Question 20

staging of cll

Answer 20

table 7

Question 21

t/f survival is long for cll patients with only lymphocytosis

Answer 21

true

Question 22

treatment for cll

Answer 22

low risk: just observe
high risk, fit: transplantation or FCR chemo
high risk, frail: don’t be agressive

Question 23

t/f patients with mutation in p53 of 17p have better diagnosis

Answer 23

false

Question 24

hallmark of hodgkin’s lymphoma

Answer 24

reed sternberg cells with owl’s eye appearance

Question 25

symptoms of lymphomas

Answer 25

bulky lymph nodes

b symptoms: fever, night sweats, weight loss

Question 26

stage 1 lymphoma

Answer 26

single lymph node

Question 27

stage 2 lymphoma

Answer 27

> 1 lymph node as long as it’s in one side of the diaphragm

Question 28

stage 3 lymphoma

Answer 28

lymph nodes on both sides of diaphragm

Question 29

stage 4 lymphoma

Answer 29

involves bone marrow, liver, or other extranodal sites

Question 30

A vs B in lymphoma

Answer 30

A: no other symptoms
B: other symptoms

Question 31

diagnostics of lymphomas

Answer 31

morphology, cytochemical, immunophenotyping, flow cytometry, imaging (ct form brain to pelvis, pet to see active LNs)
serum chemistry

Question 32

treatment for diffuse large b cell lymphoma

Answer 32

RCHOP
Rituximab
Cyclophosphamide
Hydroxydaunomycin
Oncovin
Prednisone

bulky tumor = + radiotherapy

Question 33

early stage hodgkin lymphoma treatment

Answer 33

short course chemo

moderate dose radiation targeting of lns

Question 34

nodular lymphocyte predominant hodgkin lymphoma treatment

Answer 34

radiation alone, good prognosis

Question 35

advanced stage HL treatment

Answer 35

chemo is main, limited role for radiation

Question 36

chemo drugs for HL

Answer 36

ABVD
Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Question 37

treatments to consider in HL

Answer 37

autologous stem cell transplant

immune checkpoint inhibitors

Question 38

treatments for refractory HL

Answer 38

anti cd30 antibody: brentuximab vedotin

Question 39

disorders involving plasma cells

Answer 39

myeloma
amyloidosis
waldenstrom’s macroglobulinemia
heavy chain disease

mature b-cell neoplasms = loss of control over igg production

Question 40

symptoms of multiple myeloma

Answer 40

CRAB
Calcium is high due to increased bone resorption
Renal failure due to immunoglobulins deposited into kidney
Anemia
Bone pain due to bone resorption

Question 41

diagnosis for multiple myeloma

Answer 41

clonal bone marrow cells >/= 10% plasma cells
+ CRAB symptoms
+ other markers like increase in serum free light-chain

Question 42

smear of multiple myeloma cells

Answer 42

numerous myeloma cells

normal to have eccentric nucleus and perinuclear clearing

Question 43

skeletal findings in multiple myeloma

Answer 43

lytic lesions due to increased osteoclast activity

Question 44

electrophoresis results in multiple myeloma

Answer 44

keeps producing one specific type of protein

Question 45

pathophysio of multiple myeloma

Answer 45

figure 12

Question 46

high risk multiple myeloma patients

Answer 46

have deletion of 17p (tp53 gene)

Question 47

treatment for multiple myeloma

Answer 47

chemo followed by autologous stem cell transplant

Question 48

drug given to MM patients eligible for transplant

Answer 48

bortezomib (proteosome inhibitor)
- cleans up all cellular protein debris

steroids
immunomodulatory drugs: thalidomide, dexamethasone

Question 49

t/f stem cells are harvested after induction in MM

Answer 49

true

Question 50

treatment for MM patients not eligible for transplant

Answer 50

give bortezomib + melphalan

Question 51

course of multiple myeloma

Answer 51

• many relapses

- still uncurable