malignancies Flashcards
Auer rods (multiple)
AML (APL)
basophilic stippling
increased or defective RBC production
nRBC
bleedin/hemolysis primary myelofibrosis (messed up BM architecture)
Howell-Jolly body
sign of asplenia (left over nuclear fragments not cleared)
ring sideroblasts
MDS: refractory anemia with ring sideroblasts
mononuclear Megs
MDS with del5q
smudge cells
CLL
what are forward scatter and side scatter proportional to on flow cytometry?
FS: size of cell
SS: granularity/segmentation of nuclei
what three commonly mutated molecules play a role in the epigenetics of acute leukemias?
Tet1/2: normally demethylate cytosines, deactivating mutation=no differentiation
WT-1: localizes Tet to target genes, deactivating mutation=no differentiation
IDH: makes alpha-kg which blocks Tet, gain of function mutation blocks Tet too much=no differentiation
what cytogenetics are associated with poor prognosis in AML? intermediate risk?
- del or monosomy of chromosomes 5 and 7 (q)
- c-KIT mutation
APL: what mutation commonly drives proliferation?
FLT3, a receptor tyrosine kinase
what is the most common chromosomal abnormality in B-ALL in children? 2nd most common?
hyperploidy
TEL-AML
what is the most common chromosomal abnormality in adult B-ALL?
BCR-ABL
BCR-ABL promotes proliferation. what usually inhibits differentiation in ALL with BCR-ABL translocation?
mutated IKZF1 transcription factor
what is MLL and what does its translocation result in? what is commonly mutated with it?
MLL=histone methyl transferase, mutation=blocked differentiation
FLT3, tyrosine kinase–proliferation
what’s the translocation theme in T-ALL
oncogene to TCR on chromosome 14
what are 4common causes of leukocytosis beside infection or myeloproliferative disease?
smoking, obesity, corticosteroids, lithium
what is erythromelalgia and what is it seen in?
red, painful digits due to clogging of small vessels
-P vera and ET
what cells are increased in the peripheral blood of AML? CML?
AML: blasts
CML: mature PMNs, bands, (meta)myelocytes, eosinophils, basophils, platelets
what cells are increased in the BM of P vera?
erythroblasts, Megs, and granulocyte precursors
what causes splenomegaly in P vera?
stagnation and congestions
-late, can cause hepatosplenomegaly due to extramedullary hematopoiesis after BM fibrosis occurs
how might you treat P vera?
- phlebotomy
- aspirin to prevent platelet aggregation
- hydroxyurea, IFN, or busulfan to prevent hematopoiesis
- Jak inhibitor
what kind of anemia may ET cause?
microcytic, hypochromic due to iron deficiency
what condition is a strong indicator of ET?
splanchnic or portal vein HTN or thrombosis
how might you treat ET?
NOT phlebotomy
- hydroxyurea, IFN
- anagrelide-specific to Megs
what do azacytidine and decitabine do and what are they used for?
hypo-methylating agents to reprogram cells in MDS
what is lenalidomide used for?
MDS with 5q-
MM: immunomodular (inhibits immune cells)
what is ibrutinib and what is it used for?
BTK inhibitor
-relapses of B cell lymphomas
which lymphomas are indolent?
- follicular
- CLL/SLL
- mycoses fungoides
- MALTomas
which lymohomas are aggresive?
- DLBL
- mantle cell
- peripheral T cell NOS
which lymphomas are highly aggressive?
Burkitt’s and T cell lymphoblastic lymphoma
CLL is a proliferation of which cells
memory B cells in marginal zone
mantle cell lymphoma is a proliferation of which cells? which immunostains are used to diagnoseit?
B cells in mantle zone, not yet activated
-Ki-67 and cyclin D1
what differentiates mantle cell lymphoma from follicular and CLL on a slide?
- smaller lymphocytes than the centroblasts of follicular lymphoma
- no proliferation centers as seen in activated B cells of CLL
what is Burkitt’s lymphoma a proliferation of? what does it look like on slide?
memory B cells
- cells very blue cytoplasm with cytoplasmic vacuoles and variation in size
- starry-sky appearance from macrophages participating in high cell turnover
what role does IL-6 play in which cancer?
MM
- stimulates growth of plasma cells
- high concentration = poor prognosis
what two values define diagnosis of MM?
serum M protein > 3g/dL
BM plasma cells > 10%
how does MM cause lytic bone disease?
produce DKK1 which stimulates RANKL and IL6 production by osteoblasts and stromal cells
- osteoclast differentiation induced
- osteoblasts inhibited
what is lymphoplasmacytic lymphoma a proliferation of and what condition does it cause?
plasma cells
Waldenstrom’s macroglobulinemia: excess IgM production causes hyperviscosity of blood
-blurred vision, changed mental status, headache
what does lymphoplasmacytic lymphoma do that MM doesn’t?
cause hepatosplenomegaly and lymphadenopathy
-overtakes BM and causes anemia
what is follicular lymphoma a proliferation of?
centroblasts and centrocytes in germinal center
-larger with clumpier chromatin than small lymphocytes
what chemo combo is commonly used in Hodgkin’s
ABVD: doxorubicin, bleomycin, vinblastine and dacarbazine
are any cell lineages increased in aplastic anemia? what type of anemia is it?
lymphocytosis: longer lived
normochromic and normocytic with low reticulocytes
