MTAP W3 (Hematology W15: Chronic Leukemia) Flashcards
LYMPHOPROLIFERATIVE DISORDERS
When neoplastic cells involve mainly the bone marrow and blood, the disorder is known as a -
leukemia
LYMPHOPROLIFERATIVE DISORDERS
When the disease is limited mainly to lymph nodes or organs, the disease is known as a -
lymphoma
Occasionally, a lymphoma develops into -
leukemia
LYMPHOPROLIFERATIVE DISORDERS
most common chronic leukemia in adult
CHRONIC LYMPHOCYTIC LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
is a slowly progressing clonal malignancy of
lymphocytes in an arrested stage of maturation.
CHRONIC LYMPHOCYTIC LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
commonly seen in adults with a mean age of occurrence at 55 years
Twice as common to men compared to women
enlarged lymph nodes, and abdominal discomfort caused by liver and spleen enlargement
CHRONIC LYMPHOCYTIC LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
Patients have a leukocytosis ranging from 10,000 to 150,000/mm3 with 80% to 90% lymphocytes persistent over a period of weeks to
months.
CHRONIC LYMPHOCYTIC LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
CLL
- are commonly found on blood smears.
smudge cells
remnants of cells that lacks any
dentcytoplasmicmembrane membrane or nuclear
structures
smudge cells
May pathologic in case of CLL, or can be an artifact
smudge cells
clover leaf or flower appearance: pathogenic in CLL
rieder cell
cytogenetic abnormalies can be detected by WHO, involves 12,14
CHRONIC LYMPHOCYTIC LEUKEMIA
develops in 10% of patients who have CLL. The patient’s blood smear
demonstrates spherocytes and reticulocytosis.
AIHA
CHRONIC LYMPHOCYTIC LEUKEMIA
95% of CLL have - cell leukemia
B cell
CHRONIC LYMPHOCYTIC LEUKEMIA
Cluster designation markers for B lymphocytes
- positive in B-lymphocyte CLLs and some lymphomas
CD5
CHRONIC LYMPHOCYTIC LEUKEMIA
Cluster designation markers for B lymphocytes
positive for late B cells and hairy-cell leukemia
CD22
CHRONIC LYMPHOCYTIC LEUKEMIA
Cluster designation markers for B lymphocytes
positive in all stages of B-lymphocyte development (i.e., Pan-B)
CD24
CHRONIC LYMPHOCYTIC LEUKEMIA
Immunologic markers for T-cell leukemia include
E-rosette marker (i.e., sheep RBCs)
CD2
CHRONIC LYMPHOCYTIC LEUKEMIA
Immunologic markers for T-cell leukemia include
positive for T-lymphocyte CLL, T-cell prolymphocytic leukemia, and infectious mononucleosis
CD3
CHRONIC LYMPHOCYTIC LEUKEMIA
Immunologic markers for T-cell leukemia include
positive for T-lymphocyte CLL
CD8
CHRONIC LYMPHOCYTIC LEUKEMIA
Treatment of CLL includes one or a combination of the following agents: (3)
- chemotherapy with alkylating drugs
- glucocorticoid
- radiotherapy
Clinical staging systems (-) for assessing prognosis in CLL were developed in the early
1980s, based on easily obtainable biological and clinical parameters.
Rai and Binet
Rai and Binet
Stage -: Bone marrow and blood lymphocytosis
0
Rai and Binet
Stage -: Lymphocytosis with enlarged nodes/ Lymphadenopathy
1
Rai and Binet
Stage -: Lymphocytosis with enlarged spleen or liver or both
2
Rai and Binet
Stage -: Lymphocytosis with anemia
3
Rai and Binet
Stage -: Lymphocytosis with thrombocytopenia
4
LYMPHOPROLIFERATIVE DISORDERS
is a variation of CLL in which there is a high number of morphologically immature larger lymphocytes, which appear as prolymphocytes.
Prolymphocytic leukemia (PLL)
LYMPHOPROLIFERATIVE DISORDERS
The prognosis is usually subacute and more
resistant to treatment than is common CLL. Patients have a mean survival of 1 year.
B-CELL PROLYMPHOCYTIC LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
PLL prolymphocytes commonly type positive with
the membrane markers -
CD 19, CD 20, CD 22, CD 24
LYMPHOPROLIFERATIVE DISORDERS
PLL prolymphocytes commonly type positive with
the membrane markers and strong expression of -
sIg/ surface immunoglobulin
LYMPHOPROLIFERATIVE DISORDERS
small B lymphocytes with abundant cytoplasm and fine (“hairy”) cytoplasmic projections.
HAIRY CELL LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
TRAP +
The cytochemical features of HCL include a strong acid phosphatase reaction that is not inhibited by tartaric acid or tartrate-resistant acid phosphatase (TRAP) stain.
HAIRY CELL LEUKEMIA
(leukemic reticuloendotheliosis)
HAIRY CELL LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
Splenomegaly is a common physical finding
B cell malignancy (CD19, CD20 positive)
CD25! IL2 receptor unique to px with -
HAIRY CELL LEUKEMIA
LYMPHOPROLIFERATIVE DISORDERS
Monoclonal gammopathy causes B cell production of excessive -
IgG, IgA
LYMPHOPROLIFERATIVE DISORDERS
Multiple skeletal system tumors of plasma cells (myeloma cells) cause - and -
- lytic bone lesions
- hypercalcemia
LYMPHOPROLIFERATIVE DISORDERS
Identified on serum protein
electrophoresis by an “M”-spike in
the gamma-globulin region;
multiple myeloma
LYMPHOPROLIFERATIVE DISORDERS
Laboratory Findings:
Marked rouleaux
Bence jones proteins
multiple myeloma
- (free light chains—kappa or lambda) found in the urine; toxic to tubular epithelial cells; cause kidney damage
bence jones proteins
LYMPHOPROLIFERATIVE DISORDERS
a hypergammaglobulinemia variant of chronic lymphocytic leukemia,
increase of monoclonal IgM in the serum
WALDENSTROM’S MACROGLOBULINEMIA
LYMPHOPROLIFERATIVE DISORDERS
Marked roleaux formation and increased ESR
BENCE jones proteins
+ coombs test
WALDENSTROM’S MACROGLOBULINEMIA
LYMPHOPROLIFERATIVE DISORDERS
Lab dx:
lymphophilia and monocytosis
lymphoma
are the hallmark of Hodgkin’s
lymphoma, may be found in the lymph
nodes and marrow of a patient who has
this disease.
Reed-Sternberg cells
owls eyes appearance, giant
binucleated or multi-nucleated cells with
acidophilic nuclei.
Reed-Sternberg cells
Hodgkin lymphoma (classical)
-of lymphomas; seen in patients between 15
and 35 years of age and over 55 years of age
40%
Hodgkin lymphoma (classical)
seen more frequently in males; certain subtypes have an - association
EBV
Hodgkin lymphoma (classical)
—70% are this subtype; lowest EBV association
nodular sclerosis
Hodgkin lymphoma (classical)
—20% are this subtype; highest EBV association MALIGNANT LEUKOCYTE DISORDERS
mixed cellularity
Non-Hodgkin lymphoma
associated with EBV, has a strong affinity for B cells; this affinity causes B-cell proliferation. When the cytolytic killer T lymphocytes’ response is deficient, an unchecked B-cell proliferation
can result in lymphoma.
Burkitt’s
Non-Hodgkin lymphoma
(i.e., Mycosis Fungoides) is an HTLV1-promoted helper-inducer T-
cell malignancy. This lymphoma is associated with a lymphocytosis of Sezary cells.
Cutaneous T-cell lymphoma
smudgey poorly defined patches and plaques
cutaneous T-cell lymphoma
M. fungoides
is the most common cutaneous
lymphoma.
M. fungoides
characteristic cerebriform nuclei
Sezary cells
