Onc Flashcards
leukemoid reaction
acute inflammatory response to infection.
incr in WBC WITH band forms / shifts.
key: incr in ALP (unlike w/ CML)
hodkin lypmphoma characteristics (4)
1) local + contiguous spread
2) Reed-sternberg
3) 50% associated w/ EBV
4) constitutional symptoms
NHL characteristics (3)
1) multiple nodes, noncontiguous spread
2) mostly B cells
3) HIV / immunosuppresion
Reed-sternberg cells
CD14 / Cd30 –> Bcell origin
prognosis for hodgkin lymphoma
- lymphocyte-rich form = better prognosis than low-lymphocytic response
- nodular sclerosing form = most common
Non-hodgkin lymphoma (4 types) B cells
1) burkitt
2) diffuse large B cell
3) mantle
4) follicular
NHL - T cells (2 types)
1) adult T cell
2) mycosis / fungoides
burkitt associations
1) t (8,14) c-myc to Ig heavy chain
2) starry sky: lymphocytes with interspred macrophages
3) EBV
diffuse large B cell lypmhoma
t (14,18) (Ig heavy chain to bcl-2); same as follicular lymphoma
mantle cell lymphoma
t (11,14) translocation of cyclin D1 to heavy chain Ig.
CD5+
follicular lymphoma
t (14, 18) –> translocation of heavy-chain Ig & bcl-2
presentation of follicular lymphoma
1) indolent course
2) painless waxing/waning lymphadenopathy
adult-T cell lymphoma gene + presentation
1) HTLV-1 (associated w/ IV drug abuse)
2) lytic bone lesions + hypercalcemia (cutaneous lesions)
mycosis fungoides / sezary syndrome
1) cutaneous patches / plaques / tumors –> potential to spread into lymph / viscera
2) malignant cells seen circulating
3) indolent / CD4+
multiple myeloma def + mneomnic
monoclonal plasma cell —> large amounts of IgG / IgA
“CRAB”
hyperCalcemia
Renal insufficiency
Anemia
Bone lysis / Back pain
how is multiple myeolma different from Waldenstrom macroglobulinemia?
there are no lytic bone lesions
how is multiple myeloma different from monoclonal gammopathy of undetermined significance (MGUS)
MGUS is asymptomatic, w/ 1-2% progressing to MM each year
findings of multiple myeloma (5)
1) primary amyloidosis (AL)
2) lytic bone lesions on xray
3) M spike on serum protein electrophoresis
4) Bench Jones protein = Ig light chains in urine
5) rouleaux formation (RBCs stacked on smear)
myelodysplastic syndromes
-stem cell disorder w/ ineffective hematopoiesis –> defects in cell maturation of non-lymphoid lineages
what are myelodysplastic syndromes associated w/
AML transformation
ALL presentation
- mediastinal mass
- Down syndrome association
- incr. lymphoblasts
ALL on labs
-TdT+
CD10+
best prognosis for ALL?
t(12,21)
where might ALL spread to?
CNS / testes
SLL markers + diagnostic findings
CD20+, CD5+
smudge cells in periphery –> autoimmune hemolytic anemia
what are the differences b/w SLL & CLL?
CLL has incr. peripheral blood lymphocytosis / bone marrow involvement
hairy cell leukemia diagnostic findings?
cells w/ filamentous hair-like projections
stains for hairy cell leukemia?
stains TRAP (tartrate-resistant acid phosphatase positive)
what are hairy cell leukemia findings?
marrow fibrosis –> dry tap on aspiration
treatment for hairy cell leukemia?
cladribine (2-CDA), which is an adenosine analog, that inhibits adenosine deaminase
AML findings
auer rods –> peroxidase positive, with cytoplasmic inclusions.
can have DIC
what are AML findings on peripheral smear?
circulating myeloblasts
risk factors for AML?
previous alkylating chemotherapy, myeloproliferative disorders, Down syndrome
AML genetic disorder?
t(15,17)
cml
9,22 translocation (bcr-abl)
incr. neutrophils, metamyelocytes, basophils and splenomegaly
what can CML transform into?
AML / ALL –. blast crisis
lab findings for CML
low leukocyte alkaline phosphatase (LAP) due to low granulocyte activity
langerhans cell histiocytosis presentation
lytic bone lesion in child w/ skin rash / recurrent otitis media w/ a mastoid mass
what is langerhans cell histiocytosis?
proliferative disorder of dendritic cell from a monocyte lineage
markers for langerhans histiocytosis?
S-100 + CD1A. bierbeck granules = tennis rackets on EM that are characteristic
myelofibrosis
fibrotic oliberation of bone marrow –> teardrop RBCs
essential thrombocytosis
overproduction of platelets –> bleeding / thrombosis.
enlarged megakaryocytes found on bone marrow
mutations in chronic myeloproliferative disorders?
JAK2 –> hematocrit > 55%, presenting as intense itching after shower
what’s the difference b/w appropriate vs. inappropriate polycythemia?
incr in RBC mass may be appropriate in cases of hypoxia, where the body increases EPO production to incr. O2 carrying capacity (i.e.: altitude, heart / lung disease, etc.)
overall, O2 saturation dec.
inappropriate polycythemia ex?
- renal cell carcinoma
- Wilms tumor
- cyst
- hematocellular carcinoma
- hydronephrosis
