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Integrated systems > Oncology > Flashcards

Oncology Flashcards

1
Q

Hematopoiesis occurs via stepwise maturation of a [marker]-positive hematopoietic stem cell

A

Hematopoiesis occurs via stepwise maturation of a CD34-positive hematopoietic stem cell

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2
Q

Chemotherapy with alkylating agents can cause leukopenia due to damage to stem cells and decreased WBCs, especially _

A

Chemotherapy with alkylating agents can cause leukopenia due to damage to stem cells and decreased WBCs, especially neutrophils

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3
Q

[WBC change] is the earliest change seen after whole body radiation treatment

A

Lymphopenia is the earliest change seen after whole body radiation treatment
* Lymphocytes are highly sensitive to radiation

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4
Q

High cortisol states (exogenous corticosteroids or Cushing syndrome) can induce apoptosis of [immune cells]

A

High cortisol states (exogenous corticosteroids or Cushing syndrome) can induce apoptosis of lymphocytes

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5
Q

High cortisol states impair _ which can result in neutrophilic leukocytosis

A

High cortisol states impair leukocyte adhesion which can result in neutrophilic leukocytosis
* Causes the marginated pool of neutrophils to fall into the blood

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6
Q

Eosinophilia in the context of malignancy; think _

A

Eosinophilia in the context of malignancy; think hodgkin lymphoma

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7
Q

Basophilia in the context of malignancy; think _

A

Basophilia in the context of malignancy; think chronic myeloid leukemia (CML)

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8
Q

EBV classically results in a _ leukocytosis comprised of reactive _ cells

A

EBV classically results in a lymphocytic leukocytosis comprised of reactive CD8+ cells
* EBV will infect the oropharynx, liver, and B cells

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9
Q

EBV causes lymphadenopathy due to T-cell hyperplasia in the [lymph node region]

A

EBV causes lymphadenopathy due to T-cell hyperplasia in the paracortex
* Recall outer cortex= B cells, paracortex= T cells

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10
Q

EBV causes splenomegaly due to T-cell hyperplasia in the [spleen region]

A

EBV causes splenomegaly due to T-cell hyperplasia in the periarterial lymphatic sheath (PALS)

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11
Q

Dormancy of EBV in [cells] leads to increased risk for [malignancy]

A

Dormancy of EBV in B cells leads to increased risk for B-cell lymphoma

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12
Q

Acute leukemia can be defined as a neoplastic proliferation of blasts in the bone marrow (greater than _ percent blasts)

A

Acute leukemia can be defined as a neoplastic proliferation of blasts in the bone marrow (> 20% blasts)

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13
Q

Three general symptoms that are expected in acute leukemia include: _ , _ , _

A

Three general symptoms that are expected in acute leukemia include: anemia , bleeding , infection
* Due to blasts crowding out normal hematopoiesis resulting in fewer RBCs, platelets, neutrophils

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14
Q

Blasts tend to be [size], immature cells with [nuceloli]

A

Blasts tend to be large, immature cells with punched out nucleoli
* They will also have little cytoplasm

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15
Q

The neoplastic accumulation of lymphoblasts ( > 20% blasts) in the bone marrow is [specific cancer]

A

The neoplastic accumulation of lymphoblasts ( > 20% blasts) in the bone marrow is acute lymphoblastic leukemia (ALL)

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16
Q

Cells in ALL will stain positive for _

A

Cells in ALL will stain positive for TdT
* TdT is a DNA polymerase found in the nucleus of lymphoblasts only
* It will not be found in myeloid blasts or mature lymphocytes

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17
Q

ALL is most common in [population]

A

ALL is most common in children

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18
Q

Of the ALLs, [type] is most common

A

Of the ALLs, B-ALL is most common

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19
Q

_ is usually characterized by lymphoblasts (TdT+) that express CD10, CD19, CD20

A

B-ALL is usually characterized by lymphoblasts (TdT+) that express CD10, CD19, CD20

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20
Q

T-ALL is characterized by lymphoblasts (TdT+) that express markers _

A

T-ALL is characterized by lymphoblasts (TdT+) that express markers CD2-CD8

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21
Q

B-ALL has an excellent response to chemo and good prognosis; however, it requires prophylaxis to the _ and _

A

B-ALL has an excellent response to chemo and good prognosis; however, it requires prophylaxis to the scrotum and CSF
* These are regions where the chemo can’t cross a BB or BT barrier

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22
Q

B-ALL in children is commonly associated with [translocation]

A

B-ALL in children is commonly associated with t(12;21)
* Good prognosis

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23
Q

B-ALL in adults has a poor prognosis and is associated with [translocation]

A

B-ALL in adults has a poor prognosis and is associated with t(9;22)
* This is Philadelphia+ ALL (classic translocation seen in CML)

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24
Q

T-ALL is most common in [population] with [presentation]

A

T-ALL is most common in teenagers with thymic (mediastinal) mass
* Will sometimes be called acute lymphoblastic lymphoma because the malignant cells form a mass

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25
Q

The neoplastic accumulation of myeloblasts ( > 20% blasts) in the bone marrow is [specific cancer]

A

The neoplastic accumulation of myeloblasts ( > 20% blasts) in the bone marrow is acute myeloid leukemia

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26
Q

Myeloblasts are usually characterized by positive cytoplasmic staining for _

A

Myeloblasts are usually characterized by positive cytoplasmic staining for myeloperoxidase (MPO)
* *Recall granulocytes are derived from myeloblasts and need MPO to kill microorganisms via oxygen dependent killing

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27
Q

Auer rods are crystal aggregates of _ and are found most commonly in _

A

Auer rods are crystal aggregates of MPO and are found most commonly in AML or APL

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28
Q

AML is most common in [population]

A

AML is most common in older adults (50-60s)

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29
Q

_ is a subclassification of AML that involves numerous auer rods and increases the risk for DIC

A

Acute promyelocytic leukemia (APL) is a subclassification of AML that involves numerous auer rods and increases the risk for DIC

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30
Q

Acute promyelocytic leukemia is characterized by [translocation]

A

Acute promyelocytic leukemia is characterized by t(15;17)

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31
Q

APL involves a translocation of the _ on chromosome 17 to chromosome 15

A

APL involves a translocation of the retinoic acid receptor (RAR) on chromosome 17 to chromosome 15
* Disrupting RAR blocks maturation and leads to accumulation of promyelocytes

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32
Q

Treatment for APL is with _

A

Treatment for APL is with all-trans-retinoic acid (ATRA)
* Binds the altered RAR and causes blasts to mature and eventually die

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33
Q

_ is a subclassification of AML that involves infiltration of the gums

A

Acute monocytic leukemia is a subclassification of AML that involves infiltration of the gums

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34
Q

Acute monocytic leukemia involves the proliferation of monoblasts and usually lacks _

A

Acute monocytic leukemia involves the proliferation of monoblasts and usually lacks MPO

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35
Q

_ is a proliferation of megakaryoblasts; lack MPO

A

Acute megakaryoblastic leukemia is a proliferation of megakaryoblasts; lack MPO

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36
Q

_ is associated with children with Down syndrome, usually after age 5

A

ALL is associated with children with Down syndrome, usually after age 5

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37
Q

_ is associated with children with Down syndrome, usually before age 5

A

Acute megakaryoblastic leukemia is associated with children with Down syndrome, usually before age 5
* Subtype of AML

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38
Q

AML can occur secondary to pre-existing _ ; which usually involve cytopenias and are likely to kill the patient from bleeding or infection

A

AML can occur secondary to pre-existing myelodysplastic syndromes ; which usually involve cytopenias and are likely to kill the patient from bleeding or infection

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39
Q

AML can present in a patient following exposure to _

A

AML can present in a patient following exposure to alkylating agents or radiotherapy

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40
Q

_ is defined as neoplastic proliferation of mature circulating lymphocytes; characterized by a high WBC count

A

Chronic leukemia is defined as neoplastic proliferation of mature circulating lymphocytes; characterized by a high WBC count

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41
Q

The most common leukemia overall is _

A

The most common leukemia overall is chronic lymphocytic leukemia (CLL)

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42
Q

Chronic lymphocytic leukemia is characterized by a neoplastic proliferation of naive B cells that co-express [marker] and [marker]

A

Chronic lymphocytic leukemia is characterized by a neoplastic proliferation of naive B cells that co-express CD5 and CD20
* Recall that CD5 should normally only be found on T cells

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43
Q

Smudge cells on PBS are classic for [malignancy]

A

Smudge cells on PBS are classic for chronic lymphocytic leukemia (CLL)
* “Crushed little lymphocytes”

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44
Q

Peripheral blood smear of CLL will show increased _ and _

A

Peripheral blood smear of CLL will show increased lymphocytes and smudge cells

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45
Q

When CLL involves the lymph nodes and leads to generalized lymphadenopathy it is called _

A

When CLL involves the lymph nodes and leads to generalized lymphadenopathy it is called small lymphocytic lymphoma (SLL)

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46
Q

Name (3) possible complications of CLL

A

Name (3) possible complications of CLL:
1. Hypogammaglobulinemia
2. Autoimmune hemolytic anemia
3. Diffuse large B-cell lymphoma transformation

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47
Q

Hairy cell leukemia involves neoplastic proliferation of [cells] characterized by [feature]

A

Hairy cell leukemia involves neoplastic proliferation of mature B cells characterized by hairy cytoplasmic processes

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48
Q

Hairy cell leukemia will be positive for _

A

Hairy cell leukemia will be positive for TRAP (tartrate-resistant acid phosphatase)

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49
Q

Clinical features of hairy cell leukemia include [spleen] and _ on bone marrow aspiration, (with/without) lymphadenopathy

A

Clinical features of hairy cell leukemia include splenomegaly and dry tap on bone marrow aspiration, without lymphadenopathy
* Cells get TRAPed in the red pulp and bone marrow and can’t get to the lymph node
* Marrow fibrosis present

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50
Q

Hairy cell leukemia can be treated with adenosine deaminase inhibitor, _

A

Hairy cell leukemia can be treated with adenosine deaminase inhibitor, 2-CDA (cladribine)

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51
Q

Adult T-cell leukemia/lymphoma is a proliferation of [cells]

A

Adult T-cell leukemia/lymphoma is a proliferation of CD4+ T cells

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52
Q

Adult T-cell leukemia/lymphoma is associated with [virus]

A

Adult T-cell leukemia/lymphoma is associated with HTLV-1 (human T-cell leukemia virus-1)

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53
Q

Clinical features of Adult T-Cell Leukemia/Lymphoma may resemble [malignancy]

A

Clinical features of Adult T-Cell Leukemia/Lymphoma may resemble multiple myeloma
* Shared features: rash, lymphadenopathy, hepatosplenomegaly, lytic bone lesions with hypercalcemia

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54
Q

_ is a neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing rash/plaques/nodules

A

Mycosis fungoides is a neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing rash/plaques/nodules

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55
Q

Aggregates of neoplastic cells in the skin are called _ (in mycosis fungoides)

A

Aggregates of neoplastic cells in the skin are called Pautrier microabscesses (in mycosis fungoides)

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56
Q

When neoplastic mycosis fungoides cells spread to involve the blood it produces [syndrome]

A

When neoplastic mycosis fungoides cells spread to involve the blood it produces Sezary syndrome

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57
Q

Sezary syndrome is characterized by lymphocytes with _ nuclei on PBS

A

Sezary syndrome is characterized by lymphocytes with cerebriform nuclei on PBS

58
Q

Myeloproliferative disorders are _

A

Myeloproliferative disorders are neoplastic proliferations of mature myeloid cells (all lineages are increased but classified by the dominant cell produced)

59
Q

Complications of myeloproliferative disorders include _ and _ due to high cell turnover and progression to either marrow fibrosis or _

A

Complications of myeloproliferative disorders include hyperuricemia and gout due to high cell turnover and progression to either marrow fibrosis or AML

60
Q

CML involves a proliferation of mature myeloid cells, especially _

A

CML involves a proliferation of mature myeloid cells, especially granulocytes and their precursors
* Recall that basophils are classically increased

61
Q

CML is driven by a [translocation]

A

CML is driven by a t(9,22)
* Philadelphia chromosome

62
Q

CML involves t(9:22) which generates a _ fusion protein with increased _ activity

A

CML involves t(9:22) which generates a BCR-ABL fusion protein with increased tyrosine kinase activity

63
Q

First line treatment of CML is _

A

First line treatment of CML is imatinib
* Blocks tyrosine kinase activity

64
Q

Splenomegaly is common with CML; however enlargement may suggest progression to _

A

Splenomegaly is common with CML; however enlargement may suggest progression to AML
* CML can progress to AML or ALL since the mutation is in a pluripotent stem cell

65
Q

A reactive neutrophilic leukocytosis may also be called a _ reaction

A

A reactive neutrophilic leukocytosis may also be called a leukemoid reaction

66
Q

Three ways to differentiate CML from leukemoid reaction

A

Three ways to differentiate CML from leukemoid reaction
1. Negative LAP stain (pos in functional neutrophils)
2. Increased basophils
3. t(9:22)

67
Q

Polycythemia vera is a neoplastic proliferation of mature myeloid cells, especially _

A

Polycythemia vera is a neoplastic proliferation of mature myeloid cells, especially RBCs
* Granulocytes and platelets are also increased

68
Q

Polycythemia vera is associated with a _ mutation

A

Polycythemia vera is associated with a JAK2 kinase mutation

69
Q

Symptoms of PV are manifestations related to _

A

Symptoms of PV are manifestations related to hyperviscosity of blood
* Blurry vision, headache
* Risk of venous thrombosis (hepatic vein, portal vein, dural sinus)
* Flushed face due to congestion
* Itching, especially after bathing

70
Q

First line treatment for PV is _ ; second line treatment is _

A

First line treatment for PV is phlebotomy ; second line treatment is hydroxyurea

71
Q

In reactive polycythemia you would expect EPO to be _ , while in PV it should be _

A

In reactive polycythemia you would expect EPO to be increased , while in PV it should be decreased

72
Q

SaO2 should be _ in PV but _ in reactive polycythemia

A

SaO2 should be normal in PV but low in reactive polycythemia
* Only reactive polycythemia is driven by a demand for oxygen
* In the case of ectopic EPO production from RCC EPO could be high and SaO2 normal

73
Q

_ is a neoplastic proliferation of mature myeloid cells, especially platelets

A

Essential thrombocythemia is a neoplastic proliferation of mature myeloid cells, especially platelets
* RBCs and granulocytes also increased

74
Q

Essential thrombocythemia is associated with _ mutations

A

Essential thrombocythemia is associated with JAK2 kinase mutations

75
Q

Symptoms of ET are either related to an increase risk of _ or _

A

Symptoms of ET are either related to an increase risk of thrombosis or bleeding
* Although you have excess platelets, they become dysfunctional

76
Q

Of the myeloproliferative diseases, _ is one that rarely progresses to marrow fibrosis or acute leukemia and is less likely to cause hyperuricemia or gout

A

Of the myeloproliferative diseases, essential thrombocytopenia is one that rarely progresses to marrow fibrosis or acute leukemia and is less likely to cause hyperuricemia or gout

77
Q

Myleofibrosis is a neoplastic proliferation of mature myeloid cells, especially _ which have a role in the pathogenesis of fibrosis

A

Myleofibrosis is a neoplastic proliferation of mature myeloid cells, especially megakaryocytes which have a role in the pathogenesis of fibrosis
* 50% of cases due to JAK2 kinase mutations

78
Q

Megakaryocytes produce excess _ causing the marrow fibrosis in myelofibrosis

A

Megakaryocytes produce excess platelet-derived growth factor (PDGF) causing the marrow fibrosis in myelofibrosis

79
Q

Myelofibrosis can be identified on PBS by the presence of _

A

Myelofibrosis can be identified on PBS by the presence of tear-drop RBCs, nucleated RBCs, immature granulocytes

80
Q

Myelofibrosis patients are at increased risk of _ , _ , _ and splenomegaly due to _

A

Myelofibrosis patients are at increased risk of infection , thrombosis , bleeding and splenomegaly due to extramedullary hematopoiesis

81
Q

Painful lymphadenopathy is more often seen in cases of _

A

Painful lymphadenopathy is more often seen in cases of acute lymphadenitis from infection
* Therefore more likely to be benign

82
Q

Painless lymphadenopathy can be seen with chronic inflammation, metastatic carcinoma, or _

A

Painless lymphadenopathy can be seen with chronic inflammation, metastatic carcinoma, or lymphoma

83
Q

Lymphoma is a neoplastic proliferation of _

A

Lymphoma is a neoplastic proliferation of lymphoid cells that forms a mass
* May arise in lymph node or extranodal tissue

84
Q

Lymphoma can be divided into _ (60%) or _ (40%)

A

Lymphoma can be divided into NHL (60%) or HL (40%)

85
Q

Categorize the types of NHL by cell size

A
  1. Small B cells- follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma, small lymphocytic lymphoma
  2. Intermediate-sized B cells- Burkitt lymphoma
  3. Large B cells- diffuse large B cell lymphoma
86
Q

NHL more often arises in [age]

A

NHL more often arises in late adulthood

87
Q

HL more often arises in [age]

A

HL more often arises in young adults

88
Q

(NHL/ HL) tends to spread diffusely, often extranodal

A

NHL tends to spread diffusely, often extranodal

89
Q

HL tends to spread _

A

HL tends to spread contiguously, rarely extranodal

90
Q

Small B cell malignancies are neoplastic proliferation of [marker] B cells that expand the region for which they are named

A

Small B cell malignancies are neoplastic proliferation of CD20+ B cells that expand the region for which they are named
* Ex: follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma
* Will commonly present late in adulthood and with painless lymphadenopathy

91
Q

Follicular lymphoma is driven by [translocation]

A

Follicular lymphoma is driven by t(14;18)

92
Q

In follicular lymphoma, _ on chromosome 18 translocates to the _ on chromosome 14

A

In follicular lymphoma, BCL2 on chromosome 18 translocates to the Ig heavy chain on chromosome 14
* This results in an overexpression of BCL2 since the Ig heavy chain locus on chromosome 14 is a highly active region

93
Q

A functional BCL2 will _ apoptosis of cells

A

A functional BCL2 will block apoptosis of cells

94
Q

BCL2 _ the mitochondrial membrane and prohibits _ from leaking into the cytoplasm

A

BCL2 stabilizes the mitochondrial membrane and prohibits cytochrome c from leaking into the cytoplasm
* Blocking apoptosis

95
Q

It is problematic to overexpress BCL2 in the follicle because _

A

It is problematic to overexpress BCL2 in the follicle because cells that fail somatic hypermutation are not able to be killed by apoptosis

96
Q

Treatment for follicular lymphoma is reserved for patients who are symptomatic and involves low dose chemo or _ (anti-CD20 antibody)

A

Treatment for follicular lymphoma is reserved for patients who are symptomatic and involves low dose chemo or Rituximab (anti-CD20 antibody)

97
Q

Tingible body macrophages will be _ in the germinal centers in follicular lymphoma

A

Tingible body macrophages will be absent in the germinal centers in follicular lymphoma
* Distinguishing feature from reactive follicular hyperplasia when there is apoptosis occuring still (macrophages react to clean up debris)
* Also lose normal architecture and polyclonality

98
Q

Mantle cell lymphoma is driven by [translocation]

A

Mantle cell lymphoma is driven by t(11;14)

99
Q

In mantle cell lymphoma, _ on chromosome 11 translocates to _ on chromosome 14

A

In mantle cell lymphoma, cyclin D1 on chromosome 11 translocates to Ig heavy chain locus on chromosome 14

100
Q

Overexpression of cyclin D1 in mantle cell lymphoma promotes _

A

Overexpression of cyclin D1 in mantle cell lymphoma promotes G1/S transition allowing neoplastic proliferation
* Cyclin D phosphorylates (with help of cyclin dependent kinase)

101
Q

The marginal zone is formed by post-germinal center B cells and so lymphoma here is associated with _

A

The marginal zone is formed by post-germinal center B cells and so lymphoma here is associated with chronic inflammatory states
* ex: Hashimoto thyroiditis, Sjogren, H pylori

102
Q

MALToma is a [malignancy] at mucosal sites

A

MALToma is a marginal zone lymphoma at mucosal sites
* Gastric MALToma may regress with treatment of H pylori

103
Q

Burkitt lymphoma is an intermediate B cell lymphoma associated with _ that classically presents in [age]

A

Burkitt lymphoma is an intermediate B cell lymphoma associated with EBV that classically presents in child or young adult with extranodal mass

104
Q

The African form of Burkitt lymphoma usually involves the _ while the sporatic form involves the _

A

The African form of Burkitt lymphoma usually involves the jaw while the sporatic form involves the abdomen

105
Q

_ is the most common translocation associated with Burkitt lymphoma

A

t(8;14) is the most common translocation associated with Burkitt lymphoma

106
Q

Burkitt lymphoma is associated with a translocation of _ to the Ig heavy chain locus on chromosome 14

A

Burkitt lymphoma is associated with a translocation of c-myc to the Ig heavy chain locus on chromosome 14
* c-myc is an oncogene that promotes cell growth

107
Q

_ is characterized by a high mitotic index and starry-sky appearance on microscopy

A

Burkitt lymphoma is characterized by a high mitotic index and starry-sky appearance on microscopy

108
Q

There is a risk, particularly in _ patients of progression to diffuse large B cell lymphoma

A

There is a risk, particularly in follicular lymphoma patients of progression to diffuse large B cell lymphoma
* Presents as an enlarging lymph node

109
Q

The most common form of NHL is _

A

The most common form of NHL is diffuse large B-cell lymphoma
* These cells grow diffusely in sheets and are poorly differentiated
* Clinically aggressive and high grade cancer

110
Q

Hodgkin lymphoma is a neoplastic proliferation of large B cells with multilobed nuceli and prominent nucleoli, which are called _

A

Hodgkin lymphoma is a neoplastic proliferation of large B cells with multilobed nuceli and prominent nucleoli, which are called Reed-Sternberg cells

111
Q

Reed-Sternberg cells are classically positive for [marker] and [marker]

A

Reed-Sternberg cells are classically positive for CD15 and CD30

112
Q

Reed-Sternberg cells secrete _ which can result in B symptoms, attract other immune cells, and sometimes lead to fibrosis

A

Reed-Sternberg cells secrete cytokines which can result in B symptoms, attract other immune cells, and sometimes lead to fibrosis

113
Q

The bulk of the tumor in HL is made up by _

A

The bulk of the tumor in HL is made up by reactive inflammatory cells
* Whcih are recruited via reed-sternberg cells secreting cytokines
* Versus NHL the whole mass is made up by the malignant cells

114
Q

Name (4) subtypes of HL

A

Name (4) subtypes of HL
1. Nodular sclerosis
2. Lymphocyte-rich
3. Mixed cellularity
4. Lymphocyte-depleted

115
Q

The most common subtype of HL (70% of cases) is _

A

The most common subtype of HL (70% of cases) is nodular sclerosis

116
Q

Of all types of HL, _ has the best prognosis

A

Of all types of HL, lymphocyte-rich has the best prognosis
* Lymphocyte depleted is the most aggressive type and usually seen in older adults or HIV positive individuals

117
Q

Young adult female presents with an enlarging cervical or mediastinal lymph node; histology shows lymph node divided by bands of sclerosis; Reed-sternberg cells are present in lake-like spaces; what’s the diagnosis?

A

Young adult female presents with an enlarging cervical or mediastinal lymph node; histology shows lymph node divided by bands of sclerosis; Reed-sternberg cells are present in lake-like spaces; Nodular sclerosis HL

118
Q

Multiple myeloma is a malignant proliferation of [cells] in the bone marrow

A

Multiple myeloma is a malignant proliferation of plasma cells in the bone marrow

119
Q

The most common primary malignancy of the bone is _ but the most common malignant lesion of the bone overall is _

A

The most common primary malignancy of the bone is multiple myeloma but the most common malignant lesion of the bone overall is metastatic cancer

120
Q

Multiple myeloma may be associated with high [cytokine levels] which stimulates plasma cell growth and Ig production

A

Multiple myeloma may be associated with high IL-6 which stimulates plasma cell growth and Ig production

121
Q

Clinical features of multiple myeloma can be remembered with the mneumonic _

A

Clinical features of multiple myeloma can be remembered with the mneumonic CRAB

122
Q

The bone pain and hypercalcemia in multiple myeloma is mediated by _ activation via neoplastic plasma cells

A

The bone pain and hypercalcemia in multiple myeloma is mediated by RANK receptor activation via neoplastic plasma cells
* Recall that rank receptors are found on osteoclasts

123
Q

_ are classic on x-ray of multiple myeloma

A

Lytic “punched out” lesions are classic on x-ray of multiple myeloma
* Specifically of the vertebrae and skull

124
Q

_ is a classic finding on serum protein electrophoresis (SPEP) for multiple myeloma

A

M spike is a classic finding on serum protein electrophoresis (SPEP) for multiple myeloma
* Neoplastic plasma cells are producing immunoglobulin
* M spike represents albumin and Ig

125
Q

Multiple myeloma is associated with increased serum proteins, specifically [Immunoglobulin]

A

Multiple myeloma is associated with increased serum proteins, specifically IgG or IgA

126
Q

The most common cause of death in multiple myeloma is _

A

The most common cause of death in multiple myeloma is infection
* Increased risk of infection because the monoclonal antibodies lack antigenic diversity

127
Q

Increased serum protein in multiple myeloma has the effect of _ on RBCs

A

Increased serum protein in multiple myeloma has the effect of decreasing charge between RBCs
* Leads to rouleaux formation

128
Q

In multiple myeloma, free light chains circulate in the serum and deposit in the tissues causing [amyloidosis]

A

In multiple myeloma, free light chains circulate in the serum and deposit in the tissues causing primary AL amyloidosis

129
Q

Myeloma kidney is a build up of _ in the kidney tubules that can lead to renal failure

A

Myeloma kidney is a build up of free light chain in the kidney tubules that can lead to renal failure

130
Q

In MM, free light chain is excreted in the urine as _ protein

A

In MM, free light chain is excreted in the urine as Bence Jones protein

131
Q

Increased serum protein with M spike on SPEP but no other features of multiple myeloma is diagnostic of _

A

Increased serum protein with M spike on SPEP but no other features of multiple myeloma is diagnostic of monoclonal gammopathy of undetermined significance (MGUS)
* No lytic bone lesions, hypercalcemia, AL amyloid, or Bence Jones proteinuria

132
Q

Monoclonal gammopathy of undetermined significance (MGUS) is most common in [age]

A

Monoclonal gammopathy of undetermined significance (MGUS) is most common in elderly

133
Q

Waldenstrom macroglobulinemia is a B cell lymphoma with monoclonal [immunoglobulin] production

A

Waldenstrom macroglobulinemia is a B cell lymphoma with monoclonal IgM production
* IgM pentamers are very large = MACROglobulinemia

134
Q

All of the clinical manifestations of Waldenstrom macroglobulinemia are a result of [hematologic effect] due to high IgM

A

All of the clinical manifestations of Waldenstrom macroglobulinemia are a result of hyperviscosity due to high IgM
* Generalized lymphadenopathy
* M spike
* Visual and neuro deficits (retinal hemorrhages or strokes)
* Bleeding from defective platelet aggregation

135
Q

Acute complications of Waldenstrom macroglobulinemia are treated with _

A

Acute complications of Waldenstrom macroglobulinemia are treated with plasmapheresis
* To remove IgM from the serum

136
Q

_ is a neoplastic proliferation of Langerhan cells

A

Langerhan cell histiocytosis is a neoplastic proliferation of Langerhan cells
* Recall that Langerhan cells are specialized dendritic cells primarily in the skin
* Derived from bone marrow monocytes

137
Q

Langerhans cell histiocytosis is [marker] and [marker] positive on immunohistochemistry

A

Langerhans cell histiocytosis is CD1a+ and S-100+ positive on immunohistochemistry

138
Q

Langerhans cell histiocytosis has classic [finding] on electron microscopy

A

Langerhans cell histiocytosis has classic Birbeck (tennis racket) on electron microscopy

139
Q

Leukemias can be [cells] while lymphomas are [cells]

A

Leukemias can be myeloid or lymphoid while lymphomas are lymphoid

140
Q

Leukemias typically present with CBC abnormalities while lymphomas tend to present with _

A

Leukemias typically present with CBC abnormalities while lymphomas tend to present with lymphadenopathy
* There is overlap!

141
Q

(Lymphoma/leukemia) is a discrete tumor mass arising from lymph nodes

A

Lymphoma is a discrete tumor mass arising from lymph nodes

142
Q
A

Integrated systems (4 decks)

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