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Hem/Onc 2 > Pathology > Flashcards

Pathology Flashcards

1
Q

At what cell level determines leukopenia?

A

< 5 K/uL

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2
Q

At what cell level determines leukocytosis?

A

> 10 K/uL

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3
Q

For leukopenia, what can drugs damage to result in decreased production of WBC’s, especially neutophils?

A

Stem cells

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4
Q

Why can infection cause leukopenia?

A

Theres increased movement of N0 into tissues from the blood

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5
Q

What 2 drugs may be used to boost lymphocyte production, thereby decreasing the risk of infection?

A

GM-CSF or G-CSF

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6
Q

This is the term that refers to a decreased # of circulating lymphocytes.

A

Lymphopenia

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7
Q

What are 2 important immunodeficiency causes of lymphopenia?

A

DiGeorge or HIV

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8
Q

Increased levels of what hormone can cause lymphopenia from the induction of apoptosis in lkymphocytes?

A

Cortisol

like in Cushings

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9
Q

What type of treatment causes lymphopenia because lymphocytes are super sensitive to ti?

A

Radiation

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10
Q

This is the term for increased N0 in the circulation.

A

Leukocytosis

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11
Q

When there are increased N0 release in an infection, what forms of N0 are released into the circulation?

A

Immature forms

left shift

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12
Q

The immature forms of N0 are characterized by a decrease in what?

A

Fc receptors (CD16)

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13
Q

High levels of what hormone can impair the adhesion of N0, leading to leykocytosis?

A

cortisol

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14
Q

What 2 conditions can cause monocytosis?

A

chronic inflammatory states and malignancy

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15
Q

Allergic reactions, parasitic infetions, and Hodgkin lymphoma can cause an increase in which WBC in the ticruculation?

A

Eosinophils (E0)

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16
Q

Which WBC is increased in CML?

A

Basophils (B0)

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17
Q

Viral infections can lead to an increase in which WBC?

A

Lymphocytes

lymphocytic leukocytosis

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18
Q

Which bacteria can lead to lymphocytic leukocytosis because of the production of lymphocytosis-promting factor?

A

Bordetella pertussis

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19
Q

B. pertussis releases lymphocytosis-promting factor, which blocks what process in lymhocytes?

A

Blocks circulating lymphocytes from leaving the blood to enter the lymph node

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20
Q

This is the term for enlarged lymph nodes.

A

Lymphadenopathy (LAD)

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21
Q

What processes give rise to painful LAD?

A

acute infection (like strep throat)

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22
Q

Which 3 processes give rise to painless LAD?

A

chronic inflammation
metastatic carcinoma
lymphoma

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23
Q

What 2 conditions can give rise to follicluar hyperplasia in LAD?

A

Since it’s the B cell region…

RA
early stages of HIV

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24
Q

What type of infections give rise to paracortex hyperplasia in LAD?

A

Viral

since it’s the T cell region

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25
Q

When do u see hyperplasia of the sinus histiocytes in LAD?

A

When a lymph node is draining a tissue with cancer

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26
Q

After what % of blasts in the bone marrow can u determine neoplastic proliferation?

A

> 20%

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27
Q

Since neoplastic proliferation causes the blasts to “corwd-out” normal hematopoiesis, what happens to the RBC, platelets, and N0 levels?

A

Anemia (fatigue)
Thrombocytopenia (bleeding)
Neutropenia (infection)

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28
Q

What are the 2 characteristics of blasts on smear?

A

No cytoplasm

Punched out nucleolus

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29
Q

What are the 2 subdivisions of acute leukemia?

A

AML and ALL

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30
Q

This is the form of leukemia where there is neoplatic proliferation of lymphoblasts (> 20%) in the bone marrow.

A

ALL

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31
Q

Which marker is positive in ALL, which differentiates it from AML?

A

tdt +

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32
Q

Which genetic condition can predispose you to ALL? at what age?

A

Down’s syndrome AFTER the age of 5

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33
Q

What is the most common type of ALL?

A

B-ALL

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34
Q

In addition to a + tdt, what 3 CD’s are expressed in B-ALL?

A

CD10, CD19, and CD20

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35
Q

Does B-ALL have a good or bad response to chemo?

A

excellent

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36
Q

What 2 areas must u treat prophylactically when doing chemo in the Tx of B-ALL?

A

Scrotum

CSF

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37
Q

Which form of B-ALL has a good prognosis and is seen in kids?

A

t(12;21)

“good palindrome”

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38
Q

Which form of B-ALL has a bad prognosis and is seen in adults?

A

t(9;22)

philadelphia chromosome

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39
Q

Which form of ALL is + to tdt, CD2 - CD8?

A

T-ALL

NO CD10

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40
Q

What are the 3 T’s for T-ALL?

A

T-all
Thymic mass
Teenager

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41
Q

What is the causitive problem for N0 with toxic granulations (dark), Dhole bodies (puddles of ER), and cytoplasmic vacuoles?

A

Sepsis or severe inflammatory disorders

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42
Q

This si form of leukemia where there is neoplastic proliferation of myeloblasts (> 20%) in the bone marrow.

A

AML

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43
Q

What is the marker that is + in AML, which distinguishes it from ALL?

A

MPO

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44
Q

What are the crystalized aggregates of MPO called in cells?

A

Auer rods

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45
Q

Which age group typically gets AML?

A

older adults (50-60)

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46
Q

What is the form of AML that is characterized by t(15;17) involving the RAR on 17 moving to 15?

A

APL

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47
Q

What is disrupted when RAR moves from 17 to 15?

A

maturation –> promyelocytes (blasts) accumulate

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48
Q

What condition does APL set u up for because of the accumulation of numerous primary granules?

A

DIC

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49
Q

What is the treatment for APL, which binds the altered receptor and causes the blasts to mature?

A

ATRA

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50
Q

What is the form of AML characterized by the proliferation of monoblasts?

A

Acute Monocytic Leukemia (AmcL)

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51
Q

What does AmcL lack that is different than most AML’s?

A

MPO

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52
Q

Where in the body is there infiltration of blasts in AmcL?

A

Gums

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53
Q

What is the other form of AML that lacks MPO?

A

Acute megakaryoblstic leukemia (AmkL)

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54
Q

At what age are Down’s syndrome kids at risk for AmkL?

A

< 5

remember >5 is ALL

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55
Q

What may predispose u to AML, especially with prior exposure to alklating agents or radiotherapy?

A

myelodysplastic syndromes

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56
Q

myelodysplastic syndromes usually present with what problems which sets u up for AML?

A

cytopenias
hypercellular bone marrow
abnormal maturation of the cells
increased blasts

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57
Q

What 2 things do people die from in myelodysplastic syndromes?

A

Infeciton or bleeding

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58
Q

Which form of leukemia is from neoplastic proliferation of MATURE ciruclating lymphocytes, has a high WBC count, and is seen in older adutls?

A

Chronic leukemia

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59
Q

What is the form of Chronic leukemia where there is neoplastic proliferation of naive B cells?

A

CLL

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60
Q

What 2 CD’s do B cells express in CLL?

A

CD5 (normally on T cell)

CD20

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61
Q

In addition to an increased lymphocytes, what type of cells are seen on smear in CLL?

A

Smudge cells

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62
Q

What is the condition in CLL where involvement of the lymph nodes leads to generalized lymphadenopathy?

A

Small lymphocytic lymphoma

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63
Q

What is the most common cause of death in CLL pts, because there are no plasma cells?

A

Hypogammaglobulinemia

64
Q

What hemolysis problem can u get in CLL?

A

AIHA

65
Q

What can CLL transform into, which is distinguished by enlarging lymph node or spleen?

A

B-cell lymphoma (Richter transformation)

66
Q

This is the form of chronic leukemia characterized by neoplastic proliferation of mature B cells with hairy cytoplasic processes.

A

Hairy Cell Leukemia (HCL)

67
Q

What marker is + in HCL which distinguishes it form other leukemia?

A

TRAP

68
Q

What happens to the spleen and boen marrow in HCL?

A 
Splenomegaly
Marrow fibrosis (dry tap)
69
Q

True or False: there is lymph node enalrgement in HCL.

A

FALSE

70
Q

What is the drug for HCL, which allows toxic accumulaitons of adenosine in neoplastic B cells?

A

2-CDA

71
Q

This is the form of chronic leukemia where there is neiplastic proliferation of mature CD4+ T cells and is seen in Japan and the Carribean.

A

ATLL

72
Q

What is the virus associated with ATLL?

A

HTLV-1

73
Q

What are the skin, spleen/liver, and bone findings in ATLL?

A

Rash
Hepatosplenomegaly with LAD
Lytic (punched-out) bone lesions with hypercalcemia

74
Q

The lytic (punched-out) bone lesions in ATLL looks like multiple myelomas, but what characteristic distinguishes ATLL from multiple myelomas?

A

Rash

75
Q

This is a form of chronic leukemia where there is neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing a localized skin rash, plaques, and nodules.

A

Mycosis Fungoides

76
Q

What is the term for the aggregates of neoplastic cells in the epidermis of Mycosis Fungoides?

A

Pautrier microabscesses

77
Q

What is the syndrome called in Mycosis Fungoides where the cells spread to the blood?

A

Sezary syndrome

78
Q

What cells do u see on smear that is characteristic of Sezary syndrome?

A

Cerebriform nuclei (sezary cells)

cerebriform means they look like a brain

79
Q

This is the neoplastic proliferation of lymphoid cells that forms a mass.

A

Lymphoma

80
Q

What are the 2 subdivisions of lymphoma?

A 
Non-Hodgkins Lymphoma (NHL, 60%)
Hodgkins Lymphoma (HL, 40%)
81
Q

What are the 3 different regions of a lymph node?

A

FOLLICLE, that’s surrounded by the MANTLE, which is surrounded by the MARGINAL layer

82
Q

What are the 4 different small B cell NHL’s?

A

Follicular
Mantle cell
Marginal zone
Small lymphocytic (ie. CLL that involve tissue)

83
Q

What is the 1 intermediate-size NHL?

A

Burkitt lymphoma

84
Q

What is the 1 large B cell NHL?

A

diffuse large B-cell lymphoma

85
Q

I’m going to give characteristics and u tell me whether they’re NHL or HL. Ready?

Higher frequency

A

NHL

86
Q

Malignant cells are lymphoid cells

A

NHL

87
Q

Painless lymphadenopathy, in late adulthood.

A

NHL

88
Q

Mass is predominantly reactive cells

A

HL

89
Q

Malignant cells are Reed-Sternberg cells

A

HL

90
Q

Mass is composed of lymphoid cells

A

NHL

91
Q

Painless lymphadenopathy occasionally with B symptoms, in young adults.

A

HL

92
Q

Diffuse spread

A

NHL

93
Q

No leukemic phase.

A

HL

94
Q

Staging guides therapy, radiation is the mainstay of treatment.

A

HL

95
Q

Has a leukemic phase.

A

NHL

96
Q

Rarely spreads

A

HL

97
Q

Staging is of limited importance

A

NHL

98
Q

This is the NHL where there is neoplastic prolfieration of small B cells (CD20+) that form follicle-like nodules.

A

Follicular lymphoma (FL)

99
Q

At what age do u get FL?

A

Late adulthood

100
Q

What is teh mutation to cause FL?

A

t(14;18)

101
Q

What is on chromosome 18 that translocates to the Ig heavy chain locus on 14?

A

BCL2

102
Q

The new overexpression of BCL2 in FL causes the inhibition of what process?

A

Apoptosis

103
Q

Treatment for Fl is with what 2 methods, and is usualyl in thos ehwo are symptomatic?

A

low-dose chemo

Rituximab (anti-CD20 Ab)

104
Q

What is the important complication in FL, which presents as an enlarging lymph node?

A

progression to diffuse B cell lymphoma

105
Q

What are the 4 ways that follicluar lymphoma is distinguished from follicular hyperplasia?

A
  1. FL disrupts normal architecture
  2. Lack of tingible body M0
  3. BCL12 expression
  4. Monoclonality
106
Q

This is the form of NHl where there is neoplastic prolfieration of small B cells that expands the mantle zone.

A

Mantle cell lymphoma (MCL)

107
Q

What is the transloacation in MCL?

A

t(11;14)

108
Q

What is the gene on chromsoome 11 that is translocated to the Ig heavy chain locus on 14 in MCL?

A

Cyclin D1

109
Q

The overexpression of cyclin D1 in MCL promotes the transition of what phases in the cell cycle?

A

G1/S

110
Q

What is the NHL that is of neoplastic proliferation of small B cells (CD20+) that expands the marginal zone?

A

Marginal zone lymphoma (MZL)

111
Q

What “states” is MZL associated with?

A

Chronic inflammatory states

like Hashimotos, Sjogrens, H pylori

112
Q

What type of B cells form the marginal zone?

A

Post-germinal B cells

113
Q

This is the form of MZL that is in mucosal sites.

A

MALToma

114
Q

What Tx might regress MALToma?

A

H pylori treatment

115
Q

This is the form of NHL where there is neoplastic proliferation of intermediate-sized B cells (CD20+).

A

Burkitt lymphoma (BkL)

116
Q

What infection is assocaited with BkL?

A

EBV

117
Q

The African form of BkL forms a mass on what area of the body?

A

Jaw

118
Q

Where in the body does the sporatic form of BkL form?

A

Abdomen

119
Q

What is the translocation to cause BkL?

A

t(8;14)

120
Q

What is the gene that is translated from 8–>14 in BkL?

A

c-myc

121
Q

The overexpression of c-myc in BkL promotes what?

A

Cell growth

122
Q

What do u see on microscopy in addition to a high mitotic index in BkL?

A

Starry sky appearance

123
Q

This is the NHl where there is neoplastic proliferation of large B cell (CD20+) that grow diffusely in sheets.

A

Diffuse Large B cell lymphoma (DLBL)

124
Q

Is DLBL aggressive or mild?

A

Aggressive

125
Q

DLBL may arise sporatically or from the transofrmation of what type of lymphoma?

A

a low-grade lymphoma, like follicular

126
Q

This is the form of lymphoma whre there is neoplastic proliferation of Reed-Sternberg cells.

A

HL

127
Q

What are reed-sternberg cells?

A

large B cells with multilobed nuclei and prominent nucleoli (owl-eye)

128
Q

What 2 markers are HL + for?

Hint: it’s not CD20, like in NHL.

A

CD15, CD30

129
Q

What are the Sx of HL because they release cytokines?

A

B symptoms, like fever, chills, and night sweats

130
Q

The cytokines released in HL causes the infiltartion of which cells, which makes up the bulk of the tumor?

A

Reactive inflammatory cells

131
Q

What is the most common subtype of HL?

A

Nodular sclerosis

132
Q

Who is at risk for nodular sclerosing HL, characterized by an enlarging cerivical tumor?

A

Young adult females

133
Q

In nodular-sclerosing HL, what happens to the lymph node?

A

it’s divided by bands of sclerosis

134
Q

In nodular-sclerosis HL, what do u see in in the RS cells?

A

RS are in lake-like spaces (lacunar cells)

135
Q

Which form of HL has the best prognosis?

A

Lymphocyte-rich HL

136
Q

This is the malignant proliferation of plasma cells in the bone marrow.

A

Multiple Myeloma (MM)

137
Q

True or False: MM is the most common primary maligancy of the bone.

A

True

138
Q

What is the most common malignant lesion of the bone overall?

A

Metastatic cancer

139
Q

Which IL is increased in MM, which stimulates plasma cell growth overall?

A

IL-6

140
Q

MM can activate the RANK receptor on osteoclasts, leading to what deformity on X-ray?

A

Punched-out skeletal lesions (esp in the verebreae and skull)

141
Q

What spike is seen on SPEP for MM, usually due to monoclinal IgG or IgA?

A

M spike

142
Q

What happens to antigenic diversity in MM?

A

It drops

143
Q

Lack of antigenic diversity in MM predisposes you to what?

A

infections (most common cause of death)

144
Q

This is the weird formation of RBC’s on smear in MM, where increased serum protein decreases the charge between RBCs.

A

Rouleaux formation

145
Q

In MM, the overproduction of L chain causes what problem?

A

Amyloidosis

146
Q

The free L chain in MM is called what in urine and kidney?

A

Urine- Bence Jones protein

Kidney- myeloma kidney

147
Q

What is it called when there is na isolated M spike and nothing else (like those seen in MM)?

A

Monoclonal Gammopathy of Undetermined Significance (MGUS)

148
Q

Who gets MGUS?

A

Elderly

149
Q

This is the B-cell lyphoma that is characterized by monoclonal IgM production.

A

Waldenstorm macroglobulinemia

150
Q

True or False: in Waldenstorm macroglobulinemia, there is generalized lymphadenopathy with lytic bone lesions.

A

FALSE.

there are no bone lesions

151
Q

True or False: in Waldenstorm macroglobulinemia, theres increased serum protein with an M spike.

A

True

152
Q

What are the CNS manifestations of Waldenstorm macroglobulinemia, as a result of increased serum hyperviscosity?

A

Visual and neurological deficits

153
Q

Waldenstorm macroglobulinemia can lead to bleeding because of what problem?

A

defectiv eplatelet aggregation

154
Q

What is the treatment for Waldenstorm macroglobulinemia?

A

Plasmapharesis

155
Q

What is the form of HL that is often assocaited with abundant E0?

A

Mixed cellularity HL

156
Q

What is the most aggressive form of HL, usually seen in the elderly and HIV+ individuals?

A

Lymphocyte-depleted HL

157
Q

Match the following translocations to the Diseases:

  1. t(8;14)
  2. t(11;14)
  3. t(14;18)
  4. t(9;22)
  5. t(12;21)
A. CML
B. Mantle cell lymphoma
C. FL
D. BkL
E. ALL
A
  1. D
  2. B
  3. C
  4. A
  5. E

Hem/Onc 2 (5 decks)

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