Pathoma Ch 6, 10, 14, 18 (WBC, GI, Male GU, MSK) Flashcards
6. WBC D/o 10. GI path 14. Male GU 18. MSK
ALL vs. AML
(a) Cell marker
(b) Age on onset
ALL vs. AML- both acute leukemias (so blasts over 20% of bone marrow), but of the two different hematopoietic lineages
ALL = acute lymphoblastic leukemia
(a) tdt positive = DNA polymerase found only in lymphoblasts (not in myeloid blasts or mature lymphocytes)
(b) Children
AML = acute myeloid leukemia
(a) MPO (enzyme used in O2 dependent killing to catalyze H2O2 –> HOCl, so makes sense it would be seen in neutrophils and macrophage lineage)
- cystal aggregates of MPO = Auer rods
(b) Adults, like over 65
Gastroschisis vs. omphalocele
Gastrochisis = failure for anterior abdominal wall to properly fuse fully => abdominal contents herniate out, not surrounded by peritoneum
Omphalocele = persistent herniation of bowel into umbilical cord => failure of bowel to return during 90 degree rotation
-associated w/ cardiac complications
How to differentiate follicular lymphoma from follicular hyplerplasia (as a result of RA or early HIV)
(a) Tingible body macrophages
(b) Architecture of LN
Follicular lymphoma (neoplastic prolif) vs. follicular hyperplasia (hyperplastic prolif)
(a) Tingible body macrophages are eating up dead cells- won’t be seen in Follicular lymphoma b/c apoptosis is inhibited
(b) LN architecture in maintained in follicular hyplerplasia (follicles all on the periphery, just more of them and they’re bigger), while in follicular lymphoma the follicles take over the entire lymph node (into the cortex) and normal architecture of LN is not maintained
(a) Triad of Behcet syndrome
(b) Mechanism of disease
(b) Behcet syndrome = autoimmune vasculitis (immune complex inflammation of small vessels)
(a) Oculo-oro-genital syndrome
- recurrent apthous ulcers (canker sores), genital ulcers, and uveitis
CLL vs. Hairy Cell Leukemia
(a) Cell of origin
(b) Classic molecular marker or stain
Both are neoplastic proliferation of B cells
CLL
(a) Neoplastic proliferation of naive B cells
(b) CD5 and CD10 posiitve
Hairy Cell Leukemia
(a) Neoplastic proliferation of mature B cells
(b) TRAP stain positive
Differentiate acute and chronic leukemia
Acute leukemia = neoplastic proliferation of immature cells of the myeloid or lymphoid lineage
Chronic leukemia = neoplastic proliferation of mature circulating lymphocytes
MC form of Non Hodgkin Lymphoma
(a) Growth pattern
(b) Differentiation
DLBCL = diffuse large B cell lymphoma
(a) Grows diffusely in sheets
(b) Aggressive cancer b/c it’s poorly differentiated, larger the cell the less they are like the normal cell (so more poorly differentiated they are)
Name 3 complications of myeloproliferative disorders
Myeloproliferative disorders = neoplastic accumulation of mature cells of the myeloid lineage
3 complications
- transformation to AML
- bone marrow fibrosis
- increased risk of hyperuricemia and gout
- 2/2 increased DNA turnover
Differentiate leukoplakia and hairy leukoplakia
Leukoplakia = white plaque that can’t be scared off (so not candida), pre-malignant lesion to squamous cell carcinoma of the mouth
Hairy leukoplakia = rough white patch on LATERAL tongue (lateral is key) in immunocompromised pts, 2/2 EBV infection
-EBV-induced squamous cell hyperplasia, NOT pre-malignant
2 tests to confirm H. pylori eradication
- Negative urea breath test
- b/c H. pylori produced urease (and proteases), so urea will be present in breath - lack of stool antigen
CML
(a) Protein responsible
(b) Tx
(c) Transformation to which acute leukemia?
(d) Key CBC finding
CML = chronic myeloid leukemia
(a) t(9,22) makes BCl-ABL fusion protein that is a constitutively active tyrosine kinase
(b) Tx = Imatinib to block tyrosine kinase activity
(c) If CML transforms to acute leukemia: 2/3 AML and 1/3 ALL
- key here that it’s not only AML!!!! b/c the mutation is in the hematopoietic stem cell, not the myeloid stem cell
(d) Leukocytosis specifically w/ basophilia
MC location for carcinoid tumor
Small bowel
MC subtype of Hodgkin Lymphoma
Nodular sclersois Hodgkin lymphoma (NSHL): LN divided by broad bands of fibrosis w/ Reed Sternberg cells in open spaces = Lacunar cells
Presentation of mumps infection
(a) Feared complication in teenagers
Mumps p/w b/l inflammed parotid glands
(a) Teenagers w/ mumps can develop orchitis that carries risk of sterility
Which myeloproliferative d/o has the lowest risk of hyperuricemia/gout?
Essential thrombocytopenia has the lowest risk of hyperuricemia/gout b/c the high turnover is of plts (no nuclear material), not of RBCs or granulocytes as seen in P. Vera and CML
When do carcinoid tumors cause carcinoid syndrome?
Only can cause carcinoid syndrome (bronchospasm, diarrhea, flushing from excess 5-HT) when the tumor’s drainage bypass the portal vein
So once the tumor mets to the liver and is drained by the hepatic vein, then 5-HT won’t be degraded into 5-HIAA by MAO in the liver (then 5-HIAA excreted in urine)
Pt w/ long standing celiac disease and very tight/adherent diet control presents w/ recurrent disease
Concern?
Late complications of celiac disease:
- small bowel carcinoma
- T-cell lymphoma
Key here is that Celiac disease is T-cell mediated, so causes rare lymphoma that is T-cell (almost all lymphomas are B cell!!)
These two late complications present as refractory disease despite good dietary control
Chronic autoimmune gastritis vs. H. pylori gastritis
(a) Risk of which malignancies?
(b) Location
(a) Both cause incrase risk of gastric adenocarcinoma (intestinal type) b/c chronic inflammation causes metaplasia to intestinal cells
- then H. pylori also increases risk of MALT lymphoma
(b) AI gastritis damages parietal cells which are concentrated in the body and fundus of the stomach. While H. pylori manifests MC w/ inflammation of the antrum
Quick way to differentiate Mallory-Weiss syndrome from esophageal varices
Both will cause hematemesis, but Mallory-Weiss hematemesis is painful (b/c it’s a tear in the mucosa), while esophageal varices are painless bc/ veins have already ruptured
MC genetic translocation seen in leukemias
(a) B-ALL
(b) Acute promyelocytic leukemia
(c) CML
MC genetic translocation seen in
(a) B-ALL = t(12,21)
- 21: hence association w/ Down syndrome
(b) APL: t(15,17) that disrupts retinoic acid receptor needed for promyelocytic maturation
(c) CML: t(9,22) = Philadelphia chromosome
What two areas need prophylactic chemotherapy in tx of B-ALL?
B-ALL has a very good prognosis, w/ an excellent response to chemo
-but the chemo can’t cross the BBB or the blood-testes barrier => CSF and scrotum need prophylactic chemo
Pathology behind achalasia
(a) Secondary infectious cause of achalasia
Achalasia is 2/2 damage to ganglion cells in the myenteric plexus, myenteric plexus located btwn the inner circular and outer longitudinal layers of the muscularis propria
(a) Mostly idiopathic, but achalasia can be 2/2 chagas disease (trypanosoma cruzi infxn)
How to differentiate the two types of ALL
ALL split into B-ALL and T-ALL, differentiate by cell markers
-but both tdt + (DNA polymerase in lymphoblasts)
B-ALL: CD10, CD19, CD30
T-ALL: CD2 to CD8 (no CD10)
What is Whipple disease?
(a) Cause
(b) Clinical presentation
(c) Systemic features
(a) Whipple disease = infection w/ Tropheryma whippelli organism- organism can’t be fully destroyed by macrophages => macrophages accumulate partially-destroyed organisms inside lysosomes and build up in the lamina propria (CT) of the gut
(b) Small bowel lamina propria (positive on PAS stain for organism) is inundated w/ macrophages, which block lacteals => chylomicrons can’t be absorbed => pts p/w fat malabsorption and steatorrhea
(c) Can also cause systemic tissue damage: arthritis, cardiac valves, LN, CNS