Sloka WBC malignancies

Question 1

Neoplastic proliferations etiology

Answer 1

Mutations in Stem cells/Block in differentiation/Maturation

Lymphoid - B, T cells, NK cells
Myeloid - Hematopoietic cells
Histiocytoses - Macrophages/Dendritic cells

Question 2

Lymphoid Neoplasms

Answer 2

Acute lymphoblastic leukemia/lymphoma (ALL)
Chronic Lymphocytic leukemia/lymphoma (CLL)
- Adult T cell leukemia
-Hairy cell leukemia
Plasma cell neoplasms
Hodgkin lymphoma/ Non-Hodgkin lymphoma

HL characteristic presentation & predictable spread pattern

Question 3

Lymphoid neoplasms Pathogenesis risk factors

Answer 3

(Most) Acquired mutations, Inherited mutations
Chromosomal TRANSLOCATIONS (MC in leukemia/lymphoma)
Chronic inflammation (EBV)
Ionizing radiation
Chemicals (benzene)
Viruses (EBV)
smoking

Question 4

Lymphoid neoplasms Pathogenesis

Answer 4

Pro-growth mutation in pleuripotent cell
Goes toward Warburg metabolism (anaerobic)
Pro-survival mutation(BCL2)
Increased self-renewal (IL-2?)

Question 5

WHO classification of Lymphoid Neoplasms

Answer 5

1. Precursor B-cell neoplasms (immature B-cells)
2. Peripheral B-cell neoplasms (mature B-cells)
3. Precursor T-cell neoplasms (immature T-cells)
4. Peripheral T-cell and NK-cell neoplasms (mature T cells and NK cells)
5. Hodgkin lymphoma (Reed-Sternberg cells and variants)

Question 6

General Principles of lymphoid Neoplasms

Answer 6

1. May be suspected from clinical features but biopsy is required
2. Antigen receptor rearrangement generally precedes transformation
3. Most resemble some recognizable stage of B or T-cell differentiation
4. Often associated with immune abnormalities
5. Tend to recapitulate behavior of their normal counterparts
6. Hodgkin lymphoma spreads in a predictable fashion

Question 7

pre-B Lymphoblast

Answer 7

Acute

Precursor B lymphoblastic lymphoma/leukemias

Question 8

Naive B cell

Answer 8

Small lymphocytic lymphoma

Chronic lymphocytic leukemia

Question 9

Plasma cell

Answer 9

Multiple myeloma

Question 10

Mantle zone LN

Answer 10

Mantle cell lymphoma

Question 11

Germinal center LN

Answer 11

Follicular lymphoma
Burkitt lymphoma
Diffuse large B cell lymphoma
Hodgkin’s lymphoma

Question 12

Marginal zone

Answer 12

Diffuse large B cell lymphoma
Small lymphocytic lymphoma
Chronic lymphocytic leukemia

Question 13

Immature Thymus

Answer 13

Precursor T lymphoblastic lymphoma/leukemias

Question 14

T cell neoplasm in LN

Answer 14

Peripheral T cell lymphoma

Question 15

CD1

Answer 15

Thymocytes
Langerhans cells
Histiocytes - 
Macrophages
Dendritic cells

Question 16

CD3

Answer 16

Thymocytes

Mature T cells (forms part of receptor)

Question 17

CD4

Answer 17

Helper T cells

Question 18

CD 8

Answer 18

Cytotoxic T cells

some NK cells

Question 19

CD10

Answer 19

Pre-B cells
Germinal center B cells
(lymphoblasts)

Question 20

CD 19

Answer 20

Pre-B cells
Mature B cells
NOT plasma cells

Question 21

Antibodies made in what type of neoplasms

Answer 21

Plasmacytoid?
CLL
Macroglobinemia

Question 22

CD20

Answer 22

Pre-B cells after CD19
Mature B cells
NOT plasma cells

Question 23

CD21

Answer 23

EBV receptor
Mature B cells
Follicular dendritic cells

Question 24

CD14

Answer 24

Monocytes

Question 25

CD15

Answer 25

Granulocytes
Reed-Sternberg cells
Hodgkin’s Lymphoma

Question 26

CD30

Answer 26

Reed-Sternberg cells
Hodgkin’s lymphoma

activated B, T cells, and monocytes

Question 27

CD16

Answer 27

NK cells

granulocytes

Question 28

CD56

Answer 28

NK cells

subset of T cells

Question 29

B-cell acute lymphoblastic leukemia/lymphoma

Answer 29

Bone marrow precursor B cell

t(12:21) RUNX1 and ETV6 - 25%

3 y.o. children

Aggressive

Question 30

T-cell acute lymphoblastic leukemia

Answer 30

Precursor T cell (thymus mc)

translocations
-NOTCH1?

Adolescent Males

Aggressive - difficult to tx

Question 31

ALL epidemiology

Answer 31

MC (B>T) cancer and leukemia in children

-

Question 32

Early Pre-B cell ALL

Answer 32

Common ALL ag: CD10*
TdT+
t(12:21), hyperdiploidy

-Prognosis
95% remission
75-85% cures

Question 33

Early Pre-B cell ALL Laboratory & sx

Answer 33

WBC - (lymphoids^)
NN anemia*
Thromocytopenia*
Lymphoblasts - Peripheral &/or BM

Aching sternum

Question 34

Pre-T cell ALL

Answer 34

CD10 neg
TdT+*
Anterior medistinal mass/acute leukemia
Adolescent males

Usually lymphoma only

NN anemia*
Thromocytopenia*

Question 35

Small Lymphocytic lymphoma/ CLL

Answer 35

MC naive B cell
some memory B cells

Olderadults w/ BM, LN, spleen, and liver disease

Minority: autoimmune hemolysis & thrombocytopenia

Question 36

CLL

Answer 36

MC leukemia 15000 - adults
>60 y.o.
MC generalized LAD
Virgin B-cell* maturation

Question 37

MC leukemia

Answer 37

CLL

Question 38

MC generalized LAD

Answer 38

CLL

Question 39

CLL Laboratory

Answer 39

WBC count - depends when found 
  -5000 dx
  -2000 early
Smudge cells*
NN anemia 50%
Thrombocytopenia 40%
Hypogammaglobulinemia - may have Ig spike Ab for hemolysis
BM -

Question 40

Bilateral axillary LAD suggests

Answer 40

CLL

Question 41

Burkitt lymphoma book chart

Answer 41

Germinal center B-cell
t(8:14) MYC, IgG
-EBV associated

Adolescents or young adults w/ extranodal masses
-rare leukemia presentation

Question 42

t(8:14)

Answer 42

Burkitt lymphoma

MYC + Ig

Question 43

Diffuse large B-cells lymphoma book chart

Answer 43

Germinal center or postgerm B cell

All ages
- older adults

Rapidly growing mass

Aggressive

HIV brain, EBV …

Question 44

Burkitt’s lymphoma variants

Answer 44

African - jaw

North American - abdominal mass

Question 45

30% of all child NHL in US (3-7 y.o.)

Answer 45

Burkitt lymphoma

-B-cell non-Hodgkins lymphoma