test 2 deck Flashcards
What defines a leukemia?
Leukemia is applied to neoplasms that typically involve the bone marrow and peripheral blood
What is the difference between a chronic and acute leukemia?
Chronic leukemia will be composed primarily of mature cells (< 20% blasts in marrow)
Acute will primarily be composed of blast cells (> 20% blasts in marrow)
What visual feature can differentiate a blast from a more mature cell?
Blast cells contain nucleoli in their nuclei
What is the only definitive visual feature that can differentiate between AML and ALL? Can this be used all the time?
AML contains Auer rods
(Auer rods are crystalized myeloperoxidase enymes)
No! Auer rods are only found in the promyelocytic subtype.
What defines a lymphoma?
Lymphoma is used to describe lymphoid tumors that present as masses within lymph nodes and other soft tissues
Draw the hematopoiesis lineage (Pathoma version)
Where in the hematopoiesis lineage are Acute Myeloid Leukemias?
What are the general clinical symptoms of AML?
Bone infiltration of blasts results in:
anemia
neutropenia
thrombocytopenia
What are the 3 subtypes of Acute Myeloid Leukemia (AML)?
Acute promyelocytic leukemia
Acute monocytic leukemia
Acute magakaryoblastic leukemia
Name the genetic mutation, lab finding, common complication, and treatment for Acute Promyelotic Leukemia.
Genetic mutation: t(15;17) PML-RAR-alpha
Common lab finding: Auer rods (crystalized myeloperoxidase)
Common complication: DIC (ruptered cells release Auer rods)
Treatment: ATRA (Vitamin D); forces cells to mature
Name the common complication for Acute Monocytic Leukemia.
gum infiltration
Where in the hematopoietic lineage are myeloproliferative disorders?
What are the 4 myeloproliferative disorders (important to us?)
Polycythemia vera
CML
Essential thrombosis
Myelofibrosis
Name the genetic mutation, lab finding, PE finding, common complication, and treatment for Acute Promyelotic Leukemia.
Genetic: t(9;22) philadelphia translocation BCR-ABL
Lab finding: pancytosis (basophilia is common) and decrease alkaline phosphatase
PE finding: splenomegaly
complication: Blast crisis (either AML or ALL)
Treatment: Imatinib
Name the genetic mutation, lab finding, common complication, and treatment for Polycythemia vera
Genetic: JAK2 mutation
Lab finding: pancytosis, especially in RBCs
Common complication: erythromelalgia, pruritus after shower, and headache
Treatment: phelbotomy and ASA to prevent thrombosis
Where in the hematopoietic lineage are ALLs?
What are the 2 types of ALLs we need to know? How common are they?
B-ALL (very common)
T-ALL (not common)
Name the genetic mutation, lab finding, and common complication for B-ALL.
Genetic: t(12;21) good progrnosis; t(9;22) bad prognosis
lab findings: Express CD10 (calla), CD19, CD20; tDt +
Common complications: brain and testes mets
Name the lab findings and common PE finding for B-ALL.
lab finding: CD2-CD8
mediastinal mass (thymus)
Where in the hematopoietic lineage are chronic leukemias?
What are the 4 types of chronic leukemias?
CLL
Hairy cell
Adult T-Cell Leukemia/Lymphoma
Mycosis Fungoides
Name the cell type (B or T), genetic mutation, lab finding, and common complication for CLL.
Cell type: B cell
Genetic: Del 17q (TP53) - bad prognosis; Del 13q - good prognosis
Lab findings: Cells co-express CD5 (T cells) and CD20 (B cells)
Common complication: can cause LAD, which then becomes small lymphocytic lymphoma; autoimmune hemolytic anemia (warm and cold)
Is lymphadenopathy common in lymphomas?
yes
What is a virchow’s node?
supraclavicular LAD (virchow’s node) usually indicates malignancy
What are B symptoms?
Fever, night sweats, weight loss
What are the two types of lymphomas (big categories)
Hodgkin lymphoma
Non-Hodgkin lymphoma
Are B cells or T cells more common in NHL?
B cells (~85%)
T cells & NK cells (~15%)
What are the 5 types of NHLs? (Only the B cells)
Follicular lymphoma
Mantle cell lymphoma
Marginal cell lymphoma
Burkitt lymphoma
Diffuse large B cell lymphoma
Name the genetic mutation, lab findings, clinical course (fast/slow growing), and PE finding for follicular lymphoma.
genetic: t(14;18) Bcl2-IgH (Bcl2 inhibits apoptosis)
lab findings: mutliple follicles even in the medula; Cleft nucleus
Clinical course: indolent
PE finding: LAD
Name the genetic mutation, lab finding, and PE finding for Mantle cell lymphoma.
genetic: t(11;14) cyclinD-IgH (cyclinD pushes G1/S cycle)
Lab finding: CD5+, CD20+
PE finding: LAD
Name the genetic mutation, lab finding, subtypes, and common association for Burkitt lymphoma.
Genetic: t(8;14) c-myc-IgH
Lab findings: starry sky apprearance (sheets of lymphocytes and stars are macrophages); cytoplasmic vacuoles
subtypes: Sporatic (abdomen) and Endemic (jaw)
Common association: EBV
Name the genetic mutation and lab finding for Diffuse Large B Cell Lymphoma.
genetic: unknown
lab findings: large atypical cells
Where in the hematopoietic lineage are plasma cell malignancies?
What is the plasma cell malignancies we need to know?
Monoclonal gammapathy of undetermined significance (MGUS)
multiple myeloma
What is MGUS (basic)?
MGUS is basically MM without the CRAAB symptoms
What is multiple myeloma?
Malignant proliferation of plasma cells in bone marrow
What are the clinical manifestations of MM? (CRAAB)
- HyperCalcemia
-
Renal involvement
- Bence-Jones protein in urine (free light chains)
- Renal failure is free light chains deposit into the tubules
- Anemia
- Amyloidosis
- Bone lytic lesions/Back pain
What would indicate MGUS or MM on SPEP?
M spike
in MM, how do RBCs arrange themselves?
Rouleaux formation
