The hematologic system CH 30

Question 1

Burkitt Lymphoma

Answer 1

B-cell non-Hodgkin’s lymphoma
• 30% of childhood lymphomas world wide
• Highly aggressive, fastest growing human tumor
• In children and young adults
3 types
1. Endemic: common in Africa, linked to EBV, and coinfection with malaria
a.Rapid growing tumor of jaw and facial bones
2. Sporadic: occurs worldwide
a.Involves the abdomen, extensive bone marrow invasion and replacement
3. Immunodeficiency-related: seen in people with AIDS

Clinical manifestations:
• Abdominal swelling
• Tumor of jaw and facial bones
• Involvement of eye, ovaries, kidneys, glandular tissue
• Symptoms of acute abdomen, intestinal perf.
• Renal failure

Question 2

Hodgkin Lymphoma

Answer 2

• HALLMARK of HL and needed for diagnosis: Large binucleate RS cells (Reed-Sternberg)
Progresses from one group of lymph nodes to another, involves systemic symptoms.

dual peak: 2nd and 3rd decade then again in 6th and 7th decade
linked to EBV infection

•Enlarged painless lymph node in the neck

Question 3

Hypersplenism

Answer 3

When splenomegaly is present and functions of the spleen become overactive
1. Cytopenia
2. Cellular bone marrow
3. Splenomegaly
4. Improvement after splenectomy
Primary: when no contributing etiology can be identified
Secondary: presence of another condition
• Causes are numerous but some include: infection, hepatic cirrhosis, tumors, cancers
Clinical manifestation
• Affects all blood components
• May sequester up to 50% of erythrocytes
• Anemia, neutropenia
• Dilutional effects on blood

Question 4

Infectious mononucleosis

Answer 4

• Benign, acute, self-limiting lymphoproliferative syndrome
• Acute viral infection of B lymphocytes
• Most common agent is EBV
• Can be caused by cytomegalovirus (CMV) in older adults

Clinical manifestations:
• Incubation period 4-8 weeks
• Prodrome 3-5 days
• Sore throat and fever initially, malaise,
• pharyngitis, lymphadenopathy, white-green exudate from pharyngitis
• splenomegaly

Question 5

Acute Leukemia

Answer 5

• Abrupt and rapid with short survival time
• Characterized by undifferentiated or immature cells

Acute lymphocytic leukemia (ALL)
o Aggressive, fast growing, too many lymphoblasts

acute myelogenous leukemia (AML)
o aggressive, fast growing with too many myeloblasts
o the more common acute leukemia in adults

clinical manifestations:
• fatigue, bleeding, fever,
• anorexia, diminished taste, dysphagia,
• liver, spleen, lymph node enlargement, abdominal pain and tenderness, breast tenderness,
• bone and joint pain, headache, vomiting,

Question 6

Chronic Leukemia

Answer 6

Longer life expectancy than acute leukemias, extends several years from time of diagnosis
Three phases of disease. CHRONIC phase lasts 2-5 years, ACCELERATED phase lasts 6-18 mos., TERMINAL BLAST phase 3-6 mos. survival.
Chronic Myelogenous Leukemia (CML)
o Mostly a disease of adults but can occur in children
Chronic Lymphocytic Leukemia (CLL)
o In adults, most common leukemia in the western world
o Slow growing cancer
o Too many immature lymphocytes
Clinical manifestations:
• 70% asymptomatic at time of diagnosis
• Lymphadenopathy
• Increased risk for infection
• In acute phase: Painful splenomegaly, Gouty arthritis

Question 7

Lymphoblastic Lymphoma

Answer 7

o Rare variant of NHL

• Fast growing, increased number of lymphoblasts in lymph nodes and thymus

• Arises from malignant t cell in the thymus
• Very aggressive and usually presents at stage 4

Clinical manifestations
• Painless lymphadenopathy in the neck
• 70% of people have involvement of lymph nodes in the chest
• Mediastinal mass
• Chest pain, difficulty breathing
• Liver, kidney, spleen, brain may become involved
• Type B symptoms (fever, night sweats, weight loss)

Question 8

Multiple Myeloma

Answer 8

Most common, and most aggressive plasma cell cancer
• Characterized by slow proliferation of tumor cell masses in bone marrow associated with lytic bone lesions (areas of bone that have been eaten away)
• Suppression of normal plasma cells by the myeloma results in diminished or absent antibodies

(Bence jones protein), present in blood and urine in 80% of affected
• Reported incidence DOUBLED in last two decades

Clinical manifestation
•	Hypercalcemia r/t bone lysis
•	Anemia
•	Bone lesions
•	Renal failure

Question 9

Non-Hodgkin Lymphoma

Answer 9

Heterogenous group of neoplasms arising from lymphoid tissue/ varied clinical features
• Includes B cell neoplasms, T cell, and NK-cell neoplasms.
• NO RS cells
• Disease of middle age found in individuals over 50
• Risk factors include radiation, chemical exposure; viruses including EBV and HIV, immune suppression, H Pylori

Clinical manifestations:
• Lymphadenopathy that can include cervical, axillary, femoral, inguinal areas.
• Painless swelling over months or years
• May have retroperitoneal and abdominal masses
• Weight loss, night sweats, fever, fatigue in later stages of disease
• hepatomegaly