WBC Cancer Genetics

Question 1

Burkitt

Answer 1

t 8,14
c-myc, heavy Ig
c-myc oncogene promotes cell growth (high mitotic index) - intermediate B cell lymphoma => starry sky b/c growing so fast die then cleaned up by tingible body macro

Question 2

Follicular lymphoma

Answer 2

t 14. 18
Ig H, Bcl 2
Bcl 2 inhibits apoptosis - stabilizes mito membrane so no cyto c leaks out
Normally you WANT apoptosis in the follicle to kill self reactive B cells

Question 3

How do you tell the difference bet follicle hyperplasia in response to infection vs follicular lymphoma?

Answer 3

Hyperplasia - have tingible body macro b/c cells are apoptosing like they should, poly clonal explansion, no Bcl 2 expression
Neoplasma: no TBM, monoclonal expansion with kappa:lambda ratio 20:1 (should be 3:1), disrupt normal architecture

Question 4

Mantle cell lymphoma

Answer 4

t 11, 14
Cyclin D1, Ig H
Cyclin D promotes G1 -> S
“Region immediately adjacent to the follicle”

Question 5

Adult T cell leukemia/lymphoma

Answer 5

HTLV - human T lymphocyte virus

Question 6

B-ALL for kids vs adults

Answer 6

Blasts will be + for tdt, CD 10, 19 and 20
Kids: t 12,21 = good prognosis
Adults: t9,22 = Philadelphia, bad prognosis (cause really thinking CML)

Question 7

APL

Answer 7

t 15, 17
Move RAR from its spot on 17 - blasts don’t get maturation signal
Type of AML: +MPO, Auer rods
Increased risk DIC

Question 8

Which AML infiltrates the gums

Answer 8

Acute MONOCYTIC leukemia

No MPO here

Question 9

Which leukemia is associated with Downs before vs after 5yo

Answer 9

AML = before 5

ALL - after 5

Question 10

CML

Answer 10

t 9, 22 = Philadelphia
Tyrosine kinase fusion product
Use imatinib = TK I

Question 11

Difference between CML and leukemoid rxn (aka infection)

Answer 11

CML

• Negative LAP stain (normal neutrophils have ↑LAP activity)
• Increased basophils specifically - stain dark purple because of all basophilic granules
• t 9.22 mutation

Question 12

Myelodysplastic syndromes: PV, ET, myelofibrosis

Answer 12

JAK 2 mutation

Question 13

What CD receptor tells you T cell lymphoma? Name the 2 kinds

Answer 13

CD 4 (+tdt)
ATLL (HTLV) - lytic bone lesions -> hyperCa
Mycosis fungoides = cerebriform nuclei when biopsy skin lesions (weird way for lymphoma to present aka not at LN)
Sezary syndrome if MF progresses to T cell leukemia

Question 14

What is tdt

Answer 14

DNA pol @ nucleus

Specific for lymphocytes (T+B)

Question 15

Which tumors can turn into diffuse large B cell lymphoma?

Answer 15

Follicular

CLL

Question 16

What type of cell is CLL - histo

Answer 16

B cell leukemia (no chronic T cell leukemia)
CLL - crushed little lymphocytes
Looks like massive smashed potatos

Question 17

Which leukemia is presenting with a dry tap + splenomegaly? What is the cause of the splenomeg? Histo

Answer 17

HAIR CELL LEUKEMIA
Mature B cell tumor - hairy projections
TRAP +
Splenomeg b/c accum cells in RED PULP

Question 18

Which tumor is presenting as a mediastinal mass?

Answer 18

T acute LL

Question 19

RF for AML

Answer 19

Prior alkylating chemo - messing with DNA causes immature cancer
Myeloprolif disorders - replication of mature cells causes backwards step

Question 20

What is a blast crisis?

Answer 20

CML reverts into an AML or ALL
Accelerated phase
B/c the problem was always with stem cell

Question 21

Treat CML + hairy cell leukemia

Answer 21

CML: imatinib

Hairy cell: cladribine (adenosine deamin I), pentostatin

Question 22

M spike of IgG or IgA - with symptoms
W/o symptoms
M spike of IgM

Answer 22

MM
MGUS
Waldenstrom macroglobulinemia