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PATH > WBC Disorders > Flashcards

WBC Disorders Flashcards

1
Q

What are the 4 main compartments WBCs occupy in the body?

A

Bone marrow
Bloodstream
Lymph nodes
Site of infection or immune stimulation

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2
Q

What is the site of WBC transport?

A

Bloodstream

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3
Q

What is the site of WBC production?

A

Bone marrow

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4
Q

What is the site of WBC immune activation?

A

Lymph nodes

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5
Q

What is the site of WBC infection or immune stimulation?

A

Any organ or soft tissue
(what you see clinically)

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6
Q

Chronic infections

A

Monocytotic

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6
Q

Decreased serum level of leukocytes

A

Leukopenia

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7
Q

Elevated serum level of leukocytes, mostly neutrophils

A

Leukocytosis

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8
Q

Seen in the lymph node that is draining a region of infection

A

Painful lymphadenopathy

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8
Q

What is the normal level of neutrophils? What about during leukocytosis?

A

Normal = 4-10,000 ul
Leukocytosis = 15-20,000 ul

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9
Q

Bacterial infections or when there is tissue necrosis (burns, MI)

A

Neutrophilic

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9
Q

Chronic infections and some viral infections

A

Lymphocytotic

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9
Q

What do lymph nodes look like in lymphadenopathy?

A

Firm, enlarged

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9
Q

When you evaluate lymph nodes, what should they normally look like?

A

Small and non-palpable

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10
Q

Allergies (asthma, hay fever), parasitic infections, drug rxns

A

Eosinophilic

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11
Q

Seen with chronic inflammation. metastatic cancer, or lymphoma

A

Non-painful lymphadenopathy

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12
Q

Which disease?
Often localized but if generalized, there is often an underlying systemic disease

A

Lymphadenopathy

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13
Q

Most cases are self-limited and benign, particularly in children

A

Lymphadenopathy

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14
Q

Which disease?
<2 weeks or >1 year without size change is unlikely to be a neoplasm

A

Lymphadenopathy

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15
Q

What are the Lymphadenopathy etiologies?

A

MIAMI - malignancy, infectious, autoimmune, miscellaneous, iatrogenic

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15
Q

Which disease?
Risk for cancer: >6 weeks and not better by 12 weeks

A

Lymphadenopathy

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16
Q

Which disease?
Workup includes serology, imaging, possible biopsy

A

Lymphadenopathy

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17
Q

What type of Lymphadenopathy etiology?
Fever, drenching night sweats, unexplained weight loss >10% of body weight

A

Malignancy

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18
Q

What type of Lymphadenopathy etiology?
Fever, chills, fatigue, malaise

A

Infectious

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18
Q

What type of Lymphadenopathy etiology?
Supraclavicular lymphadenopathy adults or children - up to 50% have intraabdominal malignancy

A

Malignancy

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18
Q

Decreased neutrophils in blood

A

Neutropenia

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18
Q

What is the role of a dentist in the evaluation and management of lymphadenopathy?

A

Dx + tx oral infections (bacterial, viral)
Dx oral malignancies and refer
Assess risk, help dx and refer for systemic malignancy, systemic infection, autoimmune disease
Assess for skin infection/malignancy and refer

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19
Q

What type of Lymphadenopathy etiology?
Arthralgias, muscle weakness, rash

A

Autoimmune

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19
Q

What type of Lymphadenopathy etiology?
Other specific findings of each condition

A

Miscellaneous

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19
Q

What type of Lymphadenopathy etiology?
History of new meds

A

Iatrogenic

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20
Q

Decreased granulocytes (neutrophils, basophils, eosinophils) in blood

A

Agranulocytosis

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20
Q

Which disease?
Pathogenesis = decreased production in bone marrow or increased destruction in the peripheral blood

A

Neutropenia
Agranulocytosis

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20
Q

Which disease?
Most common sequela is infection

A

Neutropenia
Agranulocytosis

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21
Q

Which disease?
Symptoms are malaise, fever, chills, weakness, ulceration (oral, gingival) that is deep and punched out

A

Neutropenia
Agranulocytosis

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21
Q

Which lymph node?
Drain scalp, skin

A

Preauricular

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21
Q

Which lymph node?
Drain scalp, neck, upper thoracic skin

A

Posterior cervical

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22
Q

Which lymph node?
Differential diagnosis is scalp infection, mycobacterial infection

A

Preauricular
Posterior cervical

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22
Q

Which lymph node?
Malignancies are skin neoplasm, lymphomas, head and neck squamous cell carcinomas

A

Preauricular

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23
Q

Which lymph node?
Drain GI tract, genitourinary tract, pulmonary

A

Supraclavicular

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24
Q

Which lymph node?
Differential diagnosis is thyroid/laryngeal disease, mycobacterial/fungal infections

A

Supraclavicular

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25
Q

Which disease?
Causes of increased destruction of peripheral cells causing hypercellular marrow include: immune-mediated injury (drugs), overwhelming infections, splenomegaly

A

Neutropenia
Agranulocytosis

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25
Q

Which lymph node?
Malignancies are abdominal and thoracic

A

Supraclavicular

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26
Q

What causes this in neutropenia and agranulocytosis?
Chronic marrow hypoplasia

A

Aplastic anemia

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26
Q

Which lymph node?
Differential diagnosis is mononucleosis, URI, mycobacterial infection, toxoplasma, cytomegalovirus, dental disease, rubella

A

Submandibular
Anterior cervical

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26
Q

Which lymph node?
Drain oral cavity

A

Submandibular

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26
Q

What causes this in neutropenia and agranulocytosis?
Uses up peripheral cells

A

Overwhelming infections

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27
Q

Which lymph node?
Drain larynx, tongue, oropharynx, anterior neck

A

Anterior cervical

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27
Q

What causes this in neutropenia and agranulocytosis?
Transient marrow hyoplasia, decreasing neutrophil production

A

Chemo

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27
Q

Which lymph node?
Squamous cell carcinoma of head and neck, lymphoma, leukemia

A

Submandibular

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28
Q

Which disease?
Causes of decreased production in bone marrow include: chemo, aplastic anemia, leukemia

A

Neutropenia
Agranulocytosis

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29
Q

What causes this in neutropenia and agranulocytosis?
Replacement of normal marrow

A

Leukemia

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30
Q

What causes this in neutropenia and agranulocytosis?
Accelerates removal of granulocytes

A

Splenomegaly

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31
Q

Which disease?
Tx is removal of offending agent, control infection, give granulocyte colony-stimulating factor to stimulate granulocyte production

A

Neutropenia
Agranulocytosis

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31
Q

What are WBC neoplasm classifications based on?

A

Morphologic and molecular criteria
(lineage-specific protein markers and genetic changes)

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31
Q

What are the 3 broad categories of WBC neoplasms that are based on origin/differentiation?

A

Lymphoid neoplasms
Myeloid neoplasms
Histiocytic neoplasms

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32
Q

What is the cause of lymphoid neoplasms?

A

Increased risk for translocations/transformation in B cells

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33
Q

Involvement of bone marrow and peripheral blood

A

Leukemia

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33
Q

Why is there an increased risk for translocations/transformation in B cells?

A

B cells undergo somatic hypermutation and class switching

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33
Q

Increases AB affinity

A

Somatic hypermutation (B cells)

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33
Q

Produces multiple AB types to the same antigen

A

Class switching (B cells)

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34
Q

Which cells are genomically stable, making them an UNCOMMON cause of lymphomas?

A

T cells

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35
Q

Tumor masses in lymph nodes or other tissues

A

Lymphoma

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36
Q

All lymphoid neoplasms can spread where?

A

To lymph nodes and other tissues
(ex: spleen, bone marrow, peripheral blood)

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36
Q

Lymphoid neoplasm classification focuses on ___________ and _________ characteristics of the tumor cells due to overlap in clinical behavior and location

A

morphology; molecular

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37
Q

What are the 2 main mechanisms that lead to the formation of B cell lymphomas?

A

Somatic hypermutation
Class switching

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37
Q

What is meant by surface markers?

A

Molecular characteristics

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37
Q

What tumors come from cells arrested at or derived from a specific stage of normal lymphocyte differentiation?

A

B and T cell tumors

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37
Q

What is meant by shape and size?

A

Morphology

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38
Q

What cancers account for the largest proportion of cancers in children by tumor type?

A

Leukemia and lymphoma

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38
Q

What is the classification criteria for lymphoid neoplasms?

A

Morphology
Cell origin
Clinical features
Genotype

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39
Q

Which disease?
Group of hematologic malignancies characterized by tumor cells that originate in bone marrow and spill over into blood

A

Leukemia

39
Q

Which disease?
Derived from single transformed cell exhibiting clonal growth

A

Leukemia

40
Q

As B and T cell tumors progress through each stage of differentiation, what changes?

A

Morphology
Surface markers

41
Q

Which disease?
Diffuse infiltration into lymph nodes, spleen, liver, and gingiva, causing general enlargment

A

Leukemia

41
Q

Which disease?
Causes are ionizing radiation, toxins, antineoplastic chemo drugs, chromosomal abnormalities

A

Acute leukemia

41
Q

Which disease?
Pathophysiology is myelophthisic anemia, neutropenia, anemia, thrombocytopenia

A

Acute leukemia

41
Q

Replacement of normal hematopoietic cells by neoplastic “blasts” (myeloblasts, erythroblasts, and megakaryocytes) in bone marrow

A

Myelophthisic anemia

41
Q

Which disease?
Typically, all of the clonal cell population have the same surface markers

A

Leukemia

41
Q

What does Myelophthisic anemia cause?

A

Neutropenia
Anemia
Thrombocytopenia

41
Q

What is the MOST COMMON cancer in children?

A

ALL (acute lymphoblastic leukemia)

42
Q

Leads to hypoxia causing fatigue, shortness of breath, and pallor (decreased RBCs)

A

Anemia

42
Q

Leads to bacterial, viral, and fungal infections

A

Neutropenia

42
Q

Leads to bleeding and petechiae

A

Thrombocytopenia

42
Q

What do the pathophysiologic changes (myelophthisic anemia, neutropenia, anemia, and thrombocytopenia) in acute leukemia lead to?

A

Extramedullary hematopoiesis

42
Q

Does ALL have a good outcome/cure rate?

A

Yes!

42
Q

Which disease?
Neoplasm of mature circulating lymphocytes, causing high WBC count

A

Chronic leukemia

43
Q

Which acute leukemia primarily affects older adults?

A

AML (acute myeloid leukemia)

43
Q

Does AML have a good outcome/cure rate?

A

No :(

44
Q

Which disease?
Either lymphocytic or myeloid

A

Chronic leukemia

45
Q

Which disease?
Slow onset in adult pts with common symptoms like weakness/fatigue, weight loss, night sweats, swollen abdomen, infections, easy bruising

A

Chronic leukemia

46
Q

Which disease?
High WBC - neutrophils

A

CML (chronic myeloid leukemia)

47
Q

Which disease?
High WBC - lymphocytes

A

CLL (chronic lymphocytic leukemia)

47
Q

What is the MOST COMMON leukemia of ADULTS in the western world?

A

CLL

48
Q

Which chronic leukemia?
Indolent, slow growing tumor, often asymptomatic

A

CLL

48
Q

Which chronic leukemia?
Increased BCL 2

A

CLL

49
Q

What is BCL 2?

A

Anti-apoptotic protein

50
Q

Which chronic leukemia?
If it involves lymph nodes, it is called Small Lymphocytic Lymphoma (SLL)

A

CLL

50
Q

Which chronic leukemia?
Cure only achieved with hematopoietic stem cell transplant

A

CLL

51
Q

Which chronic leukemia?
Some cases undergo transformation into an acute leukemia (“blast crisis”)

A

CML

52
Q

Which chronic leukemia?
Some tumors transform to more aggressive diffuse large B cell lymphoma, and pts die within 1 year

A

CLL

52
Q

Which chronic leukemia?
Philadelphia chromosome: BCR-ABL t(9:22) translocation causing a fusion protein

A

CML

52
Q

Which chronic leukemia?
A myeloproliferative disorder that particularly shows an increase in granulocytes

A

CML

53
Q

Which chronic leukemia?
Tx is tyrosine kinase inhibitors induce sustained remissions and prevent progression to blast crisis

A

CML

54
Q

Name an example of a tyrosine kinase inhibitor

A

Imatinib (Glecvec)

54
Q

Which disease?
Disordered maturation defect where bone marrow is replaced by clonal, multipotent stem cells with capacity for differentiation into red cells (erythroid precursors), granulocytes, and platelets

A

Myelodysplastic syndrome (MDS)

54
Q

Which disease?
Usually idiopathic, but can develop after chemo or exposure to ionizing radiation

A

MDS

55
Q

Which disease?
High risk of transformation to AML

A

MDS

55
Q

What are the 3 types of B cell lymphomas?

A

Hodgkin lymphoma
Non-hodgkin lymphoma
Plasma cell disorders (multiple myeloma)

55
Q

Which disease?
Marrow is hypercellular/normocellular, but the peripheral blood shows cytopenias

A

MDS

55
Q

Which B cell lymphoma?
Typified by the Reed-Sternberg (RS) cell which is a germinal center B cell

A

Hodgkin lymphoma

56
Q

Which B cell lymphoma?
Some have EBV infection

A

Hodgkin lymphoma

56
Q

Which B cell lymphoma?
Affects adolescents/young adults or patients >50 yrs

A

Hodgkin lymphoma

56
Q

Which B cell lymphoma?
Painless LAD: single node spreads to contiguous nodes (lower cervical, supraclavicular, mediastinal)

A

Hodgkin lymphoma

57
Q

What are the “B symptoms”?

A

Fever, weight loss, night sweats

58
Q

Which B cell lymphoma?
“B symptoms,” pruritus and anemia occur with more advanced disease

A

Hodgkin lymphoma

59
Q

What are the contiguous nodes?

A

Lower cervical
Supraclavicular
Mediastinal

59
Q

Which B cell lymphoma?
Tx is chemo, radiotherapy; immunotherapy for refractory disease

A

Hodgkin lymphoma

60
Q

Which B cell lymphoma?
Prognosis: 5 year survival is > 90%

A

Hodgkin lymphoma

60
Q

Which B cell lymphoma?
H pylori-specific T cells drive growth and survival of B cells. If you kill the bug, the tumor will shrink, but polyclonal B cell growth can evolve into monoclonal change and spread to distant sites

A

Marginal zone lymphoma

60
Q

Which B cell lymphoma?
Most have the characteristic t(14;18) translocation, causing overexpression of BCL-2 protein

A

Follicular lymphoma

61
Q

Which B cell lymphoma?
Incurable, indolent lymphoma; tx is reserved for bulky or symptomatic disease

A

Follicular lymphoma

61
Q

Which B cell lymphoma?
Painless, generalized lymphadenopathy

A

Follicular lymphoma

62
Q

Which B cell lymphoma?
Affects adults > 50 years old

A

Follicular lymphoma

62
Q

Which B cell lymphoma?
30-40% progress to diffuse large B cell lymphoma

A

Follicular lymphoma

63
Q

Which B cell lymphoma?
Arise in MALT associated with epithelium (stomach, salivary glands, etc) and can cause swelling

A

Marginal zone lymphoma

63
Q

What % of follicular lymphoma cases will progress to diffuse large B cell lymphoma?

A

30-40%

64
Q

Which B cell lymphoma?
Sustained by chronic inflammation triggered by autoimmune disorders or sites of chronic infection

A

Marginal zone lymphoma

65
Q

What is the most common lymphoma in adults?

A

Diffuse large B cell lymphoma

65
Q

Which B cell lymphoma?
When localized, cured by simple excision and radiotherapy

A

Marginal zone lymphoma

66
Q

Which B cell lymphoma?
Often symptomatic; rapidly enlarging mass within a lymph node, or extranodal in any organ/tissue

A

Diffuse large B cell lymphoma

66
Q

Which B cell lymphoma?
Some have a t(14;18) translocation of BCL-2, and others have translocations of MYC (oncogene)

A

Diffuse large B cell lymphoma

67
Q

Which B cell lymphoma?
Aggressive tumor; requires intensive combo of chemo and anti-CD20 drugs w/ 60-80% complete remission

A

Diffuse large B cell lymphoma

67
Q

Which B cell lymphoma?
In North America, typically presents as an abdominal mass

A

Burkitt lymphoma

67
Q

Which B cell lymphoma?
t(8;14) translocation of MYC and IgH

A

Burkitt lymphoma

68
Q

What is the fastest growing human tumor?

A

Burkitt lymphoma

68
Q

Which B cell lymphoma?
Effects mainly children and young adults at extranodal sites

A

Burkitt lymphoma

68
Q

Which B cell lymphoma?
Highly aggressive, but with intensive chemo, most pts are cured

A

Burkitt lymphoma

69
Q

Which B cell lymphoma?
Jaw masses associated with EBV occur in Africa and in ~20% of other cases

A

Burkitt lymphoma

70
Q

Which B cell lymphoma?
“Starry sky” histologic appearance

A

Burkitt lymphoma

71
Q

Which B cell lymphoma?
Median age is 70 yrs

A

Multiple myeloma

71
Q

What do neoplastic plasma cells secrete?

A

Monoclonal immunoglobulin (M protein)
Immunoglobulin fragments with pathologic consequences

71
Q

Are M proteins large or small?

A

Large

71
Q

Where are M proteins restricted to?

A

Plasma

72
Q

Name the conditions with abnormal immunoglobulins

A

Multiple myeloma
Monoclonal gammopathy of undetermined significance (MGUS)
Amyloidosis
Waldenstrom’s macroglobulinemia

72
Q

Which B cell lymphoma?
A common lymphoid malignancy

A

Multiple myeloma

72
Q

If immunoglobulin light chains are also made by neoplastic plasma cells, where can they be detected?

A

Urine and blood

72
Q

Increased IgM blood levels in association with lymphoplasmacytic lymphoma

A

Waldenstrom’s macroglobulinemia

72
Q

Which B cell lymphoma?
If kappa or lambda light chains are produced, their small size allows excretion in the urine (Bence-Jones proteins)

A

Multiple myeloma

72
Q

Light chain deposition with or without multiple myeloma

A

Amyloidosis

72
Q

Which B cell lymphoma?
Involves bone marrow associated with lytic lesions (often “punched out” radiolucencies) throughout the skeleton

A

Multiple myeloma

73
Q

Which B cell lymphoma?
Most frequent M protein is IgG

A

Multiple myeloma

73
Q

Multiple myeloma Which B cell lymphoma?
Defective production of normal B cells -> high risk for bacterial infections

A

Multiple myeloma

73
Q

Name 3 examples of obstructive proteinaceous casts causing renal dysfunction in multiple myeloma

A

Bence-Jones proteins
Complete Ig
Albumin

73
Q

Which B cell lymphoma?
“Punched out” radiolucencies in bone

A

Multiple myeloma

73
Q

Which B cell lymphoma?
Bone resorption causing chronic pain and pathologic fracture

A

Multiple myeloma

73
Q

Which B cell lymphoma?
Renal dysfunction due to:
Obstructive proteinaceous casts
Light chain deposition in glomerulus or interstitial
Hypercalcemia leads to dehydration/renal stones
Bacterial pyelonephritis due to hypogammaglobulinemia

A

Multiple myeloma

74
Q

Which B cell lymphoma?
Hypercalcemia causes confusion, weakness, lethargy

A

Multiple myeloma

75
Q

Which B cell lymphoma?
Recurrent bacterial infections

A

Multiple myeloma

76
Q

Which B cell lymphoma?
Renal insufficiency & failure

A

Multiple myeloma

77
Q

Which B cell lymphoma?
Definitive diagnosis requires bone marrow exam

A

Multiple myeloma

78
Q

Which B cell lymphoma?
Tx is chemo and bisphosphonates

A

Multiple myeloma

79
Q

Drugs that inhibit bone resorption and reduce fractures/hypercalcemia

A

Bisphosphonates

80
Q

Which B cell lymphoma?
Death occurs within 1 year if untreated

A

Multiple myeloma

81
Q

Which B cell lymphoma?
Some patients have “smoldering myeloma” that may be asymptomatic for many years

A

Multiple myeloma

82
Q

Which B cell lymphoma?
Median survival is 4-7 years

A

Multiple myeloma

83
Q

What is the median survival for multiple myeloma?

A

4-7 years

84
Q

Variety of proliferative disorders of dendritic cells or macrophages

A

Histiocytosis

85
Q

Range from highly malignant rare neoplasms to benign/reactive proliferations in lymph nodes

A

Histiocytic neoplasms

86
Q

What disease lies between the range of highly malignant rare neoplasms to benign/reactive proliferations in lymph nodes?

A

Histiocytosis X or Langerhans cell histocytosis

87
Q

Immature dendritic cells that capture antigens and present them through MHC class II to T cells

A

Langerhans cells

88
Q

What disease?
Neoplastic cells look more like tissue macrophages than dendritic cells; eosinophils also present

A

Langerhans cell histocytosis

89
Q

What disease?
Acute/chronic presentations that affect skin, viscera, and bone

A

Langerhans cell histocytosis

90
Q

What disease?
Eosinophilic granuloma of bone is the most common clinical manifestation

A

Langerhans cell histocytosis

91
Q

What parts of the body are commonly affected in Langerhans cell histocytosis?

A

Skull, ribs, vertebrae, mandible

92
Q

What disease?
Dull pain and tenderness often present

A

Langerhans cell histocytosis

93
Q

What disease?
Punched out or ill-defined radiolucency on X-Ray

A

Langerhans cell histocytosis

PATH (2 decks)

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