WBC disorders Flashcards
what are lymphomas?
malignant proliferations of cells native to lymphoid tissue- lymphocytes and their precursors and derivatives
two main types of lymphomas?
hodgkins and non hodgkins
what is Leukemia
malignant proliferations of cells native to the bone marrow, which often spillover into the blood.
hodgkins lymphoma morphological features
- Reed-Sternberg cells admixed with a
2. variable inflammatory infiltrate
distinguishing features of hodgkins lymphoma compared to non hodgkins lymphoma
Hodgkin lymphoma (HL) is often accompanied by
- fever,
- arises in a single lymph node or chain of nodes,
- more common in young adults (average age 30 years),
- characterized by contiguous spread within lymph node groups ,
cause of hodgkins lymphoma
unknown
the neoplastic cell associated with hodgkins lymphoma
Reed-Sternberg cells
A diagnosis of Hodgkin lymphoma requires the presence of ______ in the appropriate histologic background:
RS cells
small or large numbers of RS cells are present in the involved node
small
RS cells characteristics
- large cell
- mirror image nuclei
- prominent nucleoli
Choice of therapy (chemotherapy, radiotherapy, or both) and prognosis are based on _____
stage
localized lymph node involvement, without systemic signs (fever, weight loss), and has a better prognosis denotes ____ stage
low stage disease
______-stage disease indicates widespread disease, often with bone marrow involvement, and has a worse prognosis.
high
All stages are further divided on the basis of absence (A) or presence (B) of _______
systemic symptoms,
Most patients have enlarged, painless, superficial ___________ as the initial manifestation of disease.
lymph node involvement
as disease progresses what happens
- involvement of other lymph nodes in chest and abdomen
- involve spleen and liver (seen with MRI)
- Complications with infections (decreased cell-mediated immunity), anemia, and thrombocytopenia can occur in advanced disease.
There is a low, but definite risk for developing ________ after treatment with chemotherapy and radiotherapy because of the bone marrow toxicities of the chemotherapeutic drugs used.
acute leukemia
choice of therapy
chemo, and to an lesser extent radiotherapy
There is more ______ diversity in NHL than in HD
morphologic
Non-Hodgkin lymphomas (NHL) arise in
lymphoid tissue– either in lymph nodes or lymphoid tissue of solid organ
NHL differences compared to Hodgkins lymphoma
NHLs tend to have
- multiple node involvement,
- more frequent extranodal spread and peripheral blood involvement
- affect all ages
what is required for diagnosis of NHL
histologic examination of involved tissue
The majority (85%) of NHL are clonal neoplasms of
B lymphocytes. remianing 15% is T cell involvment
B cells are involved with what
antibody production
A _______ develops when there is a monoclonal expansion of lymphocytes that have been “arrested” (or have acquired a genetic rearrangement that alters growth regulation) at a particular stage in transformation.
lymphoma
T/F all lymphoid neoplasms are considered to arise from a single transformed cell.
TRUE
NHLs are classified on the basis of……
- their morphology (microscopic appearance),
- cell of origin (immunophenotype),
- clinical features
- genotype.
T/F There is MORE correlation between stage and prognosis in NHL than in HD
FALSE, theres less
Stage 1 NHL
Involves single lymph node region or extralymphatic organ or site
Stage 2 NHL
Involves two or more lymph node regions on same side of diaphragm alone or with involvement of contiguous extralymphatic organ or tissue
Stage 3 NHL
Involves lymph node regions on both sides of diaphragm which may include spleen.
Stage 4 NHL
Multiple or disseminated foci of involvement of one or more extra lymphatic organs or tissues with or without lymphatic involvement
in distinction to the group of diseases classified as leukemias, NHL’s can…..
spread to involve
- solid organs
- GI tract
- bones
- nervous system
clinical presentation of NHL
- painless enlarged lymph nodes
- evidence of extranodal spread- enlarged liver or spleen
- bone marrow involvement
what is the ‘leukemic phase’ of the disease
when you see Circulating lymphoma cells in the peripheral blood
T/F complications with infection and treatment options are similar to hodgkins lymphoma
TRUE
Leukemias are malignant neoplasms of….
hematopoietic tissue that arise in the bone marrow.
The malignant cells __________ in the _______, commonly producing a pattern of diffuse infiltration
proliferate in the bone marrow,
what happens to these proliferating cells in the bone marrow
There is often “spill over” of the proliferating cells into the blood and other organs.
This group of diseases can be roughly conceptualized both in terms of _____ and of ______ involved
onset
cell type
disease onset can be ____ or _____
acute or chronic
leukemia cell types involved
myelogenous (myeloid and monocytic) and lymphoid.
examples of leukemias basic classification
acute lymphoblastic leukemia (ALL),
chronic lymphocytic leukemia (CLL),
acute myelogenous leukemia (AML),
chronic myelogenous leukemia (CML).
acute leukemias characteristics
- rapid
- usually fatal, survival months
- BLAST (immature cells) in blood and bone marrow (>20%)
- increase white blood cell count
chronic leukemia characteristics
- slow (indolent)
- long survival, years
- mature cells, NO BLAST
- increase white blood cell count
Acute lymphocytic leukemia
- 40% of acute leukemias
- proliferating cell is a primitive lymphoid
- principal cause of cancer deaths in childhood (<15 years old)
- Five subtypes recognized immunologically (early B precursor, pre-B, mature B, and T cell)
T/F Cytogenetic analysis has prognostic significance
TRUE
what is more common in ALL than AML.
Enlargement of lymph nodes, liver and spleen, and nervous system involvement.
what group has the best prognosis?
children 2-10 with pre-B cell types
ALL associated with _____
children cancer
Acute myelogenous leukemia (AML)
- proliferating cell is a primitive myeloid cell
- Cytoplasmic inclusions called Auer rods
- older adult population, with a median age of 50 years.
Cytoplasmic evidence of myeloid differentiation includes
includes the presence of several types of granules (myeloperoxidase) found in more mature myeloid cells.
T/F Auer rods are not used in diagnostic
FALSE, when present, they are
what is most predictive of prognosis of AML
karyotype
Sometimes the lesional cells will proliferate in ______, producing what is termed ________.
soft tissue (including the gingivae) granulocytic sarcoma
T/F Although many patients can obtain remission of disease after chemotherapy, the duration of remission is often transient.
TRUE
Infiltration of the gingivae is a feature commonly associated with _______
acute myelo-monocytic leukemias.
Clinical features result from
(1) impairment of marrow function as abnormal cells suppress growth of normal cells,
(2) infiltration of body organs due to proliferation of the abnormal cells.
other clinical features
- Anemia –> fatigue, pallor, weakness
- Thrombocytopenia (decreased platelets) –> bleeding and bruises.
- infection –> fever
- organ enlargement (lymph nodes, spleen, liver) occurs as the abnormal cells proliferate in these sites –> abdominal pain, blocked vasculature or lymphatics
Plasma cell disorders result from clonal expansion of _____
immunoglobulin-secreting cells.
increase secretion of immunoglobulin results in what
increased serum monoclonal protein (M component)
monoclonal protein (M component) may have adverse effects on
renal and neurologic function.
what makes the diagnosis of Multiple Myeloma ?
Documenting
- monoclonal protein
- skeletal lesions
Multiple Myeloma proliferating cell is a
plasma cell that produces immunoglobulin
what characterizes myeloma
Multifocal destructive bone lesions characterize myeloma
how does bone lesion occur in myeloma?
secretion of osteoclast activating factors by the myeloma cells induces bone resorption
Patients often present with _____, _____, and ______
bone pain, hypercalcemia, and renal disease.
