WBC Pathology II

Question 1

Conditions often accompanying leukemia:

Answer 1

Thrombocytopenia

Anemia

Question 2

Marked increase in WBC count is seen in ___ leukemia (chronic or acute):

Answer 2

Chronic (slight increase in acute)

Question 3

Blast cells are greater than 20% of WBC count in ___ leukemia (chronic or acute):

Answer 3

Acute

Question 4

Type of leukemia typically affecting those below 15 yrs old:

Answer 4

Acute Lymphocytic Leukemia

Question 5

In ALL, the block in B-cell maturation occurs between the ___ and ___ stages:

Answer 5

Prolymphocyte and lymphocyte

Question 6

Factors associated with poor prognosis of ALL:

Answer 6

Less than 2 y/o
Adolescent or adult pt.
Peripheral blast cells greater than 100,000
Philadelphia chromosome

Question 7

Typical chromosomal abnormalities of ALL:

Answer 7

Hyperploidy, hypoploidy

t(12:21)

Question 8

FAB classification of ALL:

Answer 8

L1 - Homogenous
L2 - Heterogenous
L3 - Large lymphocytes

Question 9

Bigger lymphocytes are associated with a ___ prognosis:

Answer 9

poorer

Question 10

Immunohistochemistry of ALL:

Answer 10

CD 10
CD 19
CD 20
IgM heavy chain
TdT positive

Question 11

S/Sx specific for ALL:

Answer 11

Testicular enlargement

Meningeal involvement

Question 12

Affected age group and primary symptom of hairy cell leukemia:

Answer 12

Middle aged males; massive splenomegaly

Question 13

Laboratory finding in hairy cell leukemia:

Answer 13

(+) tartarate resistant acid phosphatase (TRAP)

Question 14

Bone marrow findings in hairy cell leukemia:

Answer 14

Dry tap due to reticulin network

Fried egg or honeycomb appearance

Question 15

Myeloid disorders:

Answer 15

Acute Myelogenous Leukemia
Myelodysplastic syndrome
Chronic Myeloproliferative disorders

Question 16

Chonic Myeloproliferative Disorders:

Answer 16

Chronic Myelogenous Leukemia
Polycythemia Vera
Essential Thrombocytosis
Myelofibrosis

Question 17

Majority of AML cases are in the ___ range, with a peak at __:

Answer 17

30-50 y/o; 60 y/o

Question 18

t(8:21); inv (16) indicates what prognosis in AML?

Answer 18

Good prognosis

Question 19

t(15:17) (the RARA gene) indicates what prognosis for AML?

Answer 19

Intermediate prognosis

Question 20

t(11q23) indicates what prognosis in AML?

Answer 20

Poor prognosis

Question 21

This situation is associated with very poor prognosis in AML

Answer 21

AML that developed from MDS

Deletions or monosomy in chromosomes 5,7

Question 22

Retinoic acid is responsible for development of ___ to ____:

Answer 22

promyelocyte to myelocyte

Question 23

RARA deficiency is associated with which type of AML?

Answer 23

M3 (abundance of promyelocytes)

Question 24

Nonspecific esterase stains for:

Answer 24

Monoblasts

Question 25

Myeloperoxidase stains for___ and is positive in___:

Answer 25

Myeloblasts; AML

Question 26

PAS stains for___ and is positive in ___:

Answer 26

Lymphoblasts; ALL

Question 27

Distinguish AML from ALL in the peripheral smear:

Answer 27

Auer rods present Abudant cytoplasm Abundant granules

Question 28

DIC is a manifestation of which type of AML?

Answer 28

M3

Question 29

Which cells proliferate in M4 and M5 AML?

Answer 29

Monocytes

Question 30

Common clinical manifestations in M1 and M2 AML:

Answer 30

Chloroma | Granulocytic sarcoma

Question 31

MDS is typically seen in which age group:

Answer 31

the elderly (70+)

Question 32

MDS is a ___ disorder associated with ____:

Answer 32

stem cell; ineffective hematopoiesis

Question 33

Cellular abnormalities in MDS:

Answer 33

``` Ringed sideroblasts Megaloblastoid maturation Pawn ball megakaryocytes Nuclear budding Abnormal granulation Pseudo Pelger-Heut cells Myeloblasts ```

Question 34

Myeloproliferative disorders usually involve neoplastic transformation of:

Answer 34

Multipotent myelogenous progenitor cells

Question 35

MPD abnormalities are due to mutated ___:

Answer 35

tyrosine kinase

Question 36

Characteristics of MPD:

Answer 36

Proliferative drive in bone marrow Extramedullary hematopoiesis Bone marrow fibrosis Transformation to acute leukemia

Question 37

No block in stem cell maturation is seen in:

Answer 37

Chronic myelogenous leukemia

Question 38

Chromosomal abnormality in CML:

Answer 38

t(9:22) ABL to BCR

Question 39

Laboratory diagnosis of CML:

Answer 39

Greater than 100k WBC (-) alkaline phosphatase Philadelphia chromosome Thrombocytosis

Question 40

CML involves neoplastic transformation of:

Answer 40

Pluripotent granulocytic stem cell

Question 41

PBS in essential thrombosis shows:

Answer 41

Giant platelets, greater than 600k

Question 42

Symptom of essential thrombosis:

Answer 42

Erythromelalgia

Question 43

The end stage of most proliferative disorders:

Answer 43

Myelofibrosis

Question 44

Treatment for CML:

Answer 44

Imatinib (BCR-ABL inhibitor)

Question 45

Symptoms of myelofibrosis:

Answer 45

Progressive anemia Abdominal enlargement Hyperuricemia Gout

Question 46

PBS in myelofibrosis:

Answer 46

leukoerythroblastosis (teardrop shaped cells)

Question 47

Types of myeloma:

Answer 47

``` Multiple myeloma (common) Solitary Myeloma ```

Question 48

Type of solitary myeloma that may progress to multiple myeloma:

Answer 48

Osseous

Question 49

Plasma cell dyscrasias:

Answer 49

Myeloma Waldenstrom macroglobulinemia Heavy chain disease Monoclonal gammopathy

Question 50

Waldenstrom macroglobulinemia features increased B-cells resulting in increased ___, resulting in increased blood ___:

Answer 50

IgM; viscosity

Question 51

These may be increased in the blood of multiple myeloma:

Answer 51

IgG (55%) Other Ig (25%) Bence Jones protein (20%)

Question 52

Appearance of X-ray in multiple myeloma:

Answer 52

Soap bubble appearance

Question 53

Seen in bone marrow biopsy of multiple myeloma:

Answer 53

``` Replacement of marrow cells with: Russell bodies (globular inclusions) Dutcher bodies (nuclear cells ```

Question 54

Complications of multiple myeloma:

Answer 54

Myeloma nephrosis Myeloma nephropathy Systemic amyloidosis

Question 55

S/Sx of multiple myeloma:

Answer 55

Prominent bone pain Hypercalcemia Bacterial infection Renal insufficiency

Question 56

Lab diagnosis of multiple myeloma:

Answer 56

(+) Bence jones protein Increased erythrocyte sedimentation rate Increased serum Ig M protein spike in blood and urine

Question 57

Most benign histiocytosis:

Answer 57

Eosinophilic Granuloma (unifocal histiocytosis)

Question 58

Hand Schuller Histiocytosis is seen in ___:

Answer 58

young children

Question 59

Triad of Hand Schuller symptoms:

Answer 59

Bone defects Diabetes insipidus Exophthalmos

Question 60

Malignant type of histiocytosis:

Answer 60

Litterer Siwe (multifocal multisystem histiocytosis)

Question 61

Sx of Litterer Siwe Histiocytosis:

Answer 61

``` Fever Otitis media or mastoiditis Trunk and scalp eczema Spleen, liver, LN enlargement Bone lesions ```

Question 62

Thymoma is a tumor of the:

Answer 62

Thymic epithelial cells

Question 63

S/Sx of thymoma:

Answer 63

Compression of mediastinum | Myasthenia Gravis