White Blood Cell disorders, lymph nodes, spleen, thymus QandA

Question 1

3: In addition to Raynaud, what is one key thing in Waldenstrom that is characteristic?

Answer 1

You see BM infiltrated with plasmacytoid lymphocytes that have stored immunoglobulins in the cytoplasm (Russell bodies); high IgM means hyperviscosity

Question 2

6: In DLBCL, what is a particular manifestation and explain what the markers mean.

Answer 2

Occurs in older individuals with extranodal involvment, PARTICULARLY THE WALDEYER RING; staining has B cell proliferation (CD10, 19 positive), with lack of monocytes (CD15, as seen in Hodgkin) and CD3 (T cells)

Question 3

8: A myelodysplasia is characterized by

Answer 3

cellular marrow where there are maturation defects in multiple lineages (see ringed sideroblasts, megaloblasts, abnormal megakaryocytes, myeloblasts); pancytopenia without release of all these cells; can have this develop de novo or after therapy with e.g. alkylating agents
Look for 5q DELETIONS (post-therapy myelodysplasia)

Question 4

11: Strongyloides stercoralis is a

Answer 4

parasite, which explains the eosinophilia!!

Question 5

18: Chronic conditions and chronic inflamm conditions, like ____ can lead to an expansion of the ____ precursor pool in the bone marrow; how does this manifest?

Answer 5

lung abscess; myeloid;

neutrophilic leukocytosis!!

Question 6

20: CLL is characterized by

Answer 6

immunoglobulin gene clonal rearrangement, along with SMALL, ROUND, MATURE-looking lymphocytes; as well as the presence of CD5 and CD19 in particular with no TdT

Question 7

21: What is the key point in this question?

Answer 7

The .5-1.5 cm lytic lesions with a rounded “soap-bubble” appearance in lumbar and thoracic vertebrae, alluding to the punched-out bone lesions

Question 8

36: Drug toxicity led to

Answer 8

severe neutropenia and pancytopenia, predisposing her to sepsis; ASPERGILLOSIS is a cause of pulmonary nodules and neutropenia is a risk factor; you could get hemorrhagic lesions later on

Question 9

38: Hairy cell leukemia is

Answer 9

an uncommon neoplastic disorder of B cells, which infiltrate the spleen and marrow; pancytopenia can happen with poor production of hematopoietic cells in marrow and sequestration of mature cells in spleen; LOOK FOR THE HAIRY PROJECTIONS AND COEXPRESSION OF B CELL (CD19, CD20) and monocyte (CD11c) markers

Question 10

39: In IM or CMV infection, you can see on smear

Answer 10

large “atypical” lymphocytes that contain abundant cytoplasm and large nucleus with fine chromatin

Question 11

41: What in ALL favors a good prognosis? What is a worse diagnosis?

Answer 11

early precursor-B cell type, hyperdiploidy, patient age between 7 and 10, chromosomal trisomy, and t(12;21);
T cell phenotype, patient younger than 2, WBC count >100000, t(9;22), and presentation in adolescence and adulthood

Question 12

50: In anaplastic large cell lymphoma, it is often ____ and has a characteristic gene rearrangement.

Answer 12

extranodal; rearrangement on chromosome 2p23 resulting in production of anaplastic lymphoma kinase (ALK) with tyrosine kinase activity

Question 13

44: DLBCL often involve ____, show what cells, and contain what rearrangements?

Answer 13

extranodal sites; large anaplastic lymphoid cells involving tissues diffusely; BCL6!!!

Question 14

51: What are toxic granulations and Dohle bodies and what do they represent?

Answer 14

Coarse and dark primary granules; patches of dilated endoplasmic reticulum;
reactive changes of neutrophils, indicating overwhelming inflamm conditions like sepsis

Question 15

57: Cat-scratch disease is

Answer 15

a form of self-limited infectious lymphadenitis that most often is seen in children, typically “upstream” of lymphatic drainage from the site of injury, so axillary and cervical lymph node regions are most often involved; look for BARTONELLA HENSELAE