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91 Cards in this Set

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Define lymphoid malignancy
overproduction of various types of immature or mature lymphocytes
Activated B cells produce daughter cells of the same type that develop into ________ or ______.
memory cells, plasma cells
Stages of B-lymphocyte development
Develop in the bone marrow as early pre-B cells.

These mature into pre-B cells in the marrow and then progress to mature B-cells.

Mature B-cells are released into circulation to travel to the peripheral lymphoid organs.
T-lymphocytes are produced in the _______ and stimulated to move to the ______.
bone marrow, thymus
CD7 is one of the earliest and most sensitive markers for ______.
T-cell ALL
The mature thymocyte will be either a _____ expressing ____ or ________ expressing _________.
helper cell, cd4, suppressor, cd8
Habitat of lymphocytes
bone marrow, peripheral blood, lymph nodes, mucosal tissues, spleen, liver, skin, thymus
Name the plasma cell neoplasms
multiple myeloma, heavy chain diseases, amyloidosis, monoclonal gammopathy of undetermined significance, Waldenstrom's macroglobulinemia
Symptoms of acute lymphoblastic leukemia
bleeding abnormalities, weakness, flu-like symptoms
Acute lymphoblastic leukemia is characterized by ______ onset of symptoms, usually no more than _______ duration
abrubt, a few weeks
Acute lymphoblastic leukemia involves the replacement of ________ leading to ______. This leads to complications including _____, ______ and _____.
normal marrow elements, bone marrow failure, anemia, thrombocytopenia, granulocytopenia
Laboratory evaluations necessary for acute lymphoblastic leukemia
CBC, platelet count, WBC differential, peripheral blood smear examination, cytochemistry/cytogenetics/molecular diagnostics, bone marrow aspiration
Laboratory results characteristic of ALL
increased or normal leukocyte count, neutropenia, lymphoblasts, normocytic/normochromic anemia, thrombocytopenia, hypercellular bone marrow with >30% lymphoblasts
L1 morphology
small, uniform lymphoblasts

seen primarily in children
L2 morphology
large, pleomorphic lymphoblasts

seen more frequently in adults
L3 morphology
Burkitt's type (vacuolated and deeply basophilic cytoplasm)
2 WHO subgroups of ALL
Precursor B and T cell neoplasms (L1/L2)

Burkitt type ALL (L3)
B-cell lineage is defined by surface antigen _______ and/or cytoplasmic ______.
CD19, CD22
Pre-B-cell ALL is most common in ______. It usually presents with WBC count _________.
children 3-5 years of age, less than 100,000/L.
Pre-B-cell ALL usually involves the ______ and _____ but not _____.
bone marrow, blood, organs
T-cell ALL usually presents with _______ mass and ______ involvement.
mediastinal, organ
______ are affected more by T-cell ALL.
Males
T-cell ALL has what type of prognosis?
Poor compared to pre-B ALL.
What type of organ involvement may be encountered with T-cell ALL?
hepatosplenomegaly, early meningeal involvement
Precursor T-cells in ALL express what cell markers?
TdT, CD4 and CD8
T-cell lineage is defined by what cell markers?
CD2, CD3, CD5, CD7
What is the most common FAB classification for T-ALL?
L1
L1 morphology
uniform population of small blasts, scant cytoplasm, nuclear patten is homogenous, nucleoli are inconspicuous
L2 morphology
characterized by cellular heterogeneity, nuclear clefting and indentation are common, indistinguishable morphologically from AML-M2
L3 morphology
cells are uniform population of relatively large blasts, basophilic moderate to abundant cytoplasm, nucleus is round to oval with no indentations
Describe the early phase of lymphoproliferative disorders
tumor cells are small in size, few in number and have prolonged cell survival
Describe the transformation phase of lymphoproliferative disorders
tumer cells have increased numbers and appear in extramedullary sites with big, immature cells
________ is the most common lymphocytic leukemia in adults
Chronic lymphocytic leukemia
Chronic lymphocytic leukemia is most frequently a neoplasm of ____ lymphocytes.
B
Small cell lymphoma involves lymph nodes with little ____ and _____ involvement
peripheral blood, bone marrow
Cells involved in CLL are _____-lived and _______ dysfunctional lymphocytes
long, immunologically
Malignancy in CLL is an effect of failed _______.
apoptosis
Marrow replacement in CLL results in ____, ______, and _____.
anemia, thrombocytopenia, neutropenia
CLL is characterized by extreme adenopathy (T/F)
True
90% of all CLL cases occur in adults older than ________.
50 years
CLL is found mostly in males (T/F)
True, CLL is found in twice as many males as females
Signs and symptoms of CLL develop _______.
gradually
Laboratory features of CLL
minimum of 10x10^9 WBC/L in peripheral blood, 30% lymphocytosis of bone marrow, mature-appearing lymphs, normocytic/normochromic anemia, normal or low reticulocytes,
Normal blood has approximately _______ B-cells and _______ T-cells. There may be up to _____ NK cells.
20%, 60-80%, 22%
The most common chromosomal abnormality in B-cell CLL is ________, which may occur alone or with deletions/translocations of _______.
trisomy 12, chromosome 13q14.
B-prolymphocytic leukemia is characterized by prominent ______ without ________.
splenomegaly, lymphadenopathy
B-prolymphocytic leukemia is characterized by ______ prolymphocytes in the peripheral blood. WBC count is often ________.
55-70%, >100x10^9 cells/L
Small lymphocytic lymphoma is the _______ of CLL and may be described as diffuse _______ lymphoma
nodal counterpart, non-Hodgkin's
Mantle cell lymphoma arises from the ______ of the _____ zone of __________.
centrocytes, mantle, lymphoid follicles
Mantle cell lymphoma cells are of what lineage?
B-cell
In mantle cell lymphoma, peripheral white blood cells counts may exceed ________.
200 x 10^9/L
Mantle cell lymphoma has a distinct immunophenotype and typical chromosomal translocation of:
t(11;14)(q13;q32)

Cyclin D1 staining on tissue section is positive
Small cleaved cell lymphoma is a ______ lymphoma with ______ lymphocytes
Non-Hodgkin's, B
In small cleaved cell lymphoma, circulating cells have ____ cytoplasm, are ______ in shape, and have irregular _______ transversing the nucleus
scant, irregular, notches/clefts
Hairy cell leukemia is a ____ lymphocyte ______ leukemia
B, chronic
Pancytopenia is unique to what leukemia?
Hairy cell leukemia
_____ and _____ are frequently observed in hairy cell leukemia.
Splenomegaly, marrow fibrosis
The most characteristic cytochemical feature of hairy cell leukemia
Strong acid phosphatase reaction not inhibited by tartrate
Describe the morphology of circulating lymphocytes in hairy cell leukemia
Possess fine, hair-like, irregular cytoplasmic projections
Sezary syndrome is characterized by abnormal circulating lymphocytes with a ____ staining and _______ nuclear chromatin pattern with numerous folds and grooves
dark, hyperchromatic
Sezary syndrome is the leukemic phase of ___________.
the common cutaneous T-cell lymphoma mycosis fungoides
Adult T-cell leukemia/lymphoma is caused by ______
HTLV-1
Morphology of lymphocytes in adult T-cell leukemia/lymphoma
highly convoluted nuclear shape (often clover leaf), marked variation in cell size, very prominent nucleoli
Hodgkin lymphoma is characterized morphologically by:
a proliferative background of benign inflammatory cells interspersed with malignant cells and their variants
______ is the most common type of malignancy in children
Hodgkin lymphoma
_______ must be present to diagnose Hodgkin's lymphoma
Reed-Sternberg cells
________ usually presents with one firm lymph node spreading in an orderly fashion throughout the lymph system
Hodgkin's lymphoma
Extranodal involvement in Hodgkin's lymphoma may include _________.
liver, spleen, lung or bone marrow
In non-Hodgkin lymphoma, _______ can be found circulating in peripheral blood
malignant lymphoma cells
Non-Hodgkin lymphoma normally affects patients between _____ and ____ years of age
20, 40
Non-Hodgkin lymphoma typically arises in ______ and is characterized by prominent _______.
peripheral lymph nodes, lymphadenopathy
Define plasma cell disorder
condition in which one clone of plasma cells multiplies excessively and produces a large quantity of abnormal antibodies
Multiple myeloma forms tumors in the ______ and produces a large quantity of abnormal antibodies that accumulate in the ______ or ______.
bone marrow, blood, urine
Multiple myeloma is usually seen in people under 40 years of age (T/F)
False, multiple myeloma is usually seen in people over 40 years of age
Plasmacytomas are most common in:
pelvic bones, spine, ribs/skull, lungs, reproductive organs
In multiple myeloma, abnormal antibodies frequently end up in the _____, sometimes causing _______.
kidney, renal failure
Abnormal antibody light chains in the urine are known as ______. These are seen in ______ and ______.
Bence Jones proteins, multiple myeloma, Waldenstrom's macroglobulinemia
Symptoms of multiple myeloma
bone pain (especially spine or ribs), anemia, easily fractured bones, recurring bacterial infections, kidney failure, blood "thickening"
Laboratory findings in multiple myeloma
abnormal RBCs, anemia, abnormally high calcium, high erythrocyte sedimentation rate, biopsy proven plasmacytoma (>30% plasma cell in bone marrow), monoclonal protein (>3.5 g/dL serum IgG, >2.0 g/dL of serum IgA), low normal immunoglobulins
In monoclonal gammopathies of undetermined significance, a large quantity of abnormal antibody is produced but plasma cells are not ______.
cancerous
MGUS does not require _____, but may progress to _______.
treatment, multiple myeloma
Waldenstrom's macroglobulinemia is characterized by the production of _____________ by the plasma cells.
excessive quantities of macroglobulins
Macroglobulinemia may result in ______ syndrome, which is characterized by _______.
hyperviscosity, reduced blood flow to extremities, abnormal bleeding, fatigue, weakness, headache, dizziness, coma
In macroglobulinemia, tiny blood vessels in ________ can become engorged and bleed, resulting in ________.
the back of the eyes, damage to the retina and impaired eyesight
Define cryoglobulin
an abnormal antibody that precipitates in the blood when cooled below body temperature
Define Raynaud's phenomenon
hands and feet become very painful and turn white when exposed to cold, occurs with cryoglobulinemia
Define heavy chain disease
Neoplastic plasma cell dyscriasias characterized by overproduction of monoclonal immunoglobulin heavy chains
IgG gamma heavy chain disease affects the ____, _____ and ____. It normally affects the _____ population.
liver, spleen, lymph nodes, elderly
IgA alpha heavy chain disease usually produces _______. It affects ___________.
abdominal masses, younger individuals in the Mediterranean
IgM mu heavy chain disease produces _______ plasma cells.
vacuolated
L1 and L2 lymphoblasts are differentiated by _____ and _____.

______ techniques serve to confirm diagnosis.
N:C ratio, presence/absence of nucleoli, immunologic/cytogenetic