Leukemia And Lymphoma

Front 1

Leukemoid Rxn

Back 1

- due to infxn (appendicitis, whooping cough, cutaneous larva migrans)

- Inc. LAP not leukemia

Front 2

Hodgkins vs NHL

Back 2

Hodgkins
- RS cells; localized single group of nodes; "B" symptoms; 50% assoc. w/ EBV; young and old; Men>Female EXCEPT in NODULAR SCLEROSING; fish flesh on cut section; EtOH pain and hyperkeratosis

NHL
- HIV or immunosuppression
- multiple peripheral nodes; majority are B cells; 20-40yrs old

Front 3

good prognosis in hodgkins

Back 3

lots of lymphs

and dec. RS

Front 4

Reed-Sternberg

Back 4

CD30+ and CD15+ B cell origin

- necessary for diagnosis of Hodgkins

Front 5

Nodular Sclerosing

Back 5

Hodgkin
- MC type (65%)
- Females
- Collagen banding in lymph nodes
- lucunar variant RS (pale cell look like artifact)
- primarily young adults

RS +
Lymphocyte +++
excellent prognosis

Front 6

Mixed Cellularity

Back 6

Hodgkin
Men
- 25%
-Numerous RS cells, EBV assoc

RS ++++
Lymphocyte +++
intermediate prognosis

Front 7

Lymphocyte predominant

Back 7

hodgkin
6%
Males younger than 35
- L and H variant RS (large and pale)

RS +
Lymphocyte ++++
Excellent prognosis

Front 8

Lymphocyte depleted

Back 8

rare
- Older males w/ disseminated disease

RS: high relative to lymphocytes
Lymphs: +
Poor prognosis

Front 9

Burkitt's

Back 9

NHL
- young
- t(8;14) cmyc next to heavy chain Ig (14)
- Starry sky
- EBV assoc
- Jaw in africa, pelvis or abdomen in sporadic

Front 10

Diffuse large B-cell lymphoma

Back 10

NHL
MCC of adult NHL
older males, but sometimes kids
-Come from germinal center
- can be mature T cell origin

Front 11

Mantle cell

Back 11

NHL - B cell
older males
- t(11; 14)
- Poor Prognosis
- CD5+

Front 12

Follicular lymphoma

Back 12

NHL - B cell origin
adults
- t(14;18) BCL-2 expression
- difficult to cure; indolent course

Front 13

Adult T-cell lymphoma/leukemia

Back 13

HTLV-1
- activation of TAX which inhibits p53
- TdT negative and CD4+
- monoclonal CD4 T cell expansion
- Cutaneous lesions
- lytic bone lesions
- Japan, West Africa, and Caribbean
- Aggressive

Front 14

Mycosis fungoides/Sezary syndrome

Back 14

NHL - t cell type
- cutaneous patches/nodule
- Indolent CD4+
sezary when it becomes lymphoma/leukemia

Front 15

Multiple Myeloma

Back 15

blacks>white
M>F
FRIED EGG appearance
Large amounts of IgG less common IgA
- Rouleux formation; Pancytopenia and Cachexia
CRAB: hyperCalcemia (due to cytokines), Renal insufficiency, Anemia; Bone lesions

Front 16

MM association

Back 16

- in susceptibility to infxn
- primary AL
- Punch-out lesions (IL-1, clast stimulator and blast inhibitor)
- M spike
- Ig light chains in urine

Front 17

Waldenstroms

Back 17

M spike
due to inc IgM
hyperviscosity symptoms
- NO LYTIC BONE LESIONS
generalized lymphadenopathy not present in MM

Front 18

MGUS

Back 18

Plasma cell expansiom w/o symptoms of MM
- small IgG spik
- no BJ

Front 19

Leukemia ages

Back 19

ALL: til 14
AML: 14-39 and 40-60 (60% of cases)
CML; 40-60 (40% of cases in age range)
CLL: >60

Front 20

Acute vs Chronic leukemia

Back 20

Serum: WBC acute lots of blasts and chronic less than 10%

BM: hypercellular w/ Acute >20% blasts and chronic < 20% blasts

Front 21

Myeloid Neoplasms

Back 21

Chronic myeloproliferative disorders

Myelodysplastic syndromes

AML

Front 22

Chronic Myeloproliferative disorders

Back 22

PV, CML, Myeloid metaplasia w/ myelofibrosis

- splenomegaly
- progress to spent phase and transformation to acute leukemia

Front 23

ALL

Acute lymphoblastic leukemia/lymphoma

Back 23

BM in children or Mediastinal mass in adolescent males (T cell)
- BM replaced by LOTS of lymphoblasts
= TdT + (marker of pre-T and pre-B cells)
= CALLA + aka CD10 (Common ALL antigen)
- Spread to CNS and testes (Bcell types)/Tcell types Ant mediastinum
= t(12;21) better prognosis

= Tcell ALL = CD10 neg, but TdT +

Front 24

Small lymphocytic lymphoma/ Chronic lymphocytic leukemia (CLL)

Back 24

- older adults (>60)
- often asymptomatic;
= SMUDGE CELLS and WARM Antibody AUTOIMMUNE HA
- B cells can't become plasma cells
= Hypogammaglobinemia

Front 25

Hairy Cell leukemia

Back 25

- splenomegaly
- no lymphadenopathy
- Elderly
= MATURE B-Cell tumor in elderly
= FILAMENTOUS HAIRLIKE project
= stains TRAP POSITIVE

Front 26

AML

Back 26

Adults
Auer Rods = M2 and M3 (APL)
- Inc Myelooblasts on peripheral smear
- Gum infiltration

Front 27

APL

Back 27

AML type M3
- auer rods
- DIC
t(15;17) PML/RARa
- abnormal retinoic acid metabolism = high dose all-trans retinoic acid induces differentiation by maturing cells

Front 28

CML

Back 28

40-60 yr old
- subtype of Chronic myeloproliferative disorders
= Philadelphia t(9:22), BCR-ABL
= inc neuts, metamyelocytes, basophils
= can transform into AML (2/3) or ALL (1/3) -> blast crisis = differentiation from AML b/c no auer rods
= VERY LOW LAP vs leukemoid rxn
= IMATINIB (inhibits BCR-ABL tyrosine kinase)

Thrombocytosis

Front 29

Auer Rods

Back 29

Peroxidase positive inclusions in granulocytes and myeloblasts
= fused azurophilic granules
- seen in APL (M3)
- tx of APL releases auer rods which cause DIC

Front 30

t: (9;22)

t: (8:14)

(14;18)

(15:17)

11;22)

11; 14

12;21

Back 30

(9;22) = philadelphia; CML (bcr-abl)
(8;14) = Burkitt's (c-myc)
(14;18) = Follicular Lymphoma (BCL-2 activation) NHL
(15;17) = APL (PML/RARa)
(11;22) = Ewing's sarcoma
(11;14) = Mantle cell lymphoma
12;21 = ALL good prognosis

Front 31

Langerhans histiocytosis

Back 31

-dendritic/langerhans proliferation
express S-100 and CD1a
= birbeck granules "tennis rackets" on EM

Front 32

RBCs WBCs Platelets Philadelphia chromosome LAP JAK2 mutation

PV
ET
Myelofibrosis
CML

Back 32

RBCS WBCs Platelets Philadelphia LAP JAK2 mutation

PV= inc. inc inc negative >100 yes

ET = norm norm inc negative yes

Myelofibrosis = dec RBCs Negative philadelphia; normal LAP; Positive JAK2 mutation

CML= dec RBCs; inc WBCs; Inc Platelets; Pos philadelphia; dec LAP; negative JAK2

Front 33

Polycythemia Vera

Back 33

- inc. plasma vol, inc RBC mass, normal 02 and DECREASED EPO
= RCC, WILM'S, HCC, HYDRONEPHROSIS
- puritus after bathing