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50 Cards in this Set

  • Front
  • Back
What is mech of lead poisoning?
Lead interferes with heme prdouction by inhibiting
1-d-aminolevulininc acid dehydratase
Locations of patho in:
1-Coal Workers Pneumoconiosis
1-Coal Workers Pneumoconiosis
(upper lobes)
upper/superior) lobes
(lower lobes)
"garlic-scented" breath
hemorrhagic gastroenteritis
Mees Lines: transverse bands on fingernails
hyperpigmentation of skin and dermatitis
neuro (PNS and/or CNS) tox
Arsenic Poisoning
-bitter almond scented breath
-blocks cellular respiration by binding to mitochondrial cytochrome oxidase (cytochrome a/a3) of complex 4
cyanide poisoning
carcinogens in cigarrette smoke?
-carbon monoxide
-hydrogen cyanide
-nicotine (addictive component)
TdT positive
CALLA (CD10) positive
young child

What is the most common form?
early pre B-ALL

Acute Lymphoblastic Leukemia
young males
involves thymus primarily
LL: Lymphoblastic Lymphoma
CD19 or CD20 positive
CD5 positive
CD 23 positive
CD 10 negative
elderly pt (60 yo)
smudge cells
most indolent of the group
hypogammaglobulinemia leads to increased infections
CLL: Chronic Lymphocytic Leukemia if found in the blood

SLL: Small Lymphocytic Leukemia if found in the lymph nodes
CLL pt has spherocytes in the blood, why?
CLL is associated with Warm Autoimmune Hemolytic Anemia (AIHA), which causes spherocytes to be abserve in the peripheral blood
old man
TRAP positive
(Tartrate-Resistant Acid Phosphatase)
Txt: 2-CDA
Hairy Cell leukemia

2-chlorodexodyadenosine (2-CDA) inhibits adenosine deaminase (ADA) and increases levels of toxic dexyadenosine
Most common non-Hodgkins Lymphoma
B-cell tumor
up to 50% will progress to diffuse large-cell NHL
don't repond well to chemo b/c proliferate slowly
Follicular Lymphoma

t(14:18) bcl-2, gene that prevents apoptosis by blocckin the bax channel in the mitochondria
Destroy lymph node architecture
extranodal-involvement (stomach, brain, testes (in older men))
responds well to chemo b/c proliferate very rapidly
Diffuse Large B-cell Lymphoma
Medium-sized lymphocytes
Starry-sky" appearance is due to numerous reactive tingible-body macrophages (phagocytosis of apoptotic tumor cells)
t(8;14)--- gene?
Burkitt Lymphoma
(Small Noncleaved Lymphoma)

t(8;14) c-myc oncogene
what are the 2 forms of Burkitt's Lymphoma?
African type:
-primarily involves kids
-involvement of the mandible and maxilla is characteristic
-ass. w/ EBV

American (nonendemic) type:
-commonly involves the abdomen (bowel, retroperitoneum, ovaries)
-high incidence in AIDS pt's
tumor arises from the mantle cone B-lymphocytes (positive for CD19, CD20, CD5; negative for CD23)
t(11;14)--- gene?
Mantle Cell Lymphoma
(aka IDLL: Intermediate Differentiated Lymphocytic Lymphoma)

t(11;14) bcl-1 (cyclin D)
-may arise inside or outside of lymph nodes
- associated with mucosa-associated lymphoid tissue
begins as reactive polyclonal reaction and may be associated with revious autoimmune disorders.
Marginal Zone Lymphoma (MALToma)
-most common primary tumor arising from the bone of adults
-increased serum protein with a normal albumin component
-Bence-Jones proteins in the urine
-bone marrow is >20% plasma cells
-Rouleaux (stack of coins)
-Osteoclast Activating Factor
-increased risk of infection is most common cause of death
- renal dz?
Multiple Myeloma (plasma cell neoplasm)

- renal dz? Myeloma nephrosis
-amyloidosis? AL (amyloid light) chains
why is multiple myeloma associated with bone lesions and hypercalcemia?
multiple myeloma secretes osteoclastic activating factor (OAF)- lytic lessions cause hypercalcemia, bone pain, and fractures
M protein in 1-3%
-about 20% will go on to develop a plasma cell dyscrasia
MGUS: Monoclonal Gammopathy of Undetermined Significance
-Is a cross between multiple myeloma and small lymphcytic lymphoma (SLL)
-has an M spike (IgM)
-the neoplastic cells infiltrate many organs such as lymph nodes, spleen, and bone marrow
-there are no lytic lesions
-there is no hypercalcemia
-Russel bodies (sytoplasmic immunoglobulin)
-Dutcher bodies (intranuclear immunoglobulin)
-hypervisocity syndrome
Lymphoblastic Lymphoma (Waldenstrom macoglobulinemia)

-hypervisocity syndrome because IgM is a pentamer
-malignant T-cell disorder (CD-4 cells) sue to HTLV-1 infection that is found in island natins such (Japan and Carribean)
-skin lesions, hypercalcemia, enlarged lymph nodes, and spleen
Micro: hyperlobulaed 4-leaf clover lyphocytes in peripheral blood smear
Adult T-cell Leukemia/Lymphoma (ATLL)
Adult T-cell Leukemia/Lymphoma (ATLL)
associated with HTLV-1
found in Japan and Carribean
hyper-lobulated 4-leaf clover lymphocytes in the blood
sx: skin lesions, hypercalcemia, enlarged lymph nodes, liver, and spleen
-Peripheral T-cell tumor
-malignant T-cell tumor (post-thymic CD4 cells)
generalized pruritic erythematous rash (no hypercalcemia)
-initially inflammatory exzzematous skin, then plaque stage, then tumor nodule stage
-Micro: PAS-positive lymphs in epidermis (epidermotropism); aggregates of these cells are called Pautrier microabscesses
***Cerebriform Sezary cells in the peripheral blood denotes that the tumor is now Sezary syndrome (which is associated with generalized exfoliative skin rash)
Mycosis Fungoides (and Sezary Syndrome)
Hodgkin disease

Nodular Sclerosis (NS) subtype
Reed-Sternberg cell (owl-eye)
CD15 (Leu-M1) positive
CD30 (Ki-1) positive

What is the most common subtype?
-more common in women
-lymph nodes are divided by bands or fibrosis
-bomodal age distribution (lates 20s and above 50s)
-Pel-Ebstein fever (fever that comes and goes
-night sweats and sweats
Acute Myelogenous Leukemia (AML)
Auer rods are abnormal lysosomes (primary granules) that are pathognomonic for myeloblasts
-auer rods stain positive with myeloperoxidase and with Sudan-black stain
Type of AML (**most tested on USMLE)
- numerous cytoplasmic granules and numerous Auer rods
-may develop DIC!!! due to release of thromboplastic substances in granules especially when therapy kills these cells
-t(15:17)--- gene?
M3 AML (hypergranular (microgranular) promyelocytic leukemia)

-t(15:17)--- PML gene (Polymorphonuclear Leukocyte) gene on 15 and
Retinoic Acid Receptor alpha gene (RAR-alpha) on chromosome 17
** this translocation forms an abnormal retinoic acid receptor therefore txt is with all-trans retinoic acid
The second most commonly tested on USMLE:
2 types of AML:
both are monocytic variants.
They tend to involve the gingavae, the skin, and the CNS.
In the skin they will form large tumos called choromas (chlor-green, because when you cut it open it is green)
M4 and M5 AML

M4: Myelomonocytic Leukemia has both myeloblasts and monoblasts
M5: Monocytic Leukemia (may have gingival infiltrates)
Asked on USMLE:
A type of AML that is a megakaryocytic variant. The blast cells tend to be HUGE. Since megakaryocytes are involves, you tend to have fibrosis of the bone marrow, and tend to develop a myelocytic process
M7 AML: Acute Megakaryocytic Leukemia; associated with acute myelofibrosis due to release of platelet-derived growth factor (PDGF)
AML associated most with myelofibrosis (myelocytic process)?
M7 AML (Megakaryocytic Leukemia) associated with acute myelofibrosis due to release of PDGF.
-A Myeloproliferative Syndrome
-Philadelphia chromosome (9,22)--gene?
MASSIVE splenomegaly
peripheral leucytosis (neutrophils, eo's, basophils)
-Decreased LAP (Leukocyte Alkaline Phosphatase)
**Will end off in a blast crisis
CML (Chromic Myelogenous Leukemia)

9- c-abl oncogene
22- bcr (breakpoint cluster region)
the translocation forms a new protein P210 that has tyrosine kinase actiivty

txt: Imatinib mesylate (gleevec) blocks the P210 tyrosin kinase
-Myeloproliferative Syndrome
-Characteristic findings:
1-increased erythroid precursors with increased RBC mass
2- increased hematocrit
3- increased blood viscosity

-Decreased erythropoietin (EPO), but RBC's have increased sensitivity to EPO and overproliferate
-increased basophils and increased eosinophils
-histamine released from the eosinophils causes intense pruritus and gastric ulcers
-INCREASED LAP (Leukocyte Alkaline Phosphatase)
-the increased blood viscocity can cause DVT's and infarcts
-the high cell turnover can cause hyperuricemia resultin gin gout
-may eventually develop myelofibrosis
-Increased risk for acute leukemia
Polycythemia Vera
Platelet count >1,000,000, with some with abnormal shapes
Also increased numbers of leukocytes
-excessive bleeding! and occlusion of small vessels.
Essential Thrombocythemia (ET)
Condyloma Acuminatum

HPV 6 and 11
-verrucous, wartlike lesions
-may occur on the vulva, perineum, vagina, and cervix
-associated with HPV serotypes?

Micro: koilocytosis
9changes in squamous epithelium due to virus), acanthosis, hyperkeratosis, and parakeratosis
Papillary Hidradenoma
benign tumor arising from ectopic breat tissue
-occurs along the milk line
-histologically similar to an intraductal papilloma of the breast.
-it is a sharply circumscribed nodule of breast tissue found on the labia majora or the interlabial folds. It is benign and often confused with carcinoma of the vulva because of its tendency to ulcerate
Extramammary Paget Disease of the Vulva
-usually involves the labia majora
-erythematous, crusted rash
-micro: intraepidermal malignant cells with pagetoid spread
-not usually associated with underlying tumor
-arises from sweat glands
Female infants of mothers taking DES are at greater risk of developing these two vaginal cancers.
1-clear cell adenosis
2- clear cell vaginal carcinoma
Embryonal Rhabdomyosarcoma (Sarcoma boytryoides)
Affects children and infants under age 4yo
-p/w polypoid, "grapelike", soft tissue mass protruding out of the vagina
-micro: spindle-shaped tumor cells with rare cross-striation
Cambium layer:tendency of the tumor to grow beneath the vaginal epithelium
-tumor cells are positive for desmin because the tumor cells are of muscle origin
what are the most high risk HPV serotypes for cervical cancer?

what serotypes of HPV are associated with condyloma acuminutum?
what are the most high risk HPV serotypes for cervical cancer?
16, 18, 31, 33

what serotypes of HPV are associated with condyloma acuminutum?
6, 11
what are teh viral oncogenes of HPV 16, 18, 31, and 33?
viral oncogenes E6 (binds to p53) and E7 (binds to Rb)
femal p/w postcoital vaginal bleeding, dyspareunia, and malodorous discharge from vagina. dx?
cervical cancer

-ovarian "chocolate cysts--dx? Endometrioma

-what are the most common sites?
2-ovarian and uterin ligaments
3-Pouch of Douglas
4-serosa of bowel and bladder
5-peritoneal cavity
-pt p/w chronic pelvic pain, dysmenorrhea and dyspareunia, rectal pain and constipation, and infertility.
-red-brown serosal nodules ("powder burns")
-ovarian "chocolate cysts--dx?
-presence of endometrial glands and stroma outside the uterus
-what are the most common sites?
-woman p/w postmenopausal vaginal bleeding, what is next step?
-most commonly affects postmenopausal women.
-invasion into myometrium is prognostically important
-most common malignant tumor of the lower femal genital tract
Endometrial carcinoma

-woman p/w postmenopausal vaginal bleeding, what is next step? endometrial curetage to see if it is malignant

(leiomyosarcoma is the malignant variant)
-most common tumor of the femal genital tract overall
-benign smooth muscle tumor of the myometrium
-highest incidence in African-Americans
-whorl-like trabeculated appearance
-commonly multiple tumors
-locations: subserosal, intramural, and submucosal
-p/w menorrhagia, abdominal mass; pelvic pain, back pain, or suprapubic discomfort, and infertility
Lynch syndrome
"ECO" cancers
Call-Exner bodies are granulosa cells arranged haphazardly around a space containing eosinophilic fluid.

They are composed of membrane-packaged secretion of granulosa cell and have relations to the formation of liquor folliculi which are seen among closely arranged granulosa cells
They are usually associated with Granulosa cell tumour.
what is the most common metastatic tumor to the ovary?
Krukenberg tumor (gastric signet ring cell cancer)

2-breast cancer
3- endometrial cancer
androgen producing tumor of the ovaries
-p/w virilization
-complication: risk of femal pseudohermaphrodite
Sertoli-Leydig cell tumor (androblastoma)
Estrogen producing tumor of the ovary
-Call-Exner bodies
-complications: endometrial hyperplasia and cancer
Granulosa Cell tumor
-most common malignant ovarian tumor
-complex multiloculated cyst with nodular and solid areas
***papillary structures with psammoma bodies
***CA-125 positive
***associated with Lynch syndrome
Hydatidaform Mole

"snow storm" appearance on ultrasound
-tumor of trophoblastic tissue
1-excessive uterine enlargement (size greater than dates"
2- vaginal bleeding
3- passage of edematous, grapelike soft tissue
4-elevated beta-HCG

Dx: ultrasound