Quiz 3

Front 1

Acute myelomonocytic leukemia

Back 1

Aka M4. This leukemia is characterized by the differentiation along both myeloid and monocytic lines. Monocytes and promyelocytes represent >20%, <80% of the bone marrow differential.

Front 2

When stained, more than 20% should be positive for what?

Back 2

MPO and NSE

Front 3

What level is increased 3 times with M4?

Back 3

Serum lysozyme.

Front 4

Specific markers for myelomonocytic cells

Back 4

CD13 and CD33

Front 5

Chromosomal transference associated with M4

Back 5

4:11, 9:11.

Front 6

What is seen on peripheral smear with M4?

Back 6

Monocytosis.

Front 7

M4e

Back 7

Variant of M4. It is M4 with moderate eosinophilia. >5%.

Front 8

What chromosome is M4e associated with?

Back 8

Inversion of chromosome 16.

Front 9

M5

Back 9

Acute monocytic leukemia. Two subtypes. M5a and M5b.

Front 10

M5a

Back 10

Cells are poorly differentiated.

Front 11

M5b

Back 11

Shows differentiation. Most cells are recognizable promonocytes and monocytes.

Front 12

Cells associated with M5b

Back 12

More mature cells. 80% are monoblasts, promonocytes, and monocytes.

Front 13

Cells associated with M5a and chromosomal transference

Back 13

9:11. 80% monoblasts.

Front 14

C14 is found almost exclusively on which cells?

Back 14

Monocytes.

Front 15

M6

Back 15

Aka acute erythroblastic leukemia or Di Guglielmo's Syndrome. Only one in which there is hyperplasia of both the myeloid and erythroid cells. Rare and difficult to diagnose.

Front 16

Nucleated marrow cells associated with M6

Back 16

More than 50% of the Nucleated marrow cells are abnormal nucleated red blood cells. (30% considered adequate by some)

Front 17

Morphology of M6

Back 17

The leukemic red cells are frequently bizarre with extreme dysplastic features including: giant forms, multinucleation, cytoplasmic vacuolization, cytoplasmic buds, and megaloblastoid changes, ringed sideroblasts.

Front 18

Anemia with M6 is due to:

Back 18

Increase of undifferentiated erythroblasts.

Front 19

M7

Back 19

Acute megakaryotic leukemia. Rarest of AMLs constituting less than 1% of all cases.

Front 20

What disorder do patients with M7 usually have?

Back 20

A preceding myeloproliferative disorder.

Front 21

M7 in children

Back 21

Seen more frequently in patients less than 3 years of age and with Down's syndrome.

Front 22

Cytoplasm of M7 and why do blasts clump together? Translocation between which 2 chromosomes?

Back 22

Granular. Blasts will clump together due to protein change. (1;22)

Front 23

Eosinophilic leukemia

Back 23

Rare variant of acute myeloid leukemia in which blasts and immature eosinophils proliferate. CNS involvement appears to be common. Should be distinguished from CML with large numbers of eosinophils.

Front 24

Basophilic leukemia

Back 24

Rare subset of AML associated with t(6:9) and abnormal 12p. Ultra structure studies of the immature basophilic granules may be necessary.

Front 25

Philadelphia chromosome

Back 25

Associated with basophilic Leukemias. Positive cases may be related to the blast crisis of CML.

Front 26

Extramedullary myeloid cell tumor and other names

Back 26

Aka granulocytic sarcoma or chloroma is in an extra medullary tissue mass of blasts and immature myeloid cells.

Front 27

Color of EMCT and what does it represent?

Back 27

Turns green upon exposure to the air as large amounts of peroxidase are oxidized. May represent the initial manifestation of acute leukemia or signal relapse.

Front 28

Blast crisis of CML may represent:

Back 28

EMCT.

Front 29

Masses of monoblasts may be seen with:

Back 29

M5 Leukemias and sometimes referred to as EMCT.

Front 30

Blast crisis of chronic leukemia

Back 30

Refers to phase of chronic leukemia resembling an acute leukemia in which blasts are more than 30%. In CML, blast crisis signals the terminal phase of the disease for which there is no effective therapy.

Front 31

Secondary therapy induced acute leukemia

Back 31

Nearly always myeloid and is usually preceded by myelodysplastic syndrome involving all three hematopoietic cell lines. (Panmyelosis)

Front 32

Abnormalities of chromosomes with secondary acute leukemia and when is it most common?

Back 32

5, 7, and 11 are common. This is most common after alkylating chemotherapy or radiation therapy, with an average latent period of 5 years.

Front 33

Hypocellular acute leukemia

Back 33

Situation in which marrow cellularity (<30%) often resembles aplastic anemia, but with numerous (30%) blasts in the interstitium of the marrow. About 5-10% of acute myeloid Leukemias present in this form.

Front 34

Classification of acute lymphoblastic leukemia

Back 34

L-1: 85%

L-2: 14%

L3: Burkitt's 1% childhood

Front 35

What ages do most lymphoblastic Leukemias occur?

Back 35

2-10. Good prognosis. 90% go into remission. 60% completely cured.

Front 36

L1

Back 36

Aka acute lymphoblastic leukemia. Most common ALL found in children and appears to have best prognosis.

Front 37

Morphology of L1: cells, chromatin, and nuclei

Back 37

L1 blasts are small (about twice the size of small lymphocyte) and homogeneous (easier to kill). Chromatin is usually finely dispersed. Nuclei are round and regular with the clefting and inconspicuous nucleoli. Cytoplasm is scanty.

Front 38

Which cell line is lymphocytic leukemia typically associated with?

Back 38

B cells.

Front 39

L2

Back 39

Acute lymphoblastic leukemia. Most frequent ALL found in adults. Blasts demonstrate marked heterogeneity. Great deal of variability in each case.

Front 40

Morphology of M2

Back 40

Blasts are large and heterogeneous. Nuclei are irregular and often clefted (butt cells). One or more large nucleoli present. Volume of cytoplasm is variable, but abundant and may contain vacuoles.

Front 41

Cell lineage of L2

Back 41

B, but some t.

Front 42

L3

Back 42

Aka Burkitt's leukemia. Occurs in children and adults. Lymphoblasts similar to appearance to those found in Burkitt's lymphoma. Blasts are homogeneous. Large cells with abundant basophilic cytoplasm. Prominent cytoplasmic vacuolization.

Front 43

Morphology of L3

Back 43

L3 blasts are moderate large in size and homogenous. Nuclei are regular and round oval in shape. One more more prominent nucleoli. Volume of cytoplasm is moderate and contains prominent vacuoles.

Front 44

Chromosomal abnomalities of L3

Back 44

t(8;14), t(2;8), t(8;22)