Hematology Ii Exam 3

Front 1

Define lymphoid malignancy

Back 1

overproduction of various types of immature or mature lymphocytes

Front 2

Activated B cells produce daughter cells of the same type that develop into ________ or ______.

Back 2

memory cells, plasma cells

Front 3

Stages of B-lymphocyte development

Back 3

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.

Front 4

T-lymphocytes are produced in the _______ and stimulated to move to the ______.

Back 4

bone marrow, thymus

Front 5

CD7 is one of the earliest and most sensitive markers for ______.

Back 5

T-cell ALL

Front 6

The mature thymocyte will be either a _____ expressing ____ or ________ expressing _________.

Back 6

helper cell, cd4, suppressor, cd8

Front 7

Habitat of lymphocytes

Back 7

bone marrow, peripheral blood, lymph nodes, mucosal tissues, spleen, liver, skin, thymus

Front 8

Name the plasma cell neoplasms

Back 8

multiple myeloma, heavy chain diseases, amyloidosis, monoclonal gammopathy of undetermined significance, Waldenstrom's macroglobulinemia

Front 9

Symptoms of acute lymphoblastic leukemia

Back 9

bleeding abnormalities, weakness, flu-like symptoms

Front 10

Acute lymphoblastic leukemia is characterized by ______ onset of symptoms, usually no more than _______ duration

Back 10

abrubt, a few weeks

Front 11

Acute lymphoblastic leukemia involves the replacement of ________ leading to ______. This leads to complications including _____, ______ and _____.

Back 11

normal marrow elements, bone marrow failure, anemia, thrombocytopenia, granulocytopenia

Front 12

Laboratory evaluations necessary for acute lymphoblastic leukemia

Back 12

CBC, platelet count, WBC differential, peripheral blood smear examination, cytochemistry/cytogenetics/molecular diagnostics, bone marrow aspiration

Front 13

Laboratory results characteristic of ALL

Back 13

increased or normal leukocyte count, neutropenia, lymphoblasts, normocytic/normochromic anemia, thrombocytopenia, hypercellular bone marrow with >30% lymphoblasts

Front 14

L1 morphology

Back 14

small, uniform lymphoblasts

seen primarily in children

Front 15

L2 morphology

Back 15

large, pleomorphic lymphoblasts

seen more frequently in adults

Front 16

L3 morphology

Back 16

Burkitt's type (vacuolated and deeply basophilic cytoplasm)

Front 17

2 WHO subgroups of ALL

Back 17

Precursor B and T cell neoplasms (L1/L2)

Burkitt type ALL (L3)

Front 18

B-cell lineage is defined by surface antigen _______ and/or cytoplasmic ______.

Back 18

CD19, CD22

Front 19

Pre-B-cell ALL is most common in ______. It usually presents with WBC count _________.

Back 19

children 3-5 years of age, less than 100,000/L.

Front 20

Pre-B-cell ALL usually involves the ______ and _____ but not _____.

Back 20

bone marrow, blood, organs

Front 21

T-cell ALL usually presents with _______ mass and ______ involvement.

Back 21

mediastinal, organ

Front 22

______ are affected more by T-cell ALL.

Back 22

Males

Front 23

T-cell ALL has what type of prognosis?

Back 23

Poor compared to pre-B ALL.

Front 24

What type of organ involvement may be encountered with T-cell ALL?

Back 24

hepatosplenomegaly, early meningeal involvement

Front 25

Precursor T-cells in ALL express what cell markers?

Back 25

TdT, CD4 and CD8

Front 26

T-cell lineage is defined by what cell markers?

Back 26

CD2, CD3, CD5, CD7

Front 27

What is the most common FAB classification for T-ALL?

Back 27

L1

Front 28

L1 morphology

Back 28

uniform population of small blasts, scant cytoplasm, nuclear patten is homogenous, nucleoli are inconspicuous

Front 29

L2 morphology

Back 29

characterized by cellular heterogeneity, nuclear clefting and indentation are common, indistinguishable morphologically from AML-M2

Front 30

L3 morphology

Back 30

cells are uniform population of relatively large blasts, basophilic moderate to abundant cytoplasm, nucleus is round to oval with no indentations

Front 31

Describe the early phase of lymphoproliferative disorders

Back 31

tumor cells are small in size, few in number and have prolonged cell survival

Front 32

Describe the transformation phase of lymphoproliferative disorders

Back 32

tumer cells have increased numbers and appear in extramedullary sites with big, immature cells

Front 33

________ is the most common lymphocytic leukemia in adults

Back 33

Chronic lymphocytic leukemia

Front 34

Chronic lymphocytic leukemia is most frequently a neoplasm of ____ lymphocytes.

Back 34

B

Front 35

Small cell lymphoma involves lymph nodes with little ____ and _____ involvement

Back 35

peripheral blood, bone marrow

Front 36

Cells involved in CLL are _____-lived and _______ dysfunctional lymphocytes

Back 36

long, immunologically

Front 37

Malignancy in CLL is an effect of failed _______.

Back 37

apoptosis

Front 38

Marrow replacement in CLL results in ____, ______, and _____.

Back 38

anemia, thrombocytopenia, neutropenia

Front 39

CLL is characterized by extreme adenopathy (T/F)

Back 39

True

Front 40

90% of all CLL cases occur in adults older than ________.

Back 40

50 years

Front 41

CLL is found mostly in males (T/F)

Back 41

True, CLL is found in twice as many males as females

Front 42

Signs and symptoms of CLL develop _______.

Back 42

gradually

Front 43

Laboratory features of CLL

Back 43

minimum of 10x10^9 WBC/L in peripheral blood, 30% lymphocytosis of bone marrow, mature-appearing lymphs, normocytic/normochromic anemia, normal or low reticulocytes,

Front 44

Normal blood has approximately _______ B-cells and _______ T-cells. There may be up to _____ NK cells.

Back 44

20%, 60-80%, 22%

Front 45

The most common chromosomal abnormality in B-cell CLL is ________, which may occur alone or with deletions/translocations of _______.

Back 45

trisomy 12, chromosome 13q14.

Front 46

B-prolymphocytic leukemia is characterized by prominent ______ without ________.

Back 46

splenomegaly, lymphadenopathy

Front 47

B-prolymphocytic leukemia is characterized by ______ prolymphocytes in the peripheral blood. WBC count is often ________.

Back 47

55-70%, >100x10^9 cells/L

Front 48

Small lymphocytic lymphoma is the _______ of CLL and may be described as diffuse _______ lymphoma

Back 48

nodal counterpart, non-Hodgkin's

Front 49

Mantle cell lymphoma arises from the ______ of the _____ zone of __________.

Back 49

centrocytes, mantle, lymphoid follicles

Front 50

Mantle cell lymphoma cells are of what lineage?

Back 50

B-cell

Front 51

In mantle cell lymphoma, peripheral white blood cells counts may exceed ________.

Back 51

200 x 10^9/L

Front 52

Mantle cell lymphoma has a distinct immunophenotype and typical chromosomal translocation of:

Back 52

t(11;14)(q13;q32)

Cyclin D1 staining on tissue section is positive

Front 53

Small cleaved cell lymphoma is a ______ lymphoma with ______ lymphocytes

Back 53

Non-Hodgkin's, B

Front 54

In small cleaved cell lymphoma, circulating cells have ____ cytoplasm, are ______ in shape, and have irregular _______ transversing the nucleus

Back 54

scant, irregular, notches/clefts

Front 55

Hairy cell leukemia is a ____ lymphocyte ______ leukemia

Back 55

B, chronic

Front 56

Pancytopenia is unique to what leukemia?

Back 56

Hairy cell leukemia

Front 57

_____ and _____ are frequently observed in hairy cell leukemia.

Back 57

Splenomegaly, marrow fibrosis

Front 58

The most characteristic cytochemical feature of hairy cell leukemia

Back 58

Strong acid phosphatase reaction not inhibited by tartrate

Front 59

Describe the morphology of circulating lymphocytes in hairy cell leukemia

Back 59

Possess fine, hair-like, irregular cytoplasmic projections

Front 60

Sezary syndrome is characterized by abnormal circulating lymphocytes with a ____ staining and _______ nuclear chromatin pattern with numerous folds and grooves

Back 60

dark, hyperchromatic

Front 61

Sezary syndrome is the leukemic phase of ___________.

Back 61

the common cutaneous T-cell lymphoma mycosis fungoides

Front 62

Adult T-cell leukemia/lymphoma is caused by ______

Back 62

HTLV-1

Front 63

Morphology of lymphocytes in adult T-cell leukemia/lymphoma

Back 63

highly convoluted nuclear shape (often clover leaf), marked variation in cell size, very prominent nucleoli

Front 64

Hodgkin lymphoma is characterized morphologically by:

Back 64

a proliferative background of benign inflammatory cells interspersed with malignant cells and their variants

Front 65

______ is the most common type of malignancy in children

Back 65

Hodgkin lymphoma

Front 66

_______ must be present to diagnose Hodgkin's lymphoma

Back 66

Reed-Sternberg cells

Front 67

________ usually presents with one firm lymph node spreading in an orderly fashion throughout the lymph system

Back 67

Hodgkin's lymphoma

Front 68

Extranodal involvement in Hodgkin's lymphoma may include _________.

Back 68

liver, spleen, lung or bone marrow

Front 69

In non-Hodgkin lymphoma, _______ can be found circulating in peripheral blood

Back 69

malignant lymphoma cells

Front 70

Non-Hodgkin lymphoma normally affects patients between _____ and ____ years of age

Back 70

20, 40

Front 71

Non-Hodgkin lymphoma typically arises in ______ and is characterized by prominent _______.

Back 71

peripheral lymph nodes, lymphadenopathy

Front 72

Define plasma cell disorder

Back 72

condition in which one clone of plasma cells multiplies excessively and produces a large quantity of abnormal antibodies

Front 73

Multiple myeloma forms tumors in the ______ and produces a large quantity of abnormal antibodies that accumulate in the ______ or ______.

Back 73

bone marrow, blood, urine

Front 74

Multiple myeloma is usually seen in people under 40 years of age (T/F)

Back 74

False, multiple myeloma is usually seen in people over 40 years of age

Front 75

Plasmacytomas are most common in:

Back 75

pelvic bones, spine, ribs/skull, lungs, reproductive organs

Front 76

In multiple myeloma, abnormal antibodies frequently end up in the _____, sometimes causing _______.

Back 76

kidney, renal failure

Front 77

Abnormal antibody light chains in the urine are known as ______. These are seen in ______ and ______.

Back 77

Bence Jones proteins, multiple myeloma, Waldenstrom's macroglobulinemia

Front 78

Symptoms of multiple myeloma

Back 78

bone pain (especially spine or ribs), anemia, easily fractured bones, recurring bacterial infections, kidney failure, blood "thickening"

Front 79

Laboratory findings in multiple myeloma

Back 79

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

Front 80

In monoclonal gammopathies of undetermined significance, a large quantity of abnormal antibody is produced but plasma cells are not ______.

Back 80

cancerous

Front 81

MGUS does not require _____, but may progress to _______.

Back 81

treatment, multiple myeloma

Front 82

Waldenstrom's macroglobulinemia is characterized by the production of _____________ by the plasma cells.

Back 82

excessive quantities of macroglobulins

Front 83

Macroglobulinemia may result in ______ syndrome, which is characterized by _______.

Back 83

hyperviscosity, reduced blood flow to extremities, abnormal bleeding, fatigue, weakness, headache, dizziness, coma

Front 84

In macroglobulinemia, tiny blood vessels in ________ can become engorged and bleed, resulting in ________.

Back 84

the back of the eyes, damage to the retina and impaired eyesight

Front 85

Define cryoglobulin

Back 85

an abnormal antibody that precipitates in the blood when cooled below body temperature

Front 86

Define Raynaud's phenomenon

Back 86

hands and feet become very painful and turn white when exposed to cold, occurs with cryoglobulinemia

Front 87

Define heavy chain disease

Back 87

Neoplastic plasma cell dyscriasias characterized by overproduction of monoclonal immunoglobulin heavy chains

Front 88

IgG gamma heavy chain disease affects the ____, _____ and ____. It normally affects the _____ population.

Back 88

liver, spleen, lymph nodes, elderly

Front 89

IgA alpha heavy chain disease usually produces _______. It affects ___________.

Back 89

abdominal masses, younger individuals in the Mediterranean

Front 90

IgM mu heavy chain disease produces _______ plasma cells.

Back 90

vacuolated

Front 91

L1 and L2 lymphoblasts are differentiated by _____ and _____.

______ techniques serve to confirm diagnosis.

Back 91

N:C ratio, presence/absence of nucleoli, immunologic/cytogenetic