Flashcards in Lecture 10: Leukemia and Lymphoma Cases Deck (21)
What is Myelodysplastic Syndrome?
- age-related acquired genetic damage to hematopoietic cells marked by cytopenias and dysmorphic RBCs
- considered pre-leukemic
What are Gram (+) cocci and Gram (-) rods we should be concerned about getting an infection from if in a hospital? What is a common fungal infection and what stain is used to see it?
Gram (+) - staphylococcus/streptococcus
Gram (-) - E. Coli/pseudomonas
Fungus --> Candida (silver stain)
How is Candida Sepsis treated?
voriconazole and amphotericin B
- replace any central caths that caused the infection
What is a diagnostic finding and a confirmatory finding of Acute Promyelocytic Leukemia?
diagnostic - Auer Rods (in circulating blasts)
confirmatory - positive for t(15;17)
What molecules are expressed by Acute Promyelocytic Leukemia cells?
express Tissue Factor (activates Factor X) and Annexin II receptors (convert plasminogen into plasmin)
- both HIGHLY expressed on APL cells
What is the specialized chemotherapy treatment given to patients who suffer from Acute Promyelocytic Leukemia?
ATO - arsenic trioxide
ATRA - all-trans retinoic acid (Vitamin A derivative)
What are two life-threatening outcomes of APL?
massive cerebral and pulmonary hemorrhage
What does the LAP score tell us about WBCs?
positive LAP staining (red/blue) is seen in REACTIVE conditions = Leukemoid RXN
absent LAP staining = abnormal myelocyte population --> NEOPLASM
What are Pseudo-Gaucher Cells?
- macrophages that blue-green cytoplasm typically seen in CML
What does Imatinib (Gleevec) do?
- tyrosine kinase inhibitor (controls ATP-dependent processes by binding where ATP should and blocks it from activating the kinase)
- pts. with Philadelphia chromosome t(9;22) have this tyrosine kinase problem
How can we test for the Philadelphia chromosome?
Cytogenics, FISH, PCR
- PCR is the most sensitive (shows 1 in 100.000 cells vs 1/20 for cytogenics and 1/200 in FISH)
Hematologic Response vs Molecular Response
HR - where white cell count begins to normalize
MR - negative for BCR-ABL PCR
Why is monitoring CML so important?
CML can progress to Accelerated phase (10-19% blasts, thrombocytopenia, basophilia)
AP can progress to Blast phase (circulating blasts are 20% or higher)
What are 4 common findings with Chronic Myeloid Leukemia?
1. HIGH WBC count (mature granulocytes/LAP negative)
3. Hypercellular bone marrow
4. Philadelphia chromosome
What are 3 things that are suspicious for metastatic lymph node cancer?
1. subclavian LAD
2. fixed and hard LAD
3. lymph node is > 4cm
What is the only biopsy method that can diagnose Hodgkins lymphoma? What is the diagnostic cell that we are looking for?
Excision Biopsy (also best way to diagnose lymphoma)
- looking for Reed-Sternberg cells (look like owls)
- fine needle aspiration/needle biopsy not enough
What is Tumor Lysis Syndrome and what problems can it cause?
- when bulky tumors breakdown due to chemotherapy and dump their metabolic products
- efflux of potassium and uric acid crystal buildup can lead to arrythmias and acute renal failure
What lymphoma is likely to have a rapidly enlarging mass?
- CNS and bone marrow involvement MORE likely with this lymphoma than other NHL
- CNS involvement = INTRATHECAL chemotherapy (get chemotherapeutics into CSF via Lumbar Puncture)
What is Hodgkins Lymphoma?
neoplastic lymphoid proliferation with scattered B-derived Reed Sternberg cells in an ABUNDANT background of T lymphocytes, eosinophils, and other inflammatory cells
- chemotherapy VERY effective
What are the 3 typical ways that Hodgkins Lymphoma presents?
lymphadenopathy, constitutional symptoms ("B" symptoms), or incidentally on chest x-ray