Lecture 10: Leukemia and Lymphoma Cases Flashcards Preview

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Flashcards in Lecture 10: Leukemia and Lymphoma Cases Deck (21)
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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)
2. Splenomegaly
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?

Burkitt Lymphoma

- 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


What is Chronic Lymphocytic Leukemia also known as and how does it typically manifest?

also known as Small Lymphocytic Lymphoma

- peripheral disease is typically what manifests (monoclonal B cells) --> typically diagnostic of what is happening in LNs