120314 lymphoid leukemias

Question 1

what does open, light chromatin in a cell that looks like a lymphocyte but is bigger suggest?

Answer 1

immature

Question 2

CD20 is a marker for

Answer 2

mature B cells

Question 3

what does flow cytometry allow you to assess?

Answer 3

identification of cells (forward scatter reflects size, side scatter reflects complexity of cell cytoplasm, immunophenotype)

identify aberrancye

Question 4

smudge cell count is positive for

Answer 4

anything with too many lymphocytes

isn’t always CLL. could be mono

Question 5

CD34 is a marker for

Answer 5

blasts (immature cells) or stem cells

Question 6

in B-ALL, where can the lymphoblasts be found

Answer 6

CSF, lymph nodes, bone marrow, splenic sinusoids

Question 7

prognosis of B-ALL looks at

Answer 7

cytogenetic abnormalities

Question 8

CD3 is positive on

Answer 8

T cells

Question 9

most common leukemia of adults in Western world

Answer 9

CLL

Question 10

in mono, what kind of B cells can result with latent infection?

Answer 10

polyclonal B cells that proliferate

CD8 T cells against virus develop as atypical lymphocytes

Question 11

ginger snap (irregular condensations)

Answer 11

CLL

Question 12

CLL’s immunophenotype

Answer 12

CD5 +
CD19 +
CD 23 +

Question 13

CLL is indolent or aggressive?

Answer 13

indolent

Question 14

prognostic indicators for CLL

Answer 14

good prognosis: deletion 13q, mutated IgHV

intermediate: trisomy 12
bad: deletion 11q, deletion 17p, unmutated IgHV, high Rai stage, CD38/ZAP70 expression

Question 15

absolute lymphocytosis is defined as

Answer 15

more than 4,000/microliter

Question 16

reactive vs neoplastic lymphocytosis

Answer 16

duration
morphology (heterogeneous for reactive, monomorphic favors neoplasia)

absolute lymphocyte count (20-40k favors neoplastic)

clinical findings (LAD-shared by both reac and neoplastic)

flow cytometry findings (to determine polyclonal vs monoclonal)

Question 17

differential for benign lymphocytosis

Answer 17

infectious mononucleosis
mono like syndromes (CMV, adeno, acute HIV)
other viruses
TB
transient stress lymphocytosis (common)–trauma, MI, stroke

pertussis

Question 18

lymphocytosis–neoplastic/clonal differential

Answer 18

CLL
leukemic lymphoma
sezary syndrome
hairy cell leukemia
adult T cell leukemia
T cell large granular lymphocytic leukemia

Question 19

how do you test for clonality in lymphocytes?

Answer 19

B cells:

• light chain restriction on cell surface (kappa vs lambda) by flow cyto or immunohistochem
• IgH variable gene PCR
• immunophenotypic aberrancy

T cells/NK cells:

• TCR gene PCR
• immunophenotypic aberrancy

Question 20

define acute leukemia

Answer 20

greater or equal to 20% blasts in blood or bone marrow

Question 21

myeloid CDs for acute leukemia

Answer 21

CD13, 14, 15, 33, 117

Question 22

how can acute leukemias be divided?

Answer 22

myeloid vs lymphoid (important for therapy)

by morphology and immunophenotype (Auer rods, CDs)

Question 23

AML is more common in adults or children?

Answer 23

adults

Question 24

ALL types–percentage prevalance

Answer 24

85% B ALL

15% T ALL

Question 25

of B cell ALLs, what is notable about t(12;21)

Answer 25

most common in kids

Question 26

adolescent males w/ mediastinal mass

Answer 26

T cell ALL

Question 27

prognostic factors in B ALL

Answer 27

``` age cytogenetics WBC count CSF involvement marrow involvement following therapy ```

Question 28

good prognostic indicators in B-ALL

Answer 28

2-10 years old hyperdiploidy (>50) t(12;21)

Question 29

bad prognostic indicators in B-ALL

Answer 29

``` under 2, over 10 yr old t(9;22), MLL gene hypodiploidy (<45) elevated WBC (over 100k/uL) CSF involvement marrow involvement at day 15 ```

Question 30

tx for philadelphia chromosome positive B-ALL

Answer 30

tyrosine kinase inhibitor (dasatinib, imatinib)--survival is 50%

Question 31

leukemoid rxn WBC usually

Answer 31

NOT over 100,00

Question 32

CLL/SLL has what immunophenotype

Answer 32

CD5, CD19, CD20, CD23

Question 33

CLL/SLL clinical behavior in the majority of cases is?

Answer 33

indolent

Question 34

CLL/SLL is both a leukemia and lymphoma-true or false?

Answer 34

true

Question 35

small B cell leukemia/lymphoma that is CD5 positive is

Answer 35

CLL/SLL (CD23 positive) or | mantle cell lymphoma (CD23 negative)

Question 36

small B cell leukemia/lymphoma that is CD5 negative is

Answer 36

``` follicular lymphoma (CD10 positive) or marginal zone lymphoma (CD10 negative) ```

Question 37

dry tap

Answer 37

hairy cell leukemia (in HCL, also has accumulation of hairy cells in red pulp of spleen)

Question 38

atypical lymphocytes +/- lymphocytosis

Answer 38

``` CLL/SLL leukemic lymphoma (follicular, mantle, etc) hairy cell leukemia hairy cell leukemia adult T cell leukemia/lymphoma Sezary syndrome ```

Question 39

splenomegaly due to RED PULP infiltration

Answer 39

hairy cell leukemia

Question 40

TRAP + cells

Answer 40

hairy cell leukemia

Question 41

course of hairy cell leukemia

Answer 41

indolent

Question 42

cerebriform nuclei

Answer 42

Sezary syndrome

Question 43

triad of Sezary syndrome

Answer 43

erythroderma generalized LAD circulating Sezary cells

Question 44

Sezary syndrome is what type of neoplasm

Answer 44

CD4 + T cell | chronic leukemia

Question 45

adult T cell leukemia/lymphoma is what type of neoplasm

Answer 45

CD4 + T cell

Question 46

HTLV-1 association

Answer 46

adult T cell leukemia

Question 47

seen more commonly in Japan, Caribbean, Africa

Answer 47

adult T cell leukemia

Question 48

flower cell with lymphocytosis

Answer 48

adult T cell leukemia/lymphoma

Question 49

course of adult T cell leukemia

Answer 49

aggressive

Question 50

when you see a lymphocyte with pink granules, it's either

Answer 50

T or NK cells

Question 51

large granular lymphocytic leukemia

Answer 51

lymphoproliferative disorder of cytotxic T cells | associated with autoimmune disorders