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[Hematology 2] Lec > ALL > Flashcards

ALL Flashcards

1
Q

▪ Acute Lymphoblastic Leukemia

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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2
Q

▪ uncontrolled growth of abnormal lymphoid cells in the

A

spleen, bone marrow, and lymph nodes

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3
Q

Proliferation of abnormal lymphoid lineage in the bm

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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4
Q

▪ DEFECT:

A

DNA synthesis of lymphoblasts

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5
Q

• not defective but longer than normal tissues (?)

A

> 1hour

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6
Q

▪ ALL: primarily a disease of

A

childhood and adolescence

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7
Q

• accounting for [?] of childhood cancers and up to [?] of childhood leukemia (peak is at [?)

A

25%

75%

2 years of age

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8
Q

• most common:

A

children between 2-10 years old

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9
Q

uncontrolled growth of abnormal lymphoid cells in the bm = abnormal infiltration of cells in:

A

bm, spleen, liver, lymph nodes

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10
Q

▪ same with other acute leukemias (weight loss, night sweats/malaise) but

A

onset is more sudden

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11
Q

: due to proliferation of lymph. in the bm, other blood cells are not produced

A

▪ cytopenia

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12
Q

: enlargement of spleen and liver presses on the nerves (not common in AML)

A

▪ cranial nerve paralysis

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13
Q

▪ splenomegaly, hepatomegaly, and enlargement of the

A

superficial lymph nodes

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14
Q

▪ common causes of death:

A
  1. infection
  2. bleeding (spontaneous)
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15
Q

: lymph. produced are not stimulated by any microbes; no antigenic stimuli; nonreactive

A
  1. infection
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16
Q
  1. bleeding (spontaneous): due to [?]; leukemic cells infiltrates the: [?]
A

low platelet count (< 50 x 109 /L) or lower at (< 20 x 109 /L)

spleen and liver affecting Vit K dependent factors (↓: II, VII, IX, X)

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17
Q

▪ common causes of infections:

A

• S. aureus
• P. aeruginosa
• C. albicans
• H. influenza
• P. mirabilis

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18
Q

▪ WBC count:

A

• vary from low (< 5.0 x 109 /L) to high (> 100 x 109/L)

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19
Q

▪ predominant circulating cell:

A

leukemic lymphoid blast or lymphoblast

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20
Q

• except in conditions of [?] (has few or no circulating lymphoblasts)

A

aleukemic leukemia

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21
Q

▪ bone marrow:

A

• hypercellular (> 100 x 109/L WBC ct)
• heavily infiltrated with lymphoid cells
• presence of fibrosis (abnormal infiltration of lymphocytes in the bm causing bone pain)

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22
Q

B CELL ALL General criteria:

A

> 25% lymphoblast in BM is identified as Blineage lymphocytes

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23
Q

: equivalent to L1 and L2

A

▪ B-ALL & B-LBL

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24
Q

B CELL ALL morphology not mentioned by FAB

A

• lymphoblast with pseudopod projections often seen

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25
Q

▪ criteria: > 25% lymphoblasts in BM

A

A) Precursor B-lymphoblastic Leukemia (B-ALL)

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26
Q

▪ present in childhood (poor prognosis in adults)

B ALL
B LBL
T ALL
T LBL

A

A) Precursor B-lymphoblastic Leukemia (B-ALL)

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27
Q

▪ criteria: > 25% lymphoblasts in BM extranodal sites (lymph nodes and spleen; mass lession)

A

B) B-lymphoblastic Lymphoma (B-LBL)

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28
Q

▪ involvement of lymph nodes which exhibits more mass lesions (less leukemic process)

A

B) B-lymphoblastic Lymphoma (B-LBL)

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29
Q

▪ rare

B ALL or B LBL

A

B) B-lymphoblastic Lymphoma (B-LBL)

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30
Q

T CELL ALL general criteria:

A

> 25% lymphoblast in BM identified as B-lineage lymphocytes

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31
Q

▪ present in children (15-20%) and adults (25%)

A

A) Precursor T-lymphoblastic Leukemia (T-ALL)

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32
Q

▪ more mitotic blast cell

A

A) Precursor T-lymphoblastic Leukemia (T-ALL)

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33
Q

▪ frequently found in males in all ages, predominantly in adults

A

B) T-lymphoblastic Lymphoma (B-LBL)

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34
Q

BASIS OF FAB

A

▪ cytologic features

▪ degree of heterogeneity in distribution among the leukemic cell population (age)

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35
Q

▪ cytologic features:

A

cell size, chromatin, nuclear shape, nucleoli, degree of basophilia in the cytoplasm, and presence of cytoplasmic vacuolation

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36
Q

▪ Cell size: small

A

L1

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37
Q

▪ Cell size: homogenous

A

L1
L3

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38
Q

▪ Cell size: large

A

L2
L3

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39
Q

▪ Cell size: heterogenous

A

L2

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40
Q

NON-B

A

L1
L2

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41
Q

BURKITT TYPE

A

L3

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42
Q

▪ Nucleus: regular

A

L1
L3

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43
Q

▪ Nucleus: occasional clefting

A

L1

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44
Q

▪ Nucleus: irregular

A

L2

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45
Q

▪ Nucleus: common clefting or indentation

A

L2

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46
Q

▪ Nucleus: oval to round

A

L3

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47
Q

▪ Nucleus: no clefting

A

L3

48
Q

▪ Nucleoli: rare

A

L1

49
Q

▪ Nucleoli: not visible or small

A

L1

50
Q

▪ Nucleoli: inconspicuous

A

L1

51
Q

▪ Nucleoli: present (often large)

A

L2

52
Q

▪ Nucleoli: 1-3 (vesicular)

A

L3

53
Q

Chromatin : homogenous

A

L1

54
Q

▪ Chromatin : variable

A

L2

55
Q

▪ Chromatin : finely stippled

A

L3

56
Q

▪ Amount: scanty

A

L1

57
Q

▪ Amount: moderately abundant

A

L2
L3

58
Q

▪ Amount: moderately abundant

A

L2
L3

59
Q

Vacuolation: variable

A

L1
L2

60
Q

▪ Vacuolation: often prominent

A

L3

61
Q

▪ Basophilia: moderate

A

L1

62
Q

▪ Basophilia: variable

A

L2

63
Q

▪ Basophilia: intense

A

L3

64
Q

▪ Incidence: 15 y/o and below

A

L1

65
Q

▪ Incidence: older than 15 y/o (adult)

A

L2

66
Q

▪ Incidence: rare

A

L3

67
Q

▪ most common (more treatment available)

A

L1

68
Q

▪ best prognosis

A

L1

69
Q

▪ L3 cytogenic abnormality:

A

t(8;2;14;22)

70
Q

▪ worst prognosis

A

L3

71
Q

▪ “Burkitt’s lymphoma”

A

L3

72
Q

A translocation between [?] appears to mark a type of ALL that can evolve into a myeloid (AML) or monocytic diseases

A

ch4 and ch11

73
Q

Neutrophil primary granules

A

Myeloperoxidase (MPO)

74
Q

Phospholipids

A

Sudan Black B (SBB)

75
Q

Cellular enzyme

A

Specific Esterase

Non-specific Esterase

76
Q

Intranuclear enzyme

A

Terminal Deoxyribonucleotidyl Transferase (TdT)

77
Q

Glycogen

A

Periodic Acid Schiff (PAS)

78
Q

Myeloblasts are strongly positive

A

Myeloperoxidase (MPO)

Sudan Black B (SBB)

Specific Esterase

79
Q

Differentiates ALL (-) from ANLL (+)

A

Myeloperoxidase (MPO)

Sudan Black B (SBB)

80
Q

Monoblasts are strongly positive (M4, M5)

A

Non-specific Esterase

81
Q

Lymphoblasts are positive

A

Terminal Deoxyribonucleotidyl Transferase (TdT)

PAS

82
Q

Differentiates ALL (+) from ANLL (-)

A

Terminal Deoxyribonucleotidyl Transferase (TdT)

83
Q

Important in identifying blastic transformation of CML

A

Terminal Deoxyribonucleotidyl Transferase (TdT)

84
Q

(+) M6 (Erythroleukemia)

A

Periodic Acid Schiff (PAS)

85
Q

Differentiates L1 (4+) from L2 (1-2+) of ALL

A

Periodic Acid Schiff (PAS)

86
Q

Periodic Acid Schiff (PAS)

▪ L1:

▪ L2:

A

chunky granules (block-like) in staining (very reactive)

minimal granular appearance

87
Q

(+) AML-M7
(+) ALL L1-L3

A

Acid Phosphatase

88
Q

Early (pro/pre-pre) B-ALL

A

CD34, CD19, cytoplasmic CD22, TdT

89
Q

Intermediate (common)

A

BALL CD34, CD19, CD10, cytoplasmic CD22, TdT

90
Q

Pre-B ALL

A

CD34, CD19, cytoplasmic CD22, cytoplasmic m, TdT (variable)

91
Q

T-ALL

A

CD2, CD3, CD4, CD5, CD7, CD8, TdT

92
Q

Immunologic markers

A
93
Q

: detects B lymphocytes

A

Surface immunoglobulin (SIg)

94
Q

: detects T lymphocytes

A

Sheep erythrocyte receptor

95
Q

: +70% of ALL patients

A

CALLA (common acute lymphoblastic antigen)

96
Q

NOT present on normal peripheral lymphocytes

A

CALLA (common acute lymphoblastic antigen)

97
Q

NOT specific for leukemia (also present on normal BM cells that are positive for TdT and HLA-DR antigen)

A

CALLA (common acute lymphoblastic antigen)

98
Q

normal in blast cells/bm; abnormal in the circ

A

CALLA (common acute lymphoblastic antigen)

99
Q

▪ present on the leukemia cells of 70% of ALL patients

A

CALLA

100
Q

▪ not present on normal peripheral lymphocytes

A

MONOCLONAL COMMON ACUTE LYMPHOBLASTIC LEUKEMIA ANTIGEN (CALLA)

101
Q

NOT specific for leukemia because it is also present on normal BM cells that are positive for TdT and HLA-DR antigen

A

MONOCLONAL COMMON ACUTE LYMPHOBLASTIC LEUKEMIA ANTIGEN (CALLA)

102
Q

CLASSIFICATION BASED ON IMMUNOLOGIC + CYTOCHEMICAL PROPERTIES

A
103
Q

▪ absence of T antigens, SIg, and CALLA

A

Null/Unclassified ALL

104
Q

▪ presence of CALLA, HLA-DR, and TdT

A

Common ALL (cALL)

105
Q

▪ highest remission rate even after chemotherapy

A

Common ALL (cALL)

106
Q

• due the appearance of a tumor chromosome identical to Ph1 chromosome (presence makes poor prognosis)

A

Common ALL (cALL)

107
Q

▪ T-cell antigen and sheep erythrocyte receptor

A

T ALL

108
Q

▪ usually occurs in males

A

T ALL

109
Q

▪ CNS involvement

A

T ALL

110
Q

▪ poorer prognosis

A

T ALL

111
Q

▪ T-cell antigen without sheep erythrocyte receptor

A

Pre-T ALL

112
Q

▪ presence of cytoplasmic immunoglobulin (CIg)

A

Pre-B ALL

113
Q

▪ absence of SIg

A

Pre-B ALL

114
Q

▪ presence of CIg, SIg, and B cell antigen

A

B ALL

115
Q

▪ corresponds to FAB L3 classification

A

B ALL

116
Q

: present in all ALL types except B ALL

A

TdT

[Hematology 2] Lec (29 decks)

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