There is an association with smoking and which neoplastic proliferation of white cells?
Acute myeloid leukemia
Among lymphoid cells, potentially oncogenic mutations occur most frequently where and during what?
Germinal center B cells during attempted antibody diversification
What is CD11c expressed on?
- Granulocytes, monocytes, and macrophages
- Also expressed by hairy cell leukemias
How does the spread of Hodgkin lymphoma differ from that of NHL's?
- Hodgkin spreads in an orderly fashion
- Most forms of NHL spread widely early in their course and in less predictable fashion
Any child presenting with very low platelet counts has what until proven otherwise?
Acute lymphoblastic leukemia (ALL)
B-ALL is most often associated with what translocation?
What is the cell of origin for B-ALL?
Bone marrow precursor B cell
90% of ALLs have numerical or structural chromosomal changes; most common is what?
Hyperploidy (>50 chromosomes)
Which immunostaining marker and B-cell markers are positive in B-ALLs?
- (+) for TdT
- Express CD10, CD19, and CD20
A majority of T-ALLs have gain of function mutation in what gene?
Which CD markers are expressed by the cells of T-ALLs?
CD2 to CD8
Although genetically and immunophenotypically distinct, what are the clinical features shared between ALL and AML?
- Abrupt onset within days to weeks
- Sx's related to depression of marrow function, fever, infection, bleeding
- Mass effects, including bone pain; generalized LAD, hepatosplenomegaly; testicular enlargement
CNS manifestations such as HA, vomiting, and nerve palsies from meningeal spread are more common in which neoplasia of WBC's?
What are 3 factors associated with a worse prognosis of ALL?
- Age <2 y/o
- Presentation in adolescence or young adults
- Peripheral blasts >100,000
What are 5 features of ALL which would be associated with a favorable prognosis?
- Age btw 2-10 y/o
- Low WBC count
- Trisomy of chromosomes 4, 7, and 10
- Presence of t(12;22)
What are the most common genetic anomalies associated with CLL/SLL?
Trisomy 12, deletions of 11q, 13q, and 17p
Which distinct CD markers are expressed by the cells of CLL/SLL?
CD19 and CD20, as well as CD5*** and CD23
When present, which finding in the lymph nodes is pathognomonic for CLL/SLL?
Proliferation centers = large lymphocytes gathered in loos aggregates that contain mitotically active cells
What is the absolute lymphocyte count of peripheral blood in CLL that distinguishes it from SLL?
Uncommon, nucleated B cells known as prolymphocytes are sometimes seen in the lymph nodes assoc. w/ what neoplasm?
What is a characteristic finding on peripheral smear in CLL?
How does the leukocyte count vary between CLL and SLL?
- CLL can have leukocyte counts in excess of 200,000 m3
- SLL can present have leukopenia with marrow involvement
Most common age group and salient clinical features of CLL/SLL; minority of patients develop what?
- Older adults w/ bone marrow, LN, spleen, and liver disease
- Autoimmune hemolysis and thrombocytopenia in a minority
Which finding due to disruption of normal immune function is common in CLL/SLL?
HYPOgammaglobulinemia which ↑ susceptibility to infections
The presence of which mutated gene is associated with worse outcomes in CLL/SLL?
Development of a rapidly enlarging mass within a LN or spleen in pt with CLL/SLL is suggestive of what?
Richter syndrome --> prolymphocyte transformation to diffuse large B cell lymphoma = ominous event; survival <1 year
Follicular lymphoma arises from where; what is the hallmark translocation?
- Arise from germinal center B cells
- Hallmark = t(14;18) --> BCL2-IgH fusion gene
Follicular lymphoma most often occurs in what age group and which sex?
Middle aged adults; M=F
Which 4 features of follicular lymphoma distinguish it from reactive follicular hyperplasia?
- Disruption of normal LN architecture
- Lack of tingible body macrophages in germinal centers
- Bcl2 expression in follicles
The neoplastic cells of follicular lymphoma express which markers?
- CD19, CD20, CD10; surface Ig, and BCL6
- BCL2 is expressed in 90%