Chapter 13: Hematologic Disorders Flashcards Preview

Oral and Maxillofacial Pathology > Chapter 13: Hematologic Disorders > Flashcards

Flashcards in Chapter 13: Hematologic Disorders Deck (168):
1

Q image thumb

leukemia

2

is burkitt's lymphoma an aggressive malignancy?

yes

the untreated patient will succomb to the disease in 6 months

3

platelet count less than ___/mm3 is considered severe thrombocytopenia and can result in massive bleeding and death

10,000

4

___ are dendritic mononuclear cells normally found in the epidermis, mucosa, lymph nodes, and bone marrow

langerhans cells

5

burkitt's lymphoma has a predilection for the jaws.  what specific locations are more common?

posterior jaws > anterior

maxilla > mandible

6

what are the neoplastic cells of hodgkin's lymphoma?

reed-sternberg cells

typically binucleated ("owl eye" nuclei)

7

are males or females more commonly affected by hodgkin's lymphoma?

males

8

Q image thumb

mycosis fungoides

9

Q image thumb

hodgkins lymphoma

reed-sternberg cells (owl-eye nuclei)

10

the decrease in platelets in thrombocytopenia may be due to what 3 things?

  • reduced production
  • increased destruction
  • sequestration in the spleen

11

what are the two types of hodgkin's lymphoma?

  • nodular lymphocyte - predominant
  • classical

12

what are the radiographic features of multiple myeloma?

  • multiple, well-defined "punched out" radiolucencies
  • may be ragged radiolucent lesions
  • especially evident on skull film

13

what should you be able to see on a radiograph of a patient with langerhans cell histiocytosis?

  • sharply demarcated (punched-out) readiolucencies
  • occasionally may be ill-defined
  • mandibular lesions appear scooped out because the superficial alveolar bone is destroyed
  • extensive alveolar bone involvement resembles severe periodontitis clinically and radiographically the teeth look like they are floating in air

14

what is an example of a virus that can cause leukemia?

human T-cell leukemia/lymphoma virus type 1 (HTLV-1) transmitted by blood

15

Q image thumb

multiple myeloma

16

plasmacytoma typically arises in what tissue?

bone

17

what is the treatment for burkitt's lymphoma?

intensive chemotherapy

18

with acute infections, how does lymphoid hyperplasia present?

the lymphoid hyplerplasia (tonsillar) appears as enlarged, tender, soft, freely movable nodules

19

what is the prognosis of langerhans cell histiocytosis?

  • good if it is limited to bone
  • those with visceral and cutaneous involvement have a poor prognosis

20

what are the oral symptoms of agranulocytosis?

necrotizing, deep, punched out ulcerations of the buccal mucosa, tongue, and palate

21

at what platelet count is clinical evidence of thrombocytopenia seen? this condition is often initially detected due to what?

  • below 100,000/mm3
  • oral lesions

22

non-hodgkins lymphoma is also called a ___

lymphoma

23

___ lesions are the most common presentation of langerhans cell histiocytosis

bone

24

the abnormal cells of myltiple myeloma are ___, which likely arise from ___

  • monoclonal
  • a single precursor that undergoes uncontrolled mitotic division

25

what is the treatment for anemia?

depends on correcting the underlying condition

refer to physician

26

what is this, and what hematologic disorder is it associated with?

Q image thumb

petechiae

thrombocytopenia

27

non-hodgkins lymphoma occurs primarily in what age patient?

adults

28

Q image thumb

mycosis fungoides

29

50% of patients with plasmacytoma will have multiple myeloma within ___ years

2-3

30

lymphoid hyperplasia may affect what tissues?

  • lymph nodes
  • waldeyer's ring
  • aggregates of lymphoid tissues scattered throughout the oral cavity

31

some patients with multiple myeloma may have pathologic ___, complain of ___, or have ___

  • fractures
  • fatigue
  • petechiae

32

radiographic features of burkitt's lymphoma are consistent with ___

a malignant process

33

what is the prognosis for multiple myeloma? what is the median survival?

  • prognosis is poor
  • median survival of 3 years

34

NK/T cell lymphoma is also known as ___

angiocentric T-cell lymphoma

35

what is the prognosis for someone with burkitt's lymphoma?

  • stage I or II - 5-year survival is 90%
  • stage III or IV - 5-year survival is 80%
    • due to aggressive treatment

36

what is the prognosis of patients with chronic myeloid leukemia?

5-year surivival is 80%, but once blast transformation occurs, the patient will usually die within 6 months

37

what is the treatment of multiple myeloma? does it relapse?

  • chemotherapy is typically used, 60% respond
  • virtually all cases relapse
  • bisphosphonates are given to reduce fractures

38

because african burkitt's lymphoma is seen in other areas of the world, some prefer to call it ___

endemic burkitt's lymphoma

39

___ and ___ contribute to the development of leukemia

environmental and genetic factors

40

reduced platelet count in thrombocytopenia may e the result of what?

various causes, such as infiltration of the bone marrow by malignant cells or the toxic effects of cancer chemotherapy

41

___ is a unifocal, monoclonal neoplastic proliferation of plasma cells

plasmacytoma

42

what is the treatment for NK/T cell lymphoma?

lesions typically respond to radiation therapy

43

if leukemia is suspected, what should happen?

referral to appropriate physician is mandatory

44

hodgkin's lymphoma is a malignant ___ disorder

lymphoproliferative

45

what is normal platelet count? 

200,000-400,000/mm3

46

growth of a burkitt's lymphoma tumor mass may cause ___ and ___

facial swelling and proptosis (protrusion of the eye)

47

agranulocytosis is associated with bacterial infections because ___

neutrophils are the first line of host defense

48

the following is an oral symptom of what hematologic disorder?

Q image thumb

anemia, as characterized by a bald tongue

49

what are the 5 histologic subtypes of the classical presentaiton of hodgkins lymphoma?

  • lymphocyte rich
  • nodular sclerosis - F>M; 70% of cases
  • mixed cellularity
  • lymphocyte depletion
  • unclassifiable

50

what is the prognosis for patients with acute myeloid leukemia?

40% survival if they are younger than 60

10% if not

51

multiple myeloma is a malignancy of ___ origin

plasma cell

it has a multicentric origin within bone

52

plasmacytoma probably gives rise to ___

multiple myeloma

53

what is the average age patient with mycosis fungoides? male or female predilection?

average age is 60

M:F 2:1

54

in thrombocytopenia patients, the small capillaries leak blood which results in ___.  if a larger quantity of blood is extravasated, a ___ will result.  even larger amounts of extravasated blood results in a ___.

  • petechiae (pinpoint hemorrhagic lesions)
  • ecchymosis
  • hematoma

55

what are 4 general symptoms related to the reduced oxygen-carrying capacity of the blood?

  • tiredness
  • headache
  • fainting/feeling lightheaded
  • pallor

56

___ is the enlargement of lymphoid tissue

lymphoid hyperplasia

57

what type of thrombocytopenia is a serious disorder of coagulation and is probably due to endothelial damage? you should refer to a physician for treatment; 70% survival

thrombotic thrombocytopenic purpura

58

which stage of mycosis fungoides is characterized by distinct papules and nodules, and has visceral involvement?

tumor

59

what is the treatment of lymphoid hyperplasia?

once the diagnosis is confirmed, no treatment is necessary

60

what is the bimodal pattern of age at diagnosis of hodgkin's lymphoma?

  • between 15-35
  • after age 50

61

what are the histopathologic features of mycosis fungoides?

  • atypical lymphocyte cells infiltrate the surface epithelium (epidermotropism is a propensity to invade the epidermis of the skin)
  • these atypical lymphocytes are termed mycosis cells or sezary cells
  • the atypical lymphocytes form small intraepithelial aggregates termed pautrier's microabscesses

62

Q image thumb

langerhans cell histiocytosis

63

renal failure may be a presenting sign in multiple myeloma because kidneys become overburdened with excess circulating proteins, termed ___ proteins

bence jones proteins

up to 50% of multiple myeloma patients will have these proteins in their urine

64

what are the most common accompanying symptoms of langerhans cell histiocytosis?

pain and tenderness

65

what radiographic changes are seen in non-hodgkins lymphoma?

ill-defined or ragged radioluscency

66

langerhans cell histiocytosis lesions are found most commonly in what 4 locations?

  • skull
  • ribs
  • vertebrae
  • mandible - jaws are affected in 15% of cases

67

if patients with non-hodgkins lymphoma wear a denture, what might they compain of?

they may complain that their denture has become too tight

68

what population was burkitt's lymphoma first documented in?

african american children

this is why it is termed african burkitt's lymphoma

69

which spectrum of langerhans cell histiocytosis is characterized by the involvement of bone, skin, and viscera; more prominent involvement; mostly in infants (letterer-siwe disease)

acute disseminated histiocytosis

70

what is the most common type of non-hodgkin's lymphoma of the oral cavity?

diffuse large B cell (DLBC)

71

clinical signs and symptoms of leukemia relate to what?

  • the reduction in numbers of normal RBCs and WBCs
    • decreased oxygen-carrying capacity of the blood leads to fatigue
    • patients may experience easy bruising due to lack of platelets

72

which stage of mycosis fungoides is often mistaken for psoriasis, and is characterized by well-demarcated, scaly, itchy, erythematous plaque?

eczematous

73

___ leukemias run an aggressive course and will lead to the death of the patient in a few months if untreated

acute

74

85% of non-hodgkins lymphoma are ___ origin

B-lymphocyte

75

what is the treatment for mycosis fungoides?

  • topical therapy is initiated first but will ultimately fail
  • aggressive chemotherapy is usually necessary, especially with visceral involvement
  • the disease is not curable, but is usually slowly progressive

76

non-hodgkins lymphoma swellings are characteristically ___

boggy

77

___ is a rare process that is characterized clinically by an aggressive, nonrelenting destruction of the midling structures of the palate and nasal processes

NK/T cell lymphoma

78

Q image thumb

lymphoid hyperplasia

79

what is the most common type of leukemia? what is the treatment?

  • chronic lymphocytic leukemia, occurs in adulthood
  • it is incurable, patients typically survive 10 years

80

what are 4 examples of leukemia?

  • acute myeloid leukemia
  • chronic myeloid leukemia
  • acute lymphoblastic leukemia
  • chronic lymphocytic leukemia

81

the process that leads to hodgkins lymphoma almost exclusively begins in what tissue?

  • the lymph nodes, and any node is susceptible
  • 75% occur in the cervical and supraclavicular nodes

82

___ is the general term for a decrease in volume of RBCs or in the concentration of hemoglobin

anemia

83

what can lymphoma of bone be mistaken for?

it can cause vague pain or discomfort that can be mistaken for a toothache

84

what is this, and what hematologic disorder is it associated with?

Q image thumb

purpura

thrombocytopenia

85

Q image thumb

NK/T cell lymphoma

aka angiocentric T-cell lymphoma

86

oral non-hodgkins lymphomas usually appear in either the ___ or ___

soft tissues or within the jaws

87

notice the mass is posterior

Q image thumb

burkitt's lymphoma

this patient also had abdominal involvement

88

signs and symptoms of multiple myeloma result from uncontrolled proliferaiton of ___ and the uncontrolled manufacture of their ___

  • tumor cells
  • protein products

89

what chronic infections, how does lypmhoid hyperplasia present?

chronic infection (tonsillar) produce enlarged, nontender, firm, freely movable nodules

90

which leukemia shows specific chromosomal abnormalities?

  • chronic myeloid leukemia (CML) has a translocation of the chromosomal material between the long arms of chromosomes 9 and 22
    • termed the philadelphia chromosome

91

in hodgkins lymphoma cases, after 15 years posttreatment, patient mortality is due typically to what?

complications of therapy (secondary malignancy or cardiovascular disease)

92

once mycosis fungoides progresses beyond cutaneous involvement, what happens?

the patient usually dies within a year from organ failure or sepsis

93

what are the 4 histological types of hodgkins lymphoma?

  • lymphocyte predominant (7%) - best prognosis
  • nodular sclerosing (64%) - worst prognosis
  • mixed cellularity (25%)
  • lymphocyte depleted (4%)

94

non-hodgkins lymphoma lesions are typically what color?

erythematous or purple

95

what is the differential for a hole in the palate?

  • syphilis
  • NK/T cell lymphoma
  • deep fungal infection
  • recreational drug abuse

96

anemia is often a sign of what possible underlying diseases?

  • renal failure
  • liver disease
  • chronic inflammatory conditions
  • malignancies
  • vitamin or mineral deficiencies

97

___ is the most common hematologic malignancy of african americans

multiple myeloma

98

Q image thumb

leukemia

99

what is the most common cutaneous lymphoma?

mycosis fungoides

100

Q image thumb

hodgkins lymphoma, characterized by a prominent supraclavicular and cervical masses

101

___ represents several types of malignancies of hematopoietic stem cell derivation; begins as the malignant transformation of a stem cell, which proliferates in the bone marrow and overflows into the peripheral blood

leukemia

102

Q image thumb

burkitt's lymphoma

notice the starry sky pattern

103

which type of leukemia is one of the more common childhood malignancies? what percent of children survive this type of leukemia?

  • acute lymphoblastic leukemia
  • 80% of children survive

104

what do intraoral lymphoid hyperplasia lesions appear as? lesions in what location are usually bilatera?

  • discrete, nontender, submucosal swellings
    • may be normal in color or yellow
    • if lesions appear on the posterior lateral tongue, they are usually bilateral

 

105

a significant percentage of hodgkins lymphoma is linked to which virus?

EBV

106

Q image thumb

leukemia

107

what is the average age of a patient with multiple myeloma? more common in males or females? african americans or caucasians?

65yo

M>W

AA>C

108

what is this, and what hematologic disorder is it associated with?

Q image thumb

hematoma

thrombocytopenia

109

how are bone lesions from langerhans cell histiocytosis treated?

curettage or low-dose radiation

110

mycosis fungoides is so-named because it resembles a fungal infection, but it is actually a ___ lymphoma

T-cell

111

what are some of the environmental factors which may lead to leukemia?

  • exposure to pesticides and/or benzene
  • ionizing radiation

112

without treatment, what will happen to a patient with NK/T cell lymphoma?

the patient will succumb to secondary infection, massive hemorrhage, or infiltration of vital structures

113

which stage of mycosis fungoides is characterized by elevated red lesions?

plaque

114

unlike most malignancites, hodgkin's lymphoma neoplastic cells make up ___% of the cells in the lesion

1-3% (this is a very low number)

115

Q image thumb

langerhans cell histiocytosis

116

leukemias are classified according to their histogenesis and clinical behavior. what are the classifications?

  • myeloid vs lymphoid
  • acute vs chronic

117

___ leukemias run a more indolent course, though patients eventually succumb to the disease

chronic

118

is lymphoid tissue more prominent in older or younger patients?

younger patients, peaking around age 20, then decreasing in size

119

if large tonsils are symmetrical and asymptomatic, is it likely normal for that patient?

yes

tonsillar asymmetry is a potentially serious sign that should be further evaluated to rule out a metastatic tumor or lymphoma

120

which spectrum of langerhans cell histiocytosis is characterized by one or multiple lesions with no visceral involvement?

eosinophilic granuloma of bone

121

what is the average age patient with burkitt's lymphoma? male or female predilection?

average age is 7

M>F

122

what is the goal of treatment of multiple myeloma?

to make the patient confortable and control the malignancy

 

123

which spectrum of langerhans cell histiocytosis is characterized by involvement of bone, skin, and viscera (hand-schuller-christian disease)?

chronic disseminated histiocytosis

124

mycosis fungoides progresses through 3 stages. what are they?

  1. eczematous
  2. plaque
  3. tumor

125

what is a granulocytic sarcoma?

a boggy, nontender swelling produced when leukemic cells infiltrate the oral soft tissues

126

increased destruction of platelets in thrombocytopenia can be due to what?

  • immunologic reaction
  • often precipitated by drugs - heparin is the most common
  • autoimmune reaction
  • component of a systemic disease, like SE or HIV
  • abnormal blood clot formation, such as in patients with thrombic thrombocytopenic purpura (TTP)

127

most cases of agranulocytosis are induced by ___

drugs, specifically anticancer treatment

128

is topical therapy useful for mycosis fungoides?

it is initiated first but will ultimately fail

129

lymphoid hyperplasia is typically due to ___

infection

130

Q image thumb

lymphoid hyperplasia

131

what 2 conditions is agranulocytosis characterized by?

  • neutropenia - decrease in neutrophils (<1500/mm3)
  • lymphopenia - decrease in lymphocytes (immunosuppression); viral and fungal infections

132

over 90% of patients with burkitt's lymphoma are positive for what virus?

EBV

133

with nodal presentaiton of non-hodgkins lymphoma, the patient is usually aware of a nontender mass that has been slowly enlarging for months. what happens as the malignancy progresses?

  • the nodes become more numerous and are fixed
    • nodes become fixed because tumor cells violate the capsule and infiltrate the adjacent tissues

134

american (or sporadic) burkitt's lymphoma usually appear as a ___ mass

abdominal

135

chronic hyperplastic lymph nodes may be difficult to distinguish clinically from ___

lymphoma

136

what is the median survival time for patients with mycosis fungoides?

10 years

137

what are the radiographic features of burkitt's lymphoma?

  • radioluscent destruction of the bone with ragged, ill-defined margins
  • may begin as several smaller sites, which eventually enlarge and coalesce
  • patchy loss of the lamina dura is an early sign

138

what is the 5-year survival rate of patients with NK/T cell lymphoma? what about for patients with disseminated disease?

  • 85%
  • disseminated disease requires chemotherapy and have a 40% 5-yr survival rate

139

sezary syndrome (aggressive expression of mycosis fungoides) runs a fulminant course and results in the patient's death within ___ years

3 years

140

___ is a hematologic disorder characterized by a markedly decreased numer of circulating blood platelets

thrombocytopenia

141

Q image thumb

plasmacytoma involving the left maxillary sinus and nasal cavity

142

Q image thumb

mycosis fungoides, characterized by Pautrier's microabscesses

143

more than half of patients with langerhans cell histiocytosis are under what age?

15yo

144

what is the spectrum of langerhans cell histiocytosis?

  • eosinophilic granuloma of bone
  • acute disseminated histiocytosis
  • chronic disseminated histiocytosis

145

if metastatic disease is excluded, multiple myeloma accounts for ___% of all malignancies that involve bone

50%

146

non-hodgkins lymphoma is a diverse and complex group of ___ that usually arise within ___ and grow as ___

  • malignancies
  • lymph nodes
  • solid masses (70%)

147

NK/T cell lymphoma is typically found in adults or children?

adults

148

what are the oral symptoms of anemia?

mucosa may show pallor or the patient may have a bald tongue (tongue atropy) depending on the type of anemia, as well as burning (glossopyrosis) and pain (glossodynia) localized to the tongue

149

normally, what fraction of the platelet population is sequestered in the spleen? what happens to the platelets if a condition causes splenomegaly?

  • 1/3
  • larger numbers of platelets are taken out of circulation

150

Q image thumb

langerhans cell histiocytosis

151

burkitt's lymphoma has a predilection for what location?

the jaws (up to 70% present in the jaws)

152

what does agranulocytosis mean?

without granulocytes (usually neutrophils)

153

what is numb-chin syndrome?

some patients with a non-hodgkin's lymphoma can have parasthesia, particular with a mandibular lesion

154

burkitt's lymphoma is a malignancy of ___ origin

B-cell

155

what type of thrombocytopenia occurs in childhood, classically after a viral infection? (90% of these cases resolve in 6 months)

idiopathic (immune) thrombocytopenia

156

what is the usual presenting sign of hodgkins lymphoma?

persistently enlarging, nontender, discrete mass or masses in a lymph node region

early lesions are movable, late lesions are more matted and fixed

157

___ is an aggressive expression of mycosis fungoides that represents dermatopathic T-cell leukemia

sezary syndrome

158

aggregates of lymphoid tissue are most comonly seen where?

  • oropharynx
  • soft palate
  • lateral tongue
  • floor of mouth

159

what are some other lesions that can occur due to thrombocytopenia?

  • spontaneous gingival hemorrhage
  • bleeding from minor sites of trauma

160

Q image thumb

lymphoid hyperplasia

this is not a mucocele because those are usually solitary

161

what is the most characteristic presenting symptom of multiple myeloma? in what location specifically?

bone pain, most common in the lumbar spine

162

plasmacytoma shares all the same demographics, signs, and symptoms as ___

multiple myeloma

163

what are the histoplathologic features of langerhans cell histiocytosis?

  • identification of a lesional langerhans cell is necessary to confirm diagnosis
  • ultrastructurally, langerhans cells contain rod-shaped cytoplasmic structures known as birbeck granules, which differentiate them from other APCs

164

___ may result in abnormal bleeding (blood can't clot, blood leaks out of vessels, etc.)

thrombocytopenia

165

intraoral soft tissue non-hodgkins lymphoma lesions typically appear how? what tissues do they affect?

  • nontender, diffuse swellings
  • posterior hard palate, gingiva, buccal vestibule

166

___ is the volume of RBCs

hematocrit

167

what is the histopathology of burkitt's lymphoma?

low-power magnification will show the classic "starry sky" pattern, which is due to macrophages within tumor tissues

168

langerhan's cells are ___-presenting cells

antigen

Decks in Oral and Maxillofacial Pathology Class (45):