CIS: Leukemias and Lymphomas and White Cell disorders

Question 1

Definition of Leukemia

Answer 1

autonomous clonal proliferation of malignant cells that proliferate in the bone marrow and usually are readily observable in the peripheral blood

Question 2

Acute leukemia

Answer 2

the cells represent immature precursor cells

Question 3

chronic leukemia

Answer 3

the cells are more mature appearing cells

Question 4

What disease is Benzene associated with?

Answer 4

AML

Question 5

What is the big risk factor for leukemias?

Answer 5

alkylators

Question 6

What is radiation not associated with

Answer 6

CLL

Question 7

To look like a rockstar, what should we offer as a diagnosis in older patients with mild pancytopenia and macrocytosis?

Answer 7

myelodysplasia or early AML

Question 8

What does the 9-22 translocation give us?

Answer 8

the BCR-ABL proto-oncogene

-fusion gene with tryosine kinase activity

Question 9

What is 9;22 associated with?

Answer 9

CML

Question 10

What is 15;17 associated with

Answer 10

APL

Question 11

How do acute leukemias present generally?

Answer 11

very rapid onset and clinical course

-if untreated the median duration of survival for adult acute leukemia is 3 months or less

Question 12

How do chronic leukemias present generally?

Answer 12

• slow onset and chronic course
• half of all patients with chronic lymphocytic leukemia are still alive and have not required treatment 6 years after diagnosis

Question 13

What do most patients with leukemia present with?

Answer 13

• hx of fever, easy bruisability, fatigue, weight loss, or shortness of breath
• in acute leukemias (ALL) patients often complain of bone pain

Question 14

What labwork gives us the suspicious of chronic leukemia usually?

Answer 14

CBC done as part of a routine workup for another problem

Question 15

At the time of diagnosis, how are most patients with chronic leukemias?

Answer 15

asymptomatic

Question 16

What is Sweet’s syndrome?

Answer 16

• acute febrile neutrophilic dermatosis (AFND)

- Cutaneous manifestation of AML…. bx demonstrates myelopblasts in the dermis (histiocytic variant of AFND)

Question 17

What do we not want to confuse sweet’s syndrome with?

Answer 17

pyoderma gangrenosum

Question 18

Tx of sweet’s syndrome?

Answer 18

management of AML

Question 19

What are Auer Rods?

Answer 19

azurophilic rods in the cytoplasm of patients with AML

-may resemble a bundle of sticks in some cells of patients with APL

Question 20

If the Auer rods look like a bundle of sticks in cells, what do we call those cells?

Answer 20

faggot cells

Question 21

If we see gingival hypertrophy, what should we think of?

Answer 21

most common in the M4 and M5 variants of AML

Question 22

What do we think of when we see smudge cells?

Answer 22

CLL

Question 23

What do we treat people with APL t(15;17) with?

Answer 23

ATRA

-all trans retinoic acid

Question 24

What can APL (acute promyelocytic leukemia) drive ?

Answer 24

DIC

-fibrinogen will be low

Question 25

What weird neuro finding is ALL associated with?

Answer 25

leptomeningeal carcinomatosis

Question 26

What nerve will get damaged in ALL?

Answer 26

CN6 because it is the longest nerve up there

Question 27

What translocation is ALL in that 18 year old girl?

Answer 27

t(4;11)

Question 28

What do we treat the leptomeningeal carcinomatosis from the ALL with?

Answer 28

intrathecal methotrexate

Question 29

What do we use to deliver intrathecal therapy?

Answer 29

ommaya reservoir

Question 30

What is intrathecal therapy?

Answer 30

injection of drugs into the spinal canal

Question 31

When I say TRAP test, you say

Answer 31

Hair Cell Leukemia

Question 32

name and describe the Rai stages?

Answer 32

- 0: lymphocytosis only (>15,000) - 1: + LAD - 2: + splenomegaly - 3: + anemia - 4: + thrombocytopenia

Question 33

What is the Rai staging used for?

Answer 33

CLL

Question 34

How are lymph nodes in lymphomas?

Answer 34

typically non-tender and rubbery in consistency

Question 35

What happens after drinking beer with Hodgkin lymphoma?

Answer 35

pain in lymph nodes

Question 36

What can suggest retroperitoneal lymph node enlargement

Answer 36

Back pain and leg edema

Question 37

What is Richter's syndrome?

Answer 37

when ppl with CLL develop DLBCL | -represents clonal evolution with additional cytogenetic abnormalities... tough to kill

Question 38

What are B symptoms?

Answer 38

- important - fever, drenching night sweats, 10% weight loss in previous 6 months - likely paraneoplastic and associated with worse prognosis

Question 39

What are Immunosuppressed patients at increased risk for?

Answer 39

primary CNS lymphoma

Question 40

What infectious agents can lymphomas be linked to?

Answer 40

EBV- HD, Burkitt | H. pylori... gastric MALToma

Question 41

What should we consider if we see patients with cervical adenopathy?

Answer 41

infection lymphoma unusual disorders

Question 42

What is D-dimer?

Answer 42

a fibrin degradation product

Question 43

What is more common, benign causes of leukocytosis or malignant ones?

Answer 43

benign | -same goes for neutropenia

Question 44

What is a very general thing that can cause leukocytosis?

Answer 44

inflammation

Question 45

What is another thing that he had listed three times that can cause leukocytosis?

Answer 45

Drugs, drugs, DRUGS | -same for neutropenia

Question 46

In a smoker who has neutrophilia, what may be responsible for raising the count?

Answer 46

smoking....

Question 47

What's a weird thing that might cause neturopenia?

Answer 47

infections | -and drugs too

Question 48

What should we suggest as being responsible for a patient with neutropenia?

Answer 48

medications, nutritional deficiencies, or sequestration