Hematologic Malignancy Cases

Question 1

Smudge cells

Answer 1

Large pale purple blobs on a PBS
Represents remnants of cells which have been damaged and broken on the slide during the prep of the PBS
Numerous smudge cells suggests the presence of numerous fragile lymphocytes

Question 2

Flow cytometry

Answer 2

Important in the diagnosis of hematolymphoid malignancies
Can be performed using peripheral blood or bone marrow specimens
You can figure out what antibodies are bound to what cells (and so it tells you the antigens on the surface)
Tells you the immunophenotype (what type of cells they are, are they normal or abnormal)

Question 3

How can CLL be diagnosed?

Answer 3

Blood film morphology and flow cytometry alone!!

Question 4

What is CLL?

Answer 4

Neoplasm of B lymphocytes

Have an abnormal immunophenotype on flow cytometry

Question 5

SLL vs CLL

Answer 5

Malignant cells, treatment and prognosis are all the same
But CLL presents in the peripheral blood and the marrow (abnormal circulating cells and lymphadenopathy)
SLL only has lymph-node based disease

Question 6

Fluoresence in situ hybridization (FISH)

Answer 6

A test using probes and hybridization technique to search for certain known chromosomal translocations or abnormalities associated with a particular disorder
Can be helpful in diagnosis or prognostication

Question 7

Leukemia vs lymphoma

Answer 7

Leukemia: primarily a marrow and peripheral blood problem
Lymphoma: primarily a mass somewhere
Lymphomas are now lumped together with lymphoid-leukemias as lymphoid neoplasms

Question 8

What does it mean if the lymphadenopathy is tender or not?

Answer 8

Tender: local infection

Non-tender: malignancy

Question 9

Excisional lymph node biopsy

Answer 9

Important to diagnose lymphoma

Removal of the entire node

Question 10

After getting diagnosed with lymphoma, what imaging is needed?

Answer 10

CT

Question 11

Reed-Stemberg cells

Answer 11

Large cells with a single prominent nucleolus
Called Hodgkin cells
Only these cells are malignant, the other are benign reactive WBCs

Question 12

Stages
1
2
3
4
in Hodgkin's lymphoma

Answer 12

1. 1 node area
2. 2 or more node areas, on the same side of the diaphragm
3. 3 or more node areas, on both sides of the diaphragm
4. Node areas as well as diffuse or disseminated disease (ex: marrow, liver, etc)

Question 13

3 B symptoms

Answer 13

Unexplained fever >38 degC
Drenching night sweats
Unexplained loss of >10% body weight in less than 6 months

Question 14

How is Hodgkin Lymphoma clinically staged?

Answer 14

Physical exam (lymphadenopathy, hepatosplenomegaly)
Neck, chest, abdominal and pelvic CT scans
PET scan
Bone marrow biopsies are NO LONGER performed

Question 15

Splenomegaly can be due to 1 of 3 mechanisms

Answer 15

Congestive: circulating blood backs up into the spleen (ex: CHF, pHTN, IVC obstruction)
Infiltrative: spleen is enlarged due to infiltration with an abnormal cell population (benign or malignant)
Reactive: most common (ex: infectious, autoimmune, hemolysis)

Question 16

Extramedullary hematopoiesis

Answer 16

Occurs with MPN
Infiltrative splenomegaly (it is full of hematopoietic cells)
Spleen is trying to compensate for the bone marrow not being able to produce normal hematopoietic cells

Question 17

Critical test for CML

Answer 17

Cytogenetic analysis of the marrow aspirate
Looking for the philadelphia chromosome t(9;22)
Or molecular analysis for the BCR-ABL

Question 18

How can we tell its CML on a PBS?

Answer 18

Hypolobated megakaryocytes