Hematopoietic Malignancies

Question 1

What is the definition of lymphoma?

Answer 1

Malignant tumor of lymphoid tissue

Question 2

How would you typically diagnose lymphoma?

Answer 2

FNA, cytology

Question 3

T/F: Neoplastic cells are fragile and must be handled with care when trying to obtain a sample

Answer 3

True

Question 4

T/F: With lymphoma, >50% large lymphocytes/blasts indicates an intermediate to high grade lymphoma

Answer 4

True

Question 5

Besides FNA/cytology, what other tests are available to diagnose lymphoma?

Answer 5

Tissue biopsy via punch, cut, or lymph node removal

Question 6

What are some methods of identifying the cell architecture under a microscope?

Answer 6

Immunophenotyping, labeled Antibodies on the tissue

Question 7

what is the most common type of B cell lymphoid cancer?

Answer 7

Diffuse large B Cells lymphosarcoma

Question 8

What is the most important type of T cell/NK cell lymphoid cancer?

Answer 8

Peripheral T cell lymphoma

Question 9

What does PARR do?

Answer 9

PCR for Antigen Receptor Rearrangement is used to identify the permanently rearranged DNA in a neoplastic lymphoid cell

Question 10

How does flow cytometry work?

Answer 10

Counts and examines the cells by suspending them in fluid and counting through electronic detection machine.

Question 11

What are the stages of canine lymphoma?

Answer 11

Stage 1 - solitary node

Stage 2 - regional nodes affected

Stage 3 - peripheral nodes affected

Stage 4- Liver/spleen/mediastinum +- peripheral nodes

Stage 5 - Bone arrow and other non-lymphoid tissues

Question 12

What are some lymphoma and paraneoplastic syndromes?

Answer 12

Anemia (mild), hypercalcemia

Question 13

What is the point of treating canine lymphoma?

Answer 13

High response to chemotherapy. Without it, pet will last only a few weeks

Question 14

How do you assess the response to treatment against lymphoma?

Answer 14

Physical examination or imaging of tumors

Complete response, partial response, stable disease, progressive disease

Question 15

What agent is best used for single agent therapy for high grade lymphoma?

Answer 15

Doxorubicin - higher response - 60%

Longer duration of remission - 7 months

Question 16

What does CHOP used for?

Answer 16

High Grade LSA

Question 17

What does CHOP stand for?

Answer 17

Cyclophosphamide
Hydroxydaunorubin (dox)
Oncovin (vincristine)
Prednisone

Question 18

What is the response rate and remission duration for CHOP?

Answer 18

90% response

9-12 month remission (up to 2 years)

Question 19

T/F: It is harder to treat B cell lymphoma than T cell.

Answer 19

False. T cell is harder

Question 20

When should you start lymphoma therapy?

Answer 20

After it is confirmed to be lymphoma

Question 21

How often should a lymphoma patient after treatment have a recheck?

Answer 21

1-2 months. confirm relapses with FNA

Question 22

What is the typical treatment for low grade/small cell lymphoma?

Answer 22

Typically not CHOP, but prednisone or chlorambucil

Question 23

What is the % survival for patients with low grade lymphoma?

Answer 23

90% after 1.5 years diagnosis

Question 24

How much greater is the risk for a cat to obtain lymphoma if it has FeLV? FIV? Exposure to cigarette smoke?

Answer 24

FeLV - 60x
FIX - 6x
Cigarette - 3x

Question 25

Where does lymphoma typically occur in young cats?

Answer 25

Mediastinum

Question 26

What are the three major forms of feline lymphoma?

Answer 26

Lymphocytic - low grade Intermediate grade Lymphoblastic - high grade

Question 27

Which form of feline lymphoma is diagnosed with FNA?

Answer 27

lymphoblastic lymphoma

Question 28

What is the most common anatomic location for feline lymphoma?

Answer 28

Gastrointestinal

Question 29

What are the three subtypes of GI lymphoma?

Answer 29

Lymphocytic, lymphoblastic, lymphoma of large granular lymphocytes

Question 30

What are methods of diagnosing GI lymphoma?

Answer 30

Rads, U/S, Endoscopy, Surgical exploration, biopsy

Question 31

What do you expect to see on lymphocytic GI lymphoma?

Answer 31

small, mature lymphocytes

Question 32

What is a big ddx for lymphocytic GI lymphoma?

Answer 32

Infectious Bowel disease.

Question 33

How do you differentiate between Lymphocytic GI lymphoma and IBD?

Answer 33

Immunohistochemistry. IBD has a mixed lymphocyte population Lymphoma is monoclonal (T cells)

Question 34

T/F: You treat lymphocytic lymphoma with CHOP

Answer 34

False! Use prednisone!

Question 35

How do you treat lymphoBLASTIC lymphoma?

Answer 35

CHOP

Question 36

T/F: GI Lymphoma of large granular lymphocytes is poorly responsive to therapy

Answer 36

True

Question 37

What therapy is most recommended to treat colonic lymphoma?

Answer 37

Chemotherapy

Question 38

How do you typically diagnose mediastinal lymphoma?

Answer 38

radiographs, FNA cytology of mass

Question 39

What is considered high grade with mediastinal lymphoma?

Answer 39

Large lymphoblasts

Question 40

How should you treat mediastinal lymphoma?

Answer 40

Combo chemo, CHOP, with potential radiation

Question 41

What is a sign of good response to treatment with cats?

Answer 41

Rapid, robust response

Question 42

What will you see with acute lymphoblastic leukemia patients?

Answer 42

Young animals, FeLV, lymphadenopathy, splenomealy, circulating lymphoblasts

Question 43

T/F: Prognosis for treatment of lymphoblastic leukemia is typically good with fast, quality treatment

Answer 43

False

Question 44

What will you see with chronic lymphocytic leukemia?

Answer 44

Older pets, nonspecific signs, anorexia, weight loss

Question 45

How do you confirm the diagnosis for chronic lymphocytic leukemia?

Answer 45

Flow cytometry

Question 46

T/F: You don't always have to treat chronic lymphocytic leukmia

Answer 46

True

Question 47

When should you do chemo for a patient with chronic lymphocytic leukemia and what should you use?

Answer 47

Clinical signs, low cell counts Use Chlorambucil and prednisone

Question 48

T/F: All plasma cell tumors are extramedullary

Answer 48

True. B cells transform outside of the bone marrow

Question 49

Where is plasma cell tumors most commonly occurring? How do you treat it?

Answer 49

Dermal (plasmacytoma) Treat via surgical excision

Question 50

T/F: Multiple myeloma is common

Answer 50

False. RARE

Question 51

What are the must have's in order to diagnose multiple myeloma?

Answer 51

1. Plasma cells in the bone marrow/other organs 2. Monoclonal gammopathy in serum and urine 3. Osteolytic bone lesions

Question 52

How do you treat multiple myeloma?

Answer 52

Melphalan - lifelong Prednisone Cyclophosphamide, chlorambucil

Question 53

Which animal, dog or cat, responds better to treatment for multiple myeloma?

Answer 53

Dogs

Question 54

T/F: Histiocytic tumors are rare in both cats and dogs

Answer 54

True

Question 55

What tumor is considered a 'strawberry' lesion

Answer 55

Histiocytoma

Question 56

T/F: Histiocytomas resolve on their own

Answer 56

True

Question 57

T/F: Histiocytic Sarcomas have a low metastatic rate

Answer 57

False. 90%

Question 58

How do you treat histiocytic sarcomas?

Answer 58

Surgery, radiation, chemo, prednisone

Question 59

What is the prognosis of malignant histiocytosis?

Answer 59

Poor. <6 months

Question 60

T/F: systemic histiocytosis is non-neoplastic.

Answer 60

True

Question 61

T/F: Polycythemia vera is rare

Answer 61

True

Question 62

How would you treat polycythemia vera?

Answer 62

Phlebotomy, chemotherapy

Question 63

What are the most common malignancies seen in practice?

Answer 63

Lymphoma, plasma cell tumors, mast cell tumors, histiocytomas