Heme Onc

Question 1

affected cells: aml

Answer 1

myeloblasts t/f their daughters i.e. granulocytes

Question 2

isolated? hodgkin’s

Answer 2

usually, 1-2 nodes; in ic patients can be diffuse

Question 3

what is a sanctuary site and in which cancer is it especially relevant?

Answer 3

immunoprotected tissue e.g. cns or testis in which cancer hides out; A.L.L.

Question 4

fast or slow? follicular lymphoma

Answer 4

slow

Question 5

tx all

Answer 5

prolonged maintenance therapy on anti-lymphocytic drugs e.g. vinca, steroid

Question 6

complications follicular lymphoma

Answer 6

slow, so time to develop anti-cancer but more so autoimmune disease e.g. autoimmune hemolytic anemia. (this is a complication in most indolent lymphomas)

Question 7

histology burkitt’s

Answer 7

“starry sky”. dense B cells with some larger, whitish cells throughout

Question 8

tx muliple myelomas

Answer 8

bisphosphonates, thalidomide, lenalidomide, emerging tx like anti-cd38 and car-t

Question 9

mutation: polycythemia vera

Answer 9

usually jak2

Question 10

which cancer/myeloprolif: bcr-abl

Answer 10

cml

Question 11

tx: polycythemia vera

Answer 11

phlebotomy, iron deficiency

Question 12

tx apml

Answer 12

atra (all-trans retinoic acid)

Question 13

which cancer mediastinal mass?

Answer 13

most often Hodgkin’s, can be seen in others

Question 14

histology hodgkin’s

Answer 14

Reed-Sternberg cells, nodular sclerosis

Question 15

Answer 15

hodgkin’s lymphoma; note nodular sclerosis

Question 16

myeloproliferative or cancer? cml

Answer 16

myeloproliferative; differentiation intact (can progress to acute blast crisis)

Question 17

demographics aml

Answer 17

old ppl, male 2:1

Question 18

what is bcr-abl

Answer 18

constitutively active tyrosine kinase

Question 19

symptoms aml

Answer 19

anything d/t reduced granulocyte fx and proliferative takeover of bone marrow

neutropenia: infections
anemia: fatigue, pale complexion…
thrombocytopenia: bleeding
bone marrow problems: bone pain
hepatosplenomegaly

Question 20

Answer 20

cml

Question 21

multiple myeloma histology

Answer 21

“punched out” bone marrow (osteolysis) with many (>30%) clonal B cells

Question 22

multiple myeloma symptoms

Answer 22

pancytopenias (neutropenia, thrombopenia, anemia)

CRAB d/t bone resorption: high Calcium, Renal impairment, Aplastic anemia, Bone pain

Question 23

Answer 23

aml or apml; note auer rod

Question 24

histology diffuse large B cell lymphoma

Answer 24

lymph node takeover by large, immature B cells (hence “diffuse” “large”)

Question 25

Answer 25

diffuse large b cell lymphoma; note dense ("diffuse") infiltrate of large b cells (far-apart nuclei)

Question 26

Answer 26

hodgkin's lymphoma; note reed-sternberg cell

Question 27

most likely cell to be affected in all

Answer 27

b cells

Question 28

Answer 28

polycythemia vera

Question 29

causes burkitt's

Answer 29

ebv, almost always in ic patients b/c they are most susceptible to ebv and to immune evasion

Question 30

which cancer/myeloprolif: constant erythropoiesis

Answer 30

polycythemia vera

Question 31

what is M protein

Answer 31

clonal proteins found in multiple myeloma; usually igg (~50%), can be iga, light chain m spike is diagnostic

Question 32

markers all

Answer 32

CD10+, other B cell markers, some T cell markers

Question 33

histology follicular lymphoma

Answer 33

dense, nodular ("follicular") lymph nodes, tightly packed cells, memory b takeover

Question 34

cells affected: polycythemia vera

Answer 34

rbcs; others are unaffected

Question 35

mutation burkitt's

Answer 35

translocation of cmyc to IgH region. igh is constitutively active in B cells so now cmyc survival signal is on.

Question 36

myeloproliferative or cancer? aml

Answer 36

cancer. differentiation, maturation, function very much not intact

Question 37

Answer 37

multiple myeloma; not always seen but charge on m proteins can make rbcs sticky, called rouleaux formation

Question 38

causes of polycythemia vera

Answer 38

primary: bad clone; secondary: hypoxia, high epo, etc

Question 39

cml drug

Answer 39

imatinib

Question 40

histology apml

Answer 40

even more likely to form auer rods and Azur granules than in general aml

Question 41

Answer 41

aml or apml

Question 42

which cancer: philadelphia chromosome

Answer 42

CML (and about 30% of adult ALL cases)

Question 43

histology aml

Answer 43

auer rods, azur granules, open chromatin

Question 44

fast or slow? burkitt's

Answer 44

super duper fast. fastest of all neoplasms

Question 45

causes aml

Answer 45

key one are environmental toxins, e.g. occupational, chemo, radiation, esp. benzene, anything inducing dna breakage

Question 46

Answer 46

burkitt's lymphoma; note "starry sky"

Question 47

sx apml

Answer 47

coagulopathy and hemorrhage (DIC)

Question 48

Answer 48

multiple myeloma; note "punched out" appearance

Question 49

Answer 49

follicular lymphoma; note nodules/follicles

Question 50

Answer 50

all

Question 51

mutations apml

Answer 51

t(15:17), t(11:17)

Question 52

affected cell follicular lymphoma

Answer 52

usually memory b

Question 53

hsct? cml

Answer 53

yes if imatinib fails

Question 54

most likely cell to be affected in childhood all

Answer 54

committed pre-b cell

Question 55

isolated? diffuse large B cell lymphoma

Answer 55

usually isolated, metastatic potential; name "diffuse" comes from lymph node appearance not metastasis