Leukemia lymphoma

Question 1

leukemia in child

Answer 1

ALL

Langerhans cell histiocytosis

Burkitt lymphoma (bimodal)

Hodgkins lymphoma (bimodal)

Question 2

difference between leukemia reaction and CML

Answer 2

leukemoid reaction:
- incr WBC with left shift and INCREASED ALP

CML
- incr WBC with left shift and DECREASED ALP

Question 3

low grade fever, night sweats, weight loss

Answer 3

B symptoms common in Hodgkins lymphoma

Question 4

young child with pelvic and abdominal lesions

• dx
• translocation
• histology
• viral association

Answer 4

Burkitt lymphoma
t(8;14) - c-myc (8) and Ig heavy chain (14)
starry sky appearance (sheets of lymphocytes with interspersed macrophages)
EBV

Question 5

CD5+

• dx
• translocation

Answer 5

mantle cell lymphoma

t(11;14) cyclin D1 (11) and Ig heavy chain (14)

Question 6

painless waxing and waning lymphadenopathy

• dx
• translocation

Answer 6

follicular lymphoma

t(14;18) – Ig heavy chain (14), bcl-2 (18) which inhibits apoptosis

Question 7

cutaneous patches/plaques/tumors

• dx
• can spread where
• tumor marker

Answer 7

mycosis fungoides / sezary syndrome (blood form)
can spread to lymph nodes and viscera
CD4+

Question 8

hypercalcemia, renal insufficiency, anemia, bone lytic lesions and back pain

• dx
• associations
• histo
• tx

Answer 8

multiple myeloma / plasma cell myeloma
assoc w/
- incr susceptibility to infection
- primary amyloidosis (AL)
- punched out lytic bone lesions on x ray
- M spike on SPEP
- Ig light chains in urine (Bence Jones protein)
- Rouleaux formation (RBCs stacked like poker chips in blood smear)

histo: fried egg appearance, plasma cells with clock face chromatin and intracytoplasmic inclusions w/ Ig

Bortezomib (proteasome inhibitor)

Question 9

Down syndrome associated with

Answer 9

ALL

AML

Question 10

CD10+

Answer 10

ALL

Question 11

CD5+, CD20+

Answer 11

SLL/CLL

Question 12

smudge cells in peripheral smear

Answer 12

SLL/CLL

Question 13

Tdt+

Answer 13

ALL

Question 14

child with mediastinal mass

• dx
• peripheral smear shows
• markers
• mets
• what translocation has better prognosis

Answer 14

ALL

• increased lymphoblasts
• CD10+, Tdt+
• CNS and testes
• t(12;21)

Question 15

SLL and CLL is a neoplasm of what cell

Answer 15

B cell

Question 16

TRAP+, causes bone marrow fibrosis

• dx
• what cell
• tx and mechanism

Answer 16

hairy cell leukemia
B cell
cladribine (2-CDA), an adenosine analog / antimetabolite (acts on S phase)

Question 17

Auer rods

• dx
• risk factors

Answer 17

AML
alkylating chemotherapy
radiation
myeloproliferative disorders
Down syndrome

Question 18

DIC

• dx
• translocation
• peripheral smear
• tx

Answer 18

M3 AML
t(15;17)
peroxidase positive cytoplasmic inclusions
ATRA

Question 19

night sweats, fever, fatigue, splenomegaly, increased neutrophils, metamyelocytes, and basophils

• dx
• blood test
• translocation
• tx and mechanism

Answer 19

CML
LAP (low!!! vs leukemia reaction where LAP is high)
t(9;22) - bcr-abl
imatinib (inhibits bcr-abl tyrosine kinase)

Question 20

t(9;22)

Answer 20

CML

bcr-abl

Question 21

t(8;14)

Answer 21

Burkitt lymphoma

c-myc

Question 22

t(11;14)

Answer 22

Mantle cell lymphoma

cyclin D1 activation

Question 23

t(14;18)

Answer 23

follicular lymphoma

bcl-2 activation

Question 24

t(15;17)

Answer 24

M3 AML

Question 25

child with lytic bone lesions, skin rash, recurrent otitis media, mass involving mastoid bone - dx - problem - cell markers - see what on EM

Answer 25

Langerhans cell histiocytosis dendritic (Langerhans) cells don't efficiently stimulate T cells via antigen presentation S-100, CD1a Birbeck granules (tennis rackets)

Question 26

intense itching after hot shower and maybe severe burning pain and red or blue coloration due to episodic blood clots in vessels of extremities - dx - CBC shows - mutation

Answer 26

polycythemia vera Hct >55% JAK2 mutation

Question 27

bleeding, thrombosis, large megakaryocytic - dx - mutation

Answer 27

essential thrombocytosis JAK2

Question 28

bone marrow has few clear dots - dx - peripheral smear - mutation

Answer 28

myelofibrosis teardrop RBCs JAK2

Question 29

relative polycythemia - labs - associations

Answer 29

decrease plasma volume dehydration burns

Question 30

appropriate absolute polycythemia - labs - associations

Answer 30

incr RBC mass decr O2 saturation incr EPO levels lung disease congenital heart disease high altitude

Question 31

inappropriate absolute - labs - associations

Answer 31

incr RBC mass incr EPO!! (ectopic EPO) ``` renal cell carcinoma Wilms tumor cyst hepatocellular carcinoma hydronephrosis ```

Question 32

polycythemia vera | - labs

Answer 32

incr plasma volume very incr RBC mass decr EPO!