Leukemias and Lymphomas

Question 1

A patient is suspected of having leukemia and the primary care provider orders biochemical studies and a bone marrow aspirate and biopsy. The results include WBCs greater than 200,000 cells/mm3, normal RBCs, hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase.
Which test will the provider order to confirm a diagnosis in this patient?

Chest radiograph

Coagulation studies

Philadelphia chromosome test

Serum protein electrophoresis

Answer 1

findings from the CBC and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm the diagnosis of chronic myelogenous leukemia.

Question 2

Leukemia Types

Answer 2

Acute myelogenous leukemia
Acute lymphocytic leukemia

Chronic myelogenous leukemia
Chronic lymphocytic leukemia. – Most common

Question 3

Acute v. Chronic Leukemias

Answer 3

Acute leukemias are distinguished by an abnormal production of immature white blood cells (WBCs), called blasts, with rapid disease progression over approximately 6 months, which results in limited life expectancy if left untreated.

Chronic leukemias reveal an overabundance of more mature-appearing but ineffective WBCs. Disease progression is slower, over several years.

Question 4

Leukemia Risks

Answer 4

Genetic disorders
Exposure to ionizing radiation
smoking
occupational exposures in rubber or shoe making plants

Question 5

Leukemia Characteristics

Answer 5

Malignant blood disorder and blood-forming organs
Maturational arrest of immature leukocytes in acute forms
Accumulation of mature but non-functional leukocytes in chronic forms

Question 6

Leukemia Presentation

Answer 6

Non-specific symptoms related to low WBC counts or pancytopenia
Fatigue, pallor, weakness, dyspnea, easy bruising

Leukemic retinopathy is most common manifestation - usually retinal hemorrhage but other abnormal findings can occur

Enlarged spleen is a cardinal finding in chronic forms

Bone marrow aspirate is a definitive diagnostic tool

Question 7

Leukemia Treatment

Answer 7

Acute - chemotherapy, usually aggressive

Chronic - Requires oncology and hematology, many agents with high risks

Question 8

Acute Tumor Lysis Syndrome

Answer 8

Complication of leukemia treatment
Tumor cells rupture and release contents into bloodstream

Presents with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, renal injury. Treatment goal is maintain hydration and renal function, resolves in 4-7 days if renal function maintained

Question 9

Lymphomas

Answer 9

Clonal disorders from lymphocytes

Question 10

Causes of Lymphomas

Answer 10

Many types and causes. Most commons:
Infectious agents such as EBV, h. Pylori, Herpesvirus, HIV
Chemical exposures
Genetic defects
Autoimmune disease

Question 11

Lymphoma Presentation

Answer 11

Lymphadenopathy

• Lymph nodes persisting for more than 4 weeks and larger than 1.5cm is suspicious
• Fever, waxing/waning lymph size, night sweats, weight loss

Diagnosis requires excision biopsy

Question 12

Lymphoma Classification

Answer 12

By cell of origin (B, T, or NK)
By staging (i-IV)
By category of Symptoms
–A is specific symptoms, B is more general symptoms

Question 13

Hodgkin Lymphoma

Answer 13

Arises from germinal or post-germinal B cells
Reed-Sternberg cells or variants is the hallmark

While treatment is often successful, high risk of mortality from other disease

HL survivors have big risk of therapy complications even years after treatment

Question 14

Non-Hodgkin Lymphoma

Answer 14

Can be very aggressive or not

Many forms are highly aggressive

Question 15

Absolute Neutropenia

Answer 15

Fewer than 1000 neutrophils, takes weeks to recover

high risk of infection and sepsis

Question 16

A patient reports a neck mass that has been present off and on for five or six weeks which varies in size. The primary care provider palpates a lymph node measuring 1.25 cm. Which test will provide proper histologic diagnosis for this patient?

Positron emission tomography (PET) scan

Lymph node biopsy

Bone marrow aspirate

Computed tomography (CT) scan with IV contrast

Answer 16

The lymph node biopsy is used to provide proper histologic diagnosis and precise classification.