Leukemias and Lymphomas

Question 1

Hodgkin’s lymphoma (appearance, age, associations)

Answer 1

localized group of nodes, contiguous spread
better prognosis
Reed-Sternberg cells
bimodal - young adult and >55 yrs old
50% associated with EBV
constitutional “B” signs - low-grade fever, night sweats, weight loss

Question 2

Non-Hodgkin (appearance, age, associations)

Answer 2

multiple, peripheral nodes, extranodal common
B cells
20-40 yo
associated with HIV and immunosupression
fewer B signs

Question 3

Reed-Sternberg cells - appearance, markers

Answer 3

binucleate, bilobed with owl eyes
CD15+ and CD30+
nodular sclerosing form most common
lymphocyte-rich has best prognosis

Question 4

Burkitt lymphoma (appearance, age, associations, gene)

Answer 4

adolescent or young adult
jaw or pelvic lesion
associated with EBV
micro: "starry sky" 
t(8;:14) - cmyc and heavy chain Ig

Question 5

Diffuse large B-cell lymphoma (age, markers, gene)

Answer 5

usually older adult

t(14:18) - bcl-6

Question 6

Mantle cell lymphoma (age, markers, gene)

Answer 6

older males
t(11:14) - cyclin D1 and heavy chain Ig
CD5+

Question 7

Follicular lymphoma (age, markers, gene)

Answer 7

adults
painless “waxing and waning” LDN
t(14:18) - bcl-2 and Ig

Question 8

Adult T cell lymphoma

Answer 8

adult
HTLV-1 
IV drug abuse
cutaneous lesions
Japan, West Africa, Carribean
lytic bone lesions, hyperCa+

Question 9

Mycosis fungoides/Sezary syndrome

Answer 9

adults
cutaneous patches, tumors, plaques with spread to LN and viscera
circulating malignant cells
indolent, CD4+

Question 10

Multiple myeloma

Answer 10

monoclonal plasma cell ("fried egg") appearance - make IgG (55%) or IgA (25%)
elderly
x-ray - punched-out lytic beon lesions
M spike, Bence Jones proteins in urine, rouleaux formation
hyperCa+
Renal insufficiency
Anemia
Bone lytic lesions/back pain

Question 11

Waldenstrom macroglobulinemia

Answer 11

M spinke
hyperviscosity, mild anemia
inc total protein

Question 12

Monocloncal gammopathy of undetermined significance

Answer 12

monoclonal expansion - M spinke and BM with

Question 13

Acute lymphoblastic leukemia (age, present, markers, associations)

Question 14

Chronic lymphocytic leukemia (age, present, markers, associations)

Answer 14

>60 yo,
CD20+, CD5+
asymptomatic
smear: smudge cells
autoimmune hemolytic anemia
if symptomatic, txt: fludarabine, rituximab

Question 15

Hairy cell leukemia (age, present, markers, associations)

Answer 15

adults
mature B-cell tumor; cells with hair projections
TRAP+
dry tap on aspiration
txt: cladribine (adenosine analog)

Question 16

Acute myelogenous leukemia (age, present, markers, associations)

Answer 16

15-60yo
no mature blood cells = inc risk infection
Auer rods
peroxidase + ctoplasmic inclusions
risk: chemo, radiation, DS, myeloproliferative disorder
t(15:17) - txt: ATRA (vit A)
present with DIC

Question 17

Chronic myelogenous leukemia (age, present, markers, associations)

Answer 17

40-60 yo
t(9:22) - bcr-abl Philadelphia chromosome
inc PMN, metamyelocytes, basophils
splenomegaly
"blast crisis" - transform to AMl or ALL
low LAP
txt: imatinib