Onc

Question 1

leukemoid reaction

Answer 1

acute inflammatory response to infection.

incr in WBC WITH band forms / shifts.

key: incr in ALP (unlike w/ CML)

Question 2

hodkin lypmphoma characteristics (4)

Answer 2

1) local + contiguous spread
2) Reed-sternberg
3) 50% associated w/ EBV
4) constitutional symptoms

Question 3

NHL characteristics (3)

Answer 3

1) multiple nodes, noncontiguous spread
2) mostly B cells
3) HIV / immunosuppresion

Question 4

Reed-sternberg cells

Answer 4

CD14 / Cd30 –> Bcell origin

Question 5

prognosis for hodgkin lymphoma

Answer 5

• lymphocyte-rich form = better prognosis than low-lymphocytic response
• nodular sclerosing form = most common

Question 6

Non-hodgkin lymphoma (4 types) B cells

Answer 6

1) burkitt
2) diffuse large B cell
3) mantle
4) follicular

Question 7

NHL - T cells (2 types)

Answer 7

1) adult T cell

2) mycosis / fungoides

Question 8

burkitt associations

Answer 8

1) t (8,14) c-myc to Ig heavy chain
2) starry sky: lymphocytes with interspred macrophages
3) EBV

Question 9

diffuse large B cell lypmhoma

Answer 9

t (14,18) (Ig heavy chain to bcl-2); same as follicular lymphoma

Question 10

mantle cell lymphoma

Answer 10

t (11,14) translocation of cyclin D1 to heavy chain Ig.

CD5+

Question 11

follicular lymphoma

Answer 11

t (14, 18) –> translocation of heavy-chain Ig & bcl-2

Question 12

presentation of follicular lymphoma

Answer 12

1) indolent course

2) painless waxing/waning lymphadenopathy

Question 13

adult-T cell lymphoma gene + presentation

Answer 13

1) HTLV-1 (associated w/ IV drug abuse)

2) lytic bone lesions + hypercalcemia (cutaneous lesions)

Question 14

mycosis fungoides / sezary syndrome

Answer 14

1) cutaneous patches / plaques / tumors –> potential to spread into lymph / viscera
2) malignant cells seen circulating
3) indolent / CD4+

Question 15

multiple myeloma def + mneomnic

Answer 15

monoclonal plasma cell —> large amounts of IgG / IgA
“CRAB”

hyperCalcemia
Renal insufficiency
Anemia
Bone lysis / Back pain

Question 16

how is multiple myeolma different from Waldenstrom macroglobulinemia?

Answer 16

there are no lytic bone lesions

Question 17

how is multiple myeloma different from monoclonal gammopathy of undetermined significance (MGUS)

Answer 17

MGUS is asymptomatic, w/ 1-2% progressing to MM each year

Question 18

findings of multiple myeloma (5)

Answer 18

1) primary amyloidosis (AL)
2) lytic bone lesions on xray
3) M spike on serum protein electrophoresis
4) Bench Jones protein = Ig light chains in urine
5) rouleaux formation (RBCs stacked on smear)

Question 19

myelodysplastic syndromes

Answer 19

-stem cell disorder w/ ineffective hematopoiesis –> defects in cell maturation of non-lymphoid lineages

Question 20

what are myelodysplastic syndromes associated w/

Answer 20

AML transformation

Question 21

ALL presentation

Answer 21

• mediastinal mass
• Down syndrome association
• incr. lymphoblasts

Question 22

ALL on labs

Answer 22

-TdT+

CD10+

Question 23

best prognosis for ALL?

Answer 23

t(12,21)

Question 24

where might ALL spread to?

Answer 24

CNS / testes

Question 25

SLL markers + diagnostic findings

Answer 25

CD20+, CD5+ | smudge cells in periphery --> autoimmune hemolytic anemia

Question 26

what are the differences b/w SLL & CLL?

Answer 26

CLL has incr. peripheral blood lymphocytosis / bone marrow involvement

Question 27

hairy cell leukemia diagnostic findings?

Answer 27

cells w/ filamentous hair-like projections

Question 28

stains for hairy cell leukemia?

Answer 28

stains TRAP (tartrate-resistant acid phosphatase positive)

Question 29

what are hairy cell leukemia findings?

Answer 29

marrow fibrosis --> dry tap on aspiration

Question 30

treatment for hairy cell leukemia?

Answer 30

cladribine (2-CDA), which is an adenosine analog, that inhibits adenosine deaminase

Question 31

AML findings

Answer 31

auer rods --> peroxidase positive, with cytoplasmic inclusions. can have DIC

Question 32

what are AML findings on peripheral smear?

Answer 32

circulating myeloblasts

Question 33

risk factors for AML?

Answer 33

previous alkylating chemotherapy, myeloproliferative disorders, Down syndrome

Question 34

AML genetic disorder?

Answer 34

t(15,17)

Question 35

cml

Answer 35

9,22 translocation (bcr-abl) | incr. neutrophils, metamyelocytes, basophils and splenomegaly

Question 36

what can CML transform into?

Answer 36

AML / ALL --. blast crisis

Question 37

lab findings for CML

Answer 37

low leukocyte alkaline phosphatase (LAP) due to low granulocyte activity

Question 38

langerhans cell histiocytosis presentation

Answer 38

lytic bone lesion in child w/ skin rash / recurrent otitis media w/ a mastoid mass

Question 39

what is langerhans cell histiocytosis?

Answer 39

proliferative disorder of dendritic cell from a monocyte lineage

Question 40

markers for langerhans histiocytosis?

Answer 40

S-100 + CD1A. bierbeck granules = tennis rackets on EM that are characteristic

Question 41

myelofibrosis

Answer 41

fibrotic oliberation of bone marrow --> teardrop RBCs

Question 42

essential thrombocytosis

Answer 42

overproduction of platelets --> bleeding / thrombosis. enlarged megakaryocytes found on bone marrow

Question 43

mutations in chronic myeloproliferative disorders?

Answer 43

JAK2 --> hematocrit > 55%, presenting as intense itching after shower

Question 44

what's the difference b/w appropriate vs. inappropriate polycythemia?

Answer 44

incr in RBC mass may be appropriate in cases of hypoxia, where the body increases EPO production to incr. O2 carrying capacity (i.e.: altitude, heart / lung disease, etc.) overall, O2 saturation dec.

Question 45

inappropriate polycythemia ex?

Answer 45

- renal cell carcinoma - Wilms tumor - cyst - hematocellular carcinoma - hydronephrosis