WBC Disorders

Question 1

Lymphoma

Answer 1

Hodgkin & Non-Hodgkin
Malignant proliferation of lymphoid tissue
May spread to solid tissue, BM, blood

Question 2

Leukemia

Answer 2

Acute & Chronic
Myeloid & Lymphoid
Malignant proliferation of BM spilling into blood
May spread to solid tissue (typically liver & spleen)

Question 3

Main cell involved in Hodgkin lymphoma

Answer 3

Reed-sternberg cell

Question 4

Where does Hodgkin lymphoma arise?

Answer 4

In lymph node

Question 5

Is Hodgkin lymphoma curable?

Answer 5

Yes, highly

Question 6

Hodgkin lymphoma (ages affected, occurance)

Answer 6

15-30, >50 y.o.

9,000 cases/yr

Question 7

Hodgkin lymphoma (symptoms, diagnosis)

Answer 7

Painless lymphadenopathy, splenomegaly

Biopsy to find RS cells (owl-eye nuclei), Ebstein-Barr virus often present

Question 8

Hodgkin lymphoma (spread)

Answer 8

Lymph nodes – spleen – liver – BM

Question 9

Hodgkin lymphoma (staging)

Answer 9

I - Tumor in 1 or 2 sites ipsilateral to diaphragm
II - >2 tumors ipsilateral to diaphragm
III - Tumor on both sides of diaphragm in lymph node, spleen, or Waldeyer’s ring
IV - Tumor in any other organ site (lung, BM)

Question 10

Hodgkin lymphoma (survival rate)

Answer 10

Stage I or II = 100% 5 yr survival

Stage IV = 50% 5 yr survival

Question 11

“B” signs/symptoms

Answer 11

Seen in stage III & IV Hodgkin lymphoma and 30% of NHL px

Fever, weight loss, night sweats

Question 12

Hodgkin lymphoma (Tx)

Answer 12

High stage - Chemotherapy

Low stage - Chemotherapy & Radiotherapy

Question 13

Non-Hodgkin Lymphoma (ages affected, occurance)

Answer 13

Higher risk > 40 y.o.

71,000 cases/yr

Question 14

Non-Hodgkin Lymphoma (origin)

Answer 14

30% arise extranodally

85% are of B cell origin

Question 15

Non-Hodgkin Lymphoma (symptoms)

Answer 15

Painless LN enlargement
B symptoms in 30%
Freq. immune abnormalities
Splenomegaly
May involve GI, bones, CNS

Question 16

Non-Hodgkin Lymphoma (classification)

Answer 16

Growth pattern - Nodular (better) vs Diffuse (worse)

Cell size - Small (better) vs Large (worse)

Question 17

Non-Hodgkin Lymphoma (staging)

Answer 17

Exception to rule

Prognosis based more on subtype than stage

Question 18

Non-Hodgkin Lymphoma (Tx)

Answer 18

Chemotherapy
Radiation if very localized
BM transplant

Question 19

Forms of leukemia

Answer 19

ALL
AML
CLL
CML

Question 20

Acute leukemia (features)

Answer 20

Rapidly fatal
Suvival = months
Mostly blasts
Typically inc. WBC
BM >20% blasts

Question 21

Chronic leukemia (features)

Answer 21

Indolent
Survival = years
Mostly mature cells
Typically inc. WBC
BM blasts usually not inc.

Question 22

ALL (age, major cell type)

Answer 22

<15 y.o.

Primitive lymphoid cells

Question 23

ALL (features, tx, prognosis)

Answer 23

Both B & T types
Thrombocytopenia, lymphadenopathy, splenomegaly
Chemotherapy (BM tranplant if relapse)
Children good prognosis, adults bad

Question 24

AML (age, major cell type)

Answer 24

Adults
Primitive myeloid cells
AUER RODS

Question 25

AML (features, tx, prognosis)

Answer 25

Swollen interdental papillae, inc. WBC, anemia, thrombocytopenia Chemotherapy 70% px remission, but many relapse

Question 26

CLL (age, major cell type)

Answer 26

``` >60 y.o. Mature lymphocytes (typically B) ```

Question 27

CLL (features, tx, prognosis)

Answer 27

Inc. WBC, anemia, thrombocytopenia, splenomegaly, lymphadenopathy Chemotherapy All cases eventually terminate to higher grade leukemia or lymphoma

Question 28

CML (age, major cell type)

Answer 28

? | Immature granulocytes

Question 29

CML (features, tx, prognosis)

Answer 29

Assoc. w/ Philadelphia chrom t(9;22) Inc. WBC, anemia, thrombocytopenia, splenomegaly Chemotherapy targeting bcr-abl tyrosine kinase (fused molecules) - (BM transplant is used in relapse)

Question 30

Plasmocytoma

Answer 30

Multiple myeloma that occurs in a single site

Question 31

Multiple myeloma (age, major cell type)

Answer 31

Affects middle age-elderly | Monoclonal plasma cells (Terminally diff. B cells)

Question 32

Types of plasma cell proliferations

Answer 32

Polyclonal (reactive) - Kappa AND Lambda chains | Monoclonal (multiple myeloma) - Kappa OR Lambda chains

Question 33

Multiple myeloma (features)

Answer 33

Multiple lytics bone lesions w/ hypercalcemia Bence-Jones proteinuria Renal failure, infections

Question 34

Multiple myeloma (tx, prognosis)

Answer 34

Chemotherapy, BM transplant, Radiotherapy, Anti-resorptive tx Variable, but usually 5-6 yr survival