WBC Part 2

Question 1

what is the most common cancer of children (accounting for 80% of childhood leukemias)

Answer 1

Acute Lymphoblastic Leukemia/Lymphoma (ALL)

Question 2

ALL is a neoplastic population of what

Answer 2

immature lymphocytes aka lymphoblasts

Question 3

incidence of Pre-B ALL is highest when

Answer 3

age of 4 (peak population of immature lymphoblasts in BM at this time)

Question 4

incidence of Pre-T ALL is highest when

Answer 4

adolescence (when thymus reaches is maximal size)

Question 5

ALL shows with what clinical features (in general)

Answer 5

abrupt “stormy” onset
Bone Pain
generalized adenopathy
hepatosplenomegaly

Question 6

what flow cytometry results are expected in Pre-B ALL

Answer 6

CD10, CD19, CD79a
surface light chain negative
TdT

Question 7

which ALL (T or B) is usually leukemic

Answer 7

B-ALL

Question 8

which ALL (T or B) is usually lymphomic

Answer 8

T-ALL

Question 9

CD10, CD19, CD79a
surface light chain negative
TdT

Answer 9

Pre-B ALL

Question 10

what flow cytometry results are expected in Pre-T ALL

Answer 10

cCD3, CD4, CD8
CD1a, CD2, CD5, CD7
TdT

Question 11

Pre-B ALL is due to what (both good and poor prognosis)

Answer 11

Good prognosis: hyperdiploidy, t(12;21)

Poor prognosis: t(9;22)

Question 12

Pre-T ALL is due to what translation

Answer 12

TCR loci on chromosomes 7 and 14

Question 13

what is the most common leukemia of adults in the western world

Answer 13

chronic lymphocytic leukemia (CLL)

Question 14

CLL presents how

Answer 14

a leukemic process (leukocytosis) with absolute lymphocytosis, often times includes the marrow

Question 15

smudge cells and lymphocyte that looks like a soccer ball (small mature lymphs with hyper clumped nuclear chromatin) are classically seen in what cancer?

Answer 15

chronic lymphocytic leukemia (CLL)/ small lymphocytic lymphoma (SLL)

Question 16

what are the clinical feature of Chronic Lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)

Answer 16

over 50 years old
most patients are asymptomatic
immune disruption- autoimmune hemolytic anemia

Question 17

cCD3, CD4, CD8
CD1a, CD2, CD5, CD7
TdT

Answer 17

Pre-T ALL

Question 18

SLL and CLL are the same except

Answer 18

CLL has increased peripheral blood lymphocytosis or bone marrow involvement

Question 19

All T-Cell ALL can present with what clinical findings

Answer 19

mediastinal mass (airway compression)
testicular involvement

Question 20

under what conditions would one see nucleated RBCs

Answer 20

marrow stress
extramedullary hematopoiesis
something is in the bone marrow taking up space kicking out immature cells

Question 21

what spleen and liver changes are seen in SLL/CLL

Answer 21

white pulp expansion and portal tract expansion

Question 22

what is Richter syndrome (aka Richter transformation)

Answer 22

transformation from CLL to diffuse large B cell lymphoma

Question 23

what flow cytometry results would one expect from CLL/SLL

Answer 23

CD5, CD19, CD23
CD20 (dim)
surface light chain (dim)

Question 24

bcl-2 translocation are often associated with what cancer(s)

Answer 24

follicular lymphoma: t(14;18)

synovial sarcoma: t(X;18)

Question 25

CD5, CD19, CD23 CD20 (dim) surface light chain (dim)

Answer 25

CLL/SLL

Question 26

follicular lymphoma presents with what

Answer 26

painless "waxing and waning" lymphadenopathy | BM almost always involved and peripheral blood rarely involved

Question 27

germinal center B cells that mimic the normal lymphoid follicles are seen in what

Answer 27

follicular lymphoma

Question 28

in follicular lymphoma the number of centroblasts correlates with what

Answer 28

grade (the more centroblasts the higher the grade)

Question 29

what is the morphology seen in follicular lymphoma

Answer 29

nodular, small cells cleaved (folded) nucleus centrocytes centroblasts (for grading)

Question 30

what flow cytometry results would one expect in follicular lymphoma

Answer 30

CD10, CD19, CD20 surface light chain (bright) bcl-2 bcl-6

Question 31

in what two cancers would one see CD10 in flow cytometry and how can one tell the difference

Answer 31

Follicular Lymphoma Pre-B ALL (Pre-B ALL doesn't have a surface light chain present since its an immature B cell, also bcl-2 is present in follicular lymphoma)

Question 32

what does bcl-6+ mean

Answer 32

it indicates that the cells have passed through germinal center stage of mutation

Question 33

mantle cell lymphoma (MCL) is associated with what translocation

Answer 33

t(11;14)- Cyclin D1

Question 34

what cancer has tumor cells that closely resemble the normal mantle zone cells that surround the germinal centers of secondary follicles

Answer 34

mantle cell lymphoma (MCL)

Question 35

lymphomatoid polyposis is what and is associated with what cancer

Answer 35

GI involvement- multifocal mucosal involvement of small and large bowel associated with mantle cell lymphoma (MCL)

Question 36

tumor cell that overly expresses cyclin D1 and is CD5+ is most likely what

Answer 36

mantle cell lymphoma (MCL)

Question 37

how is increased cyclin D1 detected

Answer 37

FISH, PCR, immunohistochemistry

Question 38

what flow cytometry results would one see in mantle cell lymphoma (MCL)

Answer 38

CD5, CD19 CD20 (bright) surface light chain (bright)

Question 39

CD5+ and bright CD20 and surface light chain is most likely what cancer

Answer 39

mantle cell lymphoma (MCL)

Question 40

CD5+ and dim CD20 and surface light chain is most likely what cancer

Answer 40

CLL/SLL

Question 41

CD10+ and surface light chain negative is most likely what cancer

Answer 41

Pre-B ALL

Question 42

CD10+ and surface light chain positive is most likely what cancer

Answer 42

Follicular Lymphoma (also should see bcl-2)

Question 43

name one drug (monoclonal antibody we have learned) that can be used to treat mantle cell lymphoma

Answer 43

rituximab (anti-CD20)