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- What is the main distinction between LEUKEMIAs and LYMPHOMAs?
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Primary site of neoplasm:
Leukemias primary in bone marrow.
Lymphomas primary outside BM. - List the 4 most common leukemias.
-
1.Acute Lymphoblastic Leukemia
2.Acute Myelogenous Leukemia
3.Chronic Myelogenous Leukemia
4.Chronic Lymphocytic Leukemia
(=Small Lymphocytic Lymphoma) -
ALL: What does the typical patient with this disease look like? How does the patient look differentr from a pt with
-AML?
-CML?
-CLL? -
ALL: Pancytopenic (Febrile, Anemic, and Bleeding) Kids
AML: Pancytopenic (Febrile, Anemic, and Bleeding) ADULTS
CML: Elevated WBC's
CLL: Elevated lymphocytes - What is the order of diagnostic investigation(s) in patients with ALL?
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ALL:
1. BM bx
2. X-rays
3. Cytogenetics (phila chromosome is bad t9;22) - AML: What does the typical patient with this disease look like?
- AML: Pancytopenic (Febrile, Anemic, and Bleeding). If WBC count is high, signs of lukostasis, or "sludging" may be present (NEURO: Confusion -->stupor; PULMONARY: DOE--> resp distress; VASCULAR: DIC, retinal hemorrhage, MI, acute limb ischaemia, renal vein thrombosis).
- AML is subdivided into 8 different types, M0 thru M7, based on the neoplastic cell type and cytogenetics. What are some important ones to know? Why?
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AML M3: Acute promyelocytic leukemia--associated with DIC. Treated with chemo with includes all-trans retinoic acid). t(15;17)
AML M4: Eosinophilic variant = good
AML M5: Associated with gingival hyperplasia - CML: What does the typical patient with this disease look like? Describe both physical findings and labs.
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CML: **UNLIKE AML, CML will NEVER p/w bleeding; rather, CML patients p/w fatigue, night sweats, and lo-grade temp.
--p/w wicked high WBC counts.
--Splenomegaly (Massive & huge)
--Basophilia on smear
--DEFINED by presence of Philadelphia chromosome t(9;22) - CML: What is the treatment for this disease?
- While BM transplant presents the only hope for a cure, imatinib mesylate (Gleevec) can help treat by inhibiting the tyrosine kinase activity of the BCR-ABL concogene (philadelphia--which is responsible for the CML phenotype).
- What is the weird wacky lab that is characteristic of CML?
- "Smudge" cells on smear (these are leukocytes damaged during smear preparation as a result of cell fragility).
- What is CLL?
- CLL is a crossover between Leukemia and Lymphoma. Equivalent with SLL (Small Lymphocytic Lymphoma), CLL is a clonal malignancy of B cells (98%) with a median age of onset of 65.
- What is the natural course of CLL?
- Often asymptomatic at presentation, CLL follows an indolent course with a slowly progressive accumulation of long-lived small lymphocytes. Treatment is supportive during early indolent CLL, but complications down the road can include Autoimmune Hemolytic anemias and immune thrombocytopenia.
- What is the main diagnostic lab feature in CLL?
- Flow cytometry will reveal predominance of lymphocytes expressing both CD 19 and CD 5 markers. (CD19 is B, and CD 5 is T)
- What is the main distinction between Non-Hodgkin's and Hodgkins Lymphomata?
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NHL: Monoclonal B or T prolif.
Hodgkin's: Lymph malignancy of proliferating germinal ctr cell. -
What is the distinction between NHL and Hodgkin's vis-a-vis
-Age of presentation?
-Lymph node involvement? -
-AGE: NHL varies; Hodgkin's has Bimodal age distribution, first peak at 20-30 years & 2nd peak at >50 years.
-Nodes: NHL noncontiguous; Hodgkin's contiguous, with cervical +/- mediastinal LAD. - Distinguish the presentation of NHL from that of Hodgkin's?
- NHL and Hodgkin's both p/w painless LAD and B SYMPTOMS (hi fever, night sweats, or wt loss). However, Hodgkin's also presents with pruritus.
- Distinguish the physical examination findings of NHL from those of Hodgkin's?
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NHL and HD both p/w HSM.
NHL: Systemic LAD with HSM
HL: REGIONAL LAD with HSM - What is tumor lysis syndrome? What does one see happen to levels of K+, phosphate, uric acid, and calcium?
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TLS: Rapid tumor cell death releases intracellular contents
--> Increases in Potassium, Phosphate, and Urate
--> DECREASES in calcium. -
What is the best prognosis-type of NHL?
What type of NHL bears the worst prognosis? -
Best: Small follicular
Worst: Large diffuse - What is the treatment for Mucosal Associated Lymph Tumor (MALT)?
- Treat MALT with antibiotix!! (h. pylori is culprit)