onc
Terms
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- ALL
-
kids
very responsive to therapy
CD 10 or CALLA + cells are most treatable
may spread to CNS and testes - AML
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Auer Rods
Myeloblasts
adults - CLL
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older adults
infiltration of bone marrow, peripheral blood, lymph nodes, spleen, liver, other
CD16,20; CD5+, CD10-
smudge cells on smear
Warm Ab hemolytic anemia.
Hypogammaglobulinemia - Hairy Cell Leukemia
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B-cell w/ hair like filamentous projections
stain for tartrate-resistant acid phosphatase (TRAP)
Responds to aalpha-IFN, 2-chlorodeoxyadenosine and deoxycoformycin
Pancytopenia
splenomegaly - CML
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neoplastic clonal prolif of myeloid stem cells;
9, 22; bcr-abl
Marked leukocytosis
Middle to late myeloid precuros cells; few blasts
Decrease in leukocyte alk phos
Prominent splenomegaly - What is the role of Auer Rods in DIC?
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Seen in peroxidase-positive cytoplasmic inclusions of granulocytes and myeloblasts
AML
Rx- releases Auer rods-> DIC - 9,22
- CML
- 8,14
- Burkitt's c-myc
- 14,18
- Follicular- bcl2
- 15,17
- AML- responds to all-trans retinoic acid
- 11,22
- Ewing
- 11,14
- Mantle Cell
- What is different between polycythemia vera and other polycythemia?
- decreased epo
- What are some features of poly vera?
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erythrocytosis
moderate increase in circulateing granulocytes/platelets
splenomegaly
Sludging hematocrit leads to thrmbotic or hemorrhagic phenomena - what is the DDx of polycythemia?
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chronic hypoxia- pulm disease or algo asi
innapropriate epo- polycystic kidney disease
endocrine- pheo, cushings - Chronic Idiopathic myelofibrosis?
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extensive extramedullary hematopooiesis in spleen, liver.
myelofibrosis of bone marrow.
smear- tear drop RBCs
anemia and Splenomegaly - What are the postulated pathogenesis factors in Chronic idiopathic myelofibrosis?
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Megakaryocyte prolif-> PDGF -> TGF-B -> fibroblastic change
Megas are spared in marrow fibrotic process and increase in number-> prominent BM megakaryocytosis. - Multiple Myeloma
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malignant plasma cell tumor
end-stage derivative of B lymphocytes that is clearly identifiable as a plasma cell
lytic leasions in bone
sever bone pain
M protein- IgG origA
Bence Jones protein
increased ESR
Poker Chip RBCs
Anemia
Infection
Hypercalcemia
Renal insufficiency
Amyloidosis - Waldenstrom macroglbulinemia
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Lympoplasmacytic lymphoma
Serum IgM immunoglobulin of kappa or lambda
Plasmacytoid lymphocytes
no bone lesions
men > 50
slow course
Hyperviscosity- retinal vasc dilation; hemorrhaage, confusion and other CNS changes, emergency plasmapheresis to prevent blindness
Abnl bleading- vasc and platelet dysfunction 2ry to serum protein abnlty - MGUS
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5-10% of healthy people
M protein, but not too high
no bence-jones - What is rouleau formation?
- RBCs like poker chips
- Hodgkin's
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malignant neoplasm that resembles inflamm disorder
young adults, men
nodular sclerosis-> women
EBV in 50%
Reed sternberg - What is the reed-sternberg cell?
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owl-eyes
binucleated or multinucleated giant cells w/ eosinophilic inclusion-like nucleoli
severity is directly correlated w/ # of RS cells
Lacunar cells in nodular sclerosis - What is lymphocyte rich Hodgkins?
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large numbers of lymphos and histios and few RS cells
fibrous bands and lacunar cells
upper mediastinum or lower cervical nodes
good prognosis - What is mixed cellular hodgkins?
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many RS, many lymphos
intermediate prognosis
25% - What is lymphocyte depleted hodgkins?
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rare
few lymphos
some RS
poor prognosis
old men w/ disseminated disease - What are some characteristics of non-hodgkin's lymphomas?
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HIV and immunosuppressed
Multiple peripheral nodes
common extranodal involvement; non-contiguous spread
Majority involve B cells
No hypergammaglobulinemia
Fewer constitutional symps
Peak 20-40 - small lymphocytic lymphoma
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B cell, indolent, old
diffuse effacement of lymph node architecture
widespread nodal involvement; spleen, liver, bone marrow all involved
CLL like, CD 19,20; and CD5+, CD10- - Follicular lymphoma
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B cell lymphoma- indolent, old
most common of non-hodgkin
angulated grooved cells- surface IgG and CD19,20
14,18; bcl2 - mantle cell lymphoma
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11,14; bcl1; cyclin D gene
similar to small lymphocytic lymphoma - MALT type lymphoma
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chronic inflamm or autoimmune disease
salivary glands, thyroid, stomach (H. pylori) - Diffuse Large B Cell
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odler, but can occur in kids
large, extranodal; wide-spread aggressive dissemination
rare leukemic involvemen
80% B
20% T - Precusor T lymphoblastic lymphoma/leukemia
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convoluted nuclei
kids
thymic lymphocytes
progress to T-ALL
aggressive - Burkitt lymphoma
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B cell lymphoma- maxilla or mandible in africa
american form in abdominal organs
EBV infection
Starry-sky apperance- abundant cellular debris taken up by non-neoplastic macros
related to B-ALL
8,14- c-myc - Mycosis Fungoides
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erthematous eczematoid or psoriasiform
cerebriform nuclei
Pautrier microabscesses
CD4T
Sezary- leukemic form - What type of AML is most associated with DIC?
- M3
- What is M1 type of AML?
- no maturation
- What is M3 type of AML?
- promyelocitic
- What is M6 type of AML?
- acute erythroleukemia
- What is M7 type of AML?
- acute megakaryoblastic leukemia
- When you think gynecologic issues what blood abnlty to you think of?
- DIC
- What are the MCV, MCH, and MCHC changes in megaloblastic anemia?
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MCV is high
MCH is high
MCHC is normal - What is the Rx for CLL?
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Chlorambucil
alkylating agents - What is Cisplatin used for?
- teste mets
- What is Dacarbazine used for?
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Melanoma
refractory hodgkins
various sarcomas - What is vinblastine used for?
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Hodgkins
Non-Hodgkins
choriocarcinoma
lymphosarcoma
neuroblastoma - what gene goes with Burkitt?
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c-myc, 8,14
B doesn't come with B
Follicular is bcl-2, 14,18 - what gene is associated with follicular?
- bcl-2; 14,18
- How do you stain for Hairy B?
- Tartrate-resistant acid phosphatase
- What does Chromium 51 measure?
- Red cell survival
- What is nitroblue tetrazolium used for?
- evals granulocytic phagocyte function in chronic granulomatous disease
- What CD is Reed-Sternberg known for?
- CD30
- What is the first increase in blood with hemolytic destruction?
- Haptoglobin
- Where does most of the leg drain? and what doesn't drain from there?
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most drains through the saphenous
lateral dorsum of the foot goes through the short saphenous to the popiteal fossa - What is the product that is no longer created in aspirin?
- Thromboxane A2
- What type of kidney stones are found in leukemias?
- Uric Acid- from purine breakdown
- How do P. vivax and P. ovale relapse?
- they leave hypnozoites in the liver
- What can happen in late stages of CML and polycythemia vera?
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the bone marrow can burn out and you can develop fibrosis of the BM
Myeloid metaplasia with myelofibrosis