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Flashcards in FA + MTB 3 Deck (82):
1

T cell ALL can present as

Mediastinal mass (presenting as SVC-like syndrome)

2

Acute lymphoblastic leukemia/lymphoma (ALL)-better prognosis if

t(12;21)

3

Acute lymphoblastic leukemia/lymphoma (ALL) may spread to

CNS and testes

4

Acute lymphoblastic leukemia/lymphoma (ALL) markers

1. TdT+ (pre-T and pre-B cells)
2. CD10+ (pre-B cells only)

5

CLL markers

CD20 and CD5 and CD23 B cell neoplasm

6

Smudge cells in the peripheral smear leukemia

CLL

7

Richter transformation

CLL/SLL transformation into aggressive large B cell lymphoma

8

Hairy cell leukemia
Age and type of cells

Adults males
Mature B cells (with hair-like cells projections) --> fuzzy appearing on LM

9

Hair cell leukemia cells morphology/presentation

Cells with filamentous, hair-like cells projections (fuzzy appearing on LM)
presents with massive splenomegaly
peripheral lymphadenopathy is very uncommon

10

Hair cell leukemia - aspiration?

dry because of Marrow fibrosis

11

Hair cell leukemia cells detection

1. Stains TRAP (Tatrate-resistant acid phosphate)
2. Flow cytometry (largely replaced TRAP)

12

Hair cell leukemia treatment

1. Cladribine
2. Pentostatin

13

Auer robs

Perioxidase + cytoplasmic inclusions seen mostly in M3 AML

14

AML risk factors

1. Prior exposure to alkylating chemotherapy
2. Radiation
3. Myeloroliferative disorders
4. Myelodysplastic
5. Down syndrome

15

AML common presentation

DIC

16

AML M3 treatment

If t(15;17).. M3 subtype respond to all trans retinoic acid (vit A), inducing differentiation of meyloblasts

17

Philadelphia ch

t(9;22)
BCR-ABL

18

CML cells

Mature and Maturing granoulocytes
Neutrophils
Metamyelocytes
Basophils

19

Blast crisis

CML transform to AML or ALL

20

CML vs leukemoid reaction

CML has very low LAP as a result of low activity in malignant neutrophils (vs benign neutrophilia)

21

t8;14

Burkitt lymphoma (c-myc)

22

t9;22

Philadelphia (BCR-ABL)
- CML
- rarely ALL

23

t11;14

Mantle (cyclin d1)

24

t14;18

Follicular lymphoma (BCL-2)

25

t12;21

Better prognosis ALL

26

t15;17

M3 AML subtype respond to vit A

27

Langerhans cell histiocytosis present in a child as

1. Lytic bone lesions
2. Skin rash
3. Recurrent otitis with a mass involving the mastoid

28

Langerhans cell histiocytosis - T cells activation

Cells are functionally immature and do not effectively stimulate primary T cells via antigen presentation

29

Langerhans cell histiocytosis markers

S-100 (mesodermal origin)
CD1a

30

Histological feature of Langerhans cell histiocytosis

Birdeck granules (tennis racket or rob shape on EM) are characteristic

31

Polycythemia vera definition/symptoms

A form of 1ry polycythemia --> disorder oh high Hct
1. Intense itching after hot shower (due to increased basophils)
2. Erythromelalgia (rare, severe, burning pain and red blue discoloration) due to blood clots in vessel

32

Polycythemia vera respond to

phlebotomy, hydroxyuream ruxolitinib (JAK1/2 inhibitor)

33

types of polyceythemia

1. relative
2. Appropriate absolute
3. inappropriate absolute
4. Polycythemia vera

34

types of polyceythemia and O2 saturation

1. relative: normal
2. Appropriate absolute: decreased
3. inappropriate absolute: normal
4. Polycythemia vera: normal

35

Relative polycythemia - associations

1. dehydration
2. burns

36

Appropriate absolute polycythemia - associations

1. lung disease
2. congenital heart disease
3. high altitude

37

Inappropriate absolute polycythemia - associations

1. malignancy: renal, hepatocellular etc
2. hydronephrosis
(ECTOPIC EPO secretions)

38

Essential thrombocytosis definition / symptoms

massive proliferation of megakaryocytes and platelets
symptoms: 1. Bleeding 2. Thrombosis
3. Erythromelalgia may occur

39

Myelofibrosis - definition

Obliteration of bone marrow due to increased fibroblast activity in response to proliferation of monoclonal cell lines
(pathoma: neoplastic prolif of mature myeloid cells, esp megak --> PDGF --> marrow fibrosis)

40

Chronic myeloproliferative disorders - JAK2

Polycythemia vera: +
Essential thromb: + (30-50%)
Myelofibrosis: + (30-50%)
CML: -

41

Chronic myeloproliferative disorders - PHILDELFIA

CML

42

Polycythemia vera - cells

increased RBC, WBC, platelets

43

Essential thromb - cells

increased platelets

44

myelofibrosis - cells

decreased RBCs
variable WBCs and platelets

45

CML

decreased RBCs
increased WBCs and platelets

46

lung cancer - who should be treated with surgery

- the size is not the most important factor
- if the lesions is large but is surrounded by normal lung and there is enough remaining lung function post resection, the surgery is still possible

47

lung cancer - the surgery is not possible if

1. bilateral disease or lymph nodes involved on opposite size
2. malignant pleural effusion
3. heart, carina, aorta, or cena cava is involved

48

lung cancer screen

annually with low-dose chest cancer in those with:
adults 55-80 who with 30 pack year smoking history

49

ovarian cancer - most accurate test
ovarian cancer - initial test

most accurate: biopsy
initial: U/S

50

ovarian cancer - treatment

the only cancer in which removing large amounts of locally metastatic disease will benefit the patient. Remove all visible tumor and pelvic organs and give chemotherapy

51

Azathioprine, 6-mercaptopurine, 6-thioguanine side effects

1. Myelosuppresion 2. GI. 3. Liver

52

Cladribine (2-CDA) clinical use / toxicity

Hairy cell leukemia
1. Myelosupression
2. Nephrotoxicity
3. Neurotoxicity

53

Cytarabine (arabinofuranosyl cytidine) clinical use / toxicity

AML
LYMPHOMAS
1. Leukopenia
2. Thrombocytopenia
3. Megaloblastic anemia

54

Methotrexate (MTX) toxicity

1. Myelosupression (REVERSIBLE WITH LEUCOVORIN)
2. Hepatotoxicity
3. Mucositis (mount ulcers)
4. Pulmonary fibrosis

55

5-fluorouracil toxicity

Myelosupression (NOT REVERSIBLE WITH LEUCOVORIN)

56

Antitumor antibiotics

1. Bleomycin
2. Dactinomycin (actinomycin D)
3. Doxorubicin, daunorubicin

57

Bleomycin side effects

1. Pulmonary fibrosis
2. MINIMAL myelosupression
3. Skin hyperpigmentation

58

Dactinomycin (actinomycin D) side effects

Myelosuppression

59

Doxorubicin,
Daunorubicin side effects

Toxic to tissues following extravasation
1. Dilated cardiomyopathy
2. Alopecia
3. Myelosuppression

60

How to prevent dilated cardiomyopathy with doxorubicin or daunorubicin administration

Dexrazoxane, an iron chelatin agent

61

Alkylating agents

Busulfan
Cyclophosphamide, isosfamide
Nitrosoureas (carmustine, iomustine, semustine, streptozocin)

62

Busulfan side effects

1. Severe myelosuppression (almost always)
2. Pulmonary fibrosis
3. Hyperpigmentation

63

Nitrosoureas toxicity

Cns: 1. Dizziness 2. Ataxia 3. Convulsion

64

Cyclophosphamide, ifosfamide toxicity

1. Myelosuppresion
2. Hemorrhagic cystitis

65

Partially Prevent hemorrhagic cystitis in Cyclophosphamide, ifosfamide by:

Mesna (thiol group of mesna binds toxic metabolitis)

66

Microtubule inhibitors

1. Paclitaxel, and others taxols
2. Vincristine
3. Vinblastine

67

Paclitaxel toxicity

1. Myelosuppression
2. Alopecia
3. Hypersensitivity
4. Neuropathy

68

Vinblastin toxicity

Myelossupression

69

Vincristine toxicity

1.Neurotoxicity: (areflexia, peripheral neuritis)
2. Paralytic ileus

70

Hydroxyurea clinical use

1. Melanoma
2. CML
3. Sickle cell anemia (increases HbF)

71

Hydroxyurea toxicity

1. SEVERE myelosuppression
2. GI upset

72

Imatinib clinical use

1. CML (BCR-ABL)
2. GI stromal tumors (c kit)

73

Imatinib toxicity

Fluid retention

74

Rituximab toxicity

Increased risk of progressive multifocal leukoencephalopathy

75

Cisplatin carboplatin toxicity

1. Nephrotoxicity
2. Ototoxicity
3. peripheral neuropathy

76

How to prevent cisplatin or carboplatin associated nephrotoxicity

Amifostine (free radical scavenger) chloride (saline) diuresis

77

Etoposide, tenoposide - mechanism of action

Inhibits topoisomerase 2--> dna degradation

78

Etoposide tenoposide toxicity

1. Myelosuppression
2. Gi upset
3. Alopecia

79

Irinotecan, topotecan mechanism of action

Inhibit topoisomerase 1 and prevent DNA unwinding and replication

80

Irinotecan, topotecan toxicity

1. Severe myelosuppression
2. Diarrhea

81

Trastuzumab (herceptin) toxicity / clinical use

Cardiotoxicity
Her2 + breast cancer and gastric cancer

82

SERMs (tamoxifen, raloxifene) clinical

Tamoxifen: breast cancer treatment
Raloxifene: prevent osteoporosis
Both: breast cancer prevention