Pathology Flashcards
(157 cards)
1
Q
At what cell level determines leukopenia?
A
< 5 K/uL
2
Q
At what cell level determines leukocytosis?
A
> 10 K/uL
3
Q
For leukopenia, what can drugs damage to result in decreased production of WBC’s, especially neutophils?
A
Stem cells
4
Q
Why can infection cause leukopenia?
A
Theres increased movement of N0 into tissues from the blood
5
Q
What 2 drugs may be used to boost lymphocyte production, thereby decreasing the risk of infection?
A
GM-CSF or G-CSF
6
Q
This is the term that refers to a decreased # of circulating lymphocytes.
A
Lymphopenia
7
Q
What are 2 important immunodeficiency causes of lymphopenia?
A
DiGeorge or HIV
8
Q
Increased levels of what hormone can cause lymphopenia from the induction of apoptosis in lkymphocytes?
A
Cortisol
like in Cushings
9
Q
What type of treatment causes lymphopenia because lymphocytes are super sensitive to ti?
A
Radiation
10
Q
This is the term for increased N0 in the circulation.
A
Leukocytosis
11
Q
When there are increased N0 release in an infection, what forms of N0 are released into the circulation?
A
Immature forms
left shift
12
Q
The immature forms of N0 are characterized by a decrease in what?
A
Fc receptors (CD16)
13
Q
High levels of what hormone can impair the adhesion of N0, leading to leykocytosis?
A
cortisol
14
Q
What 2 conditions can cause monocytosis?
A
chronic inflammatory states and malignancy
15
Q
Allergic reactions, parasitic infetions, and Hodgkin lymphoma can cause an increase in which WBC in the ticruculation?
A
Eosinophils (E0)
16
Q
Which WBC is increased in CML?
A
Basophils (B0)
17
Q
Viral infections can lead to an increase in which WBC?
A
Lymphocytes
lymphocytic leukocytosis
18
Q
Which bacteria can lead to lymphocytic leukocytosis because of the production of lymphocytosis-promting factor?
A
Bordetella pertussis
19
Q
B. pertussis releases lymphocytosis-promting factor, which blocks what process in lymhocytes?
A
Blocks circulating lymphocytes from leaving the blood to enter the lymph node
20
Q
This is the term for enlarged lymph nodes.
A
Lymphadenopathy (LAD)
21
Q
What processes give rise to painful LAD?
A
acute infection (like strep throat)
22
Q
Which 3 processes give rise to painless LAD?
A
chronic inflammation
metastatic carcinoma
lymphoma
23
Q
What 2 conditions can give rise to follicluar hyperplasia in LAD?
A
Since it’s the B cell region…
RA
early stages of HIV
24
Q
What type of infections give rise to paracortex hyperplasia in LAD?
A
Viral
since it’s the T cell region
25
When do u see hyperplasia of the sinus histiocytes in LAD?
When a lymph node is draining a tissue with cancer
26
After what % of blasts in the bone marrow can u determine neoplastic proliferation?
> 20%
27
Since neoplastic proliferation causes the blasts to "corwd-out" normal hematopoiesis, what happens to the RBC, platelets, and N0 levels?
Anemia (fatigue)
Thrombocytopenia (bleeding)
Neutropenia (infection)
28
What are the 2 characteristics of blasts on smear?
No cytoplasm
| Punched out nucleolus
29
What are the 2 subdivisions of acute leukemia?
AML and ALL
30
This is the form of leukemia where there is neoplatic proliferation of lymphoblasts (> 20%) in the bone marrow.
ALL
31
Which marker is positive in ALL, which differentiates it from AML?
tdt +
32
Which genetic condition can predispose you to ALL? at what age?
Down's syndrome AFTER the age of 5
33
What is the most common type of ALL?
B-ALL
34
In addition to a + tdt, what 3 CD's are expressed in B-ALL?
CD10, CD19, and CD20
35
Does B-ALL have a good or bad response to chemo?
excellent
36
What 2 areas must u treat prophylactically when doing chemo in the Tx of B-ALL?
Scrotum
| CSF
37
Which form of B-ALL has a good prognosis and is seen in kids?
t(12;21)
"good palindrome"
38
Which form of B-ALL has a bad prognosis and is seen in adults?
t(9;22)
| philadelphia chromosome
39
Which form of ALL is + to tdt, CD2 - CD8?
T-ALL
| NO CD10
40
What are the 3 T's for T-ALL?
T-all
Thymic mass
Teenager
41
What is the causitive problem for N0 with toxic granulations (dark), Dhole bodies (puddles of ER), and cytoplasmic vacuoles?
Sepsis or severe inflammatory disorders
42
This si form of leukemia where there is neoplastic proliferation of myeloblasts (> 20%) in the bone marrow.
AML
43
What is the marker that is + in AML, which distinguishes it from ALL?
MPO
44
What are the crystalized aggregates of MPO called in cells?
Auer rods
45
Which age group typically gets AML?
older adults (50-60)
46
What is the form of AML that is characterized by t(15;17) involving the RAR on 17 moving to 15?
APL
47
What is disrupted when RAR moves from 17 to 15?
maturation --> promyelocytes (blasts) accumulate
48
What condition does APL set u up for because of the accumulation of numerous primary granules?
DIC
49
What is the treatment for APL, which binds the altered receptor and causes the blasts to mature?
ATRA
50
What is the form of AML characterized by the proliferation of monoblasts?
Acute Monocytic Leukemia (AmcL)
51
What does AmcL lack that is different than most AML's?
MPO
52
Where in the body is there infiltration of blasts in AmcL?
Gums
53
What is the other form of AML that lacks MPO?
Acute megakaryoblstic leukemia (AmkL)
54
At what age are Down's syndrome kids at risk for AmkL?
< 5
| remember >5 is ALL
55
What may predispose u to AML, especially with prior exposure to alklating agents or radiotherapy?
myelodysplastic syndromes
56
myelodysplastic syndromes usually present with what problems which sets u up for AML?
cytopenias
hypercellular bone marrow
abnormal maturation of the cells
increased blasts
57
What 2 things do people die from in myelodysplastic syndromes?
Infeciton or bleeding
58
Which form of leukemia is from neoplastic proliferation of MATURE ciruclating lymphocytes, has a high WBC count, and is seen in older adutls?
Chronic leukemia
59
What is the form of Chronic leukemia where there is neoplastic proliferation of naive B cells?
CLL
60
What 2 CD's do B cells express in CLL?
CD5 (normally on T cell)
| CD20
61
In addition to an increased lymphocytes, what type of cells are seen on smear in CLL?
Smudge cells
62
What is the condition in CLL where involvement of the lymph nodes leads to generalized lymphadenopathy?
Small lymphocytic lymphoma
63
What is the most common cause of death in CLL pts, because there are no plasma cells?
Hypogammaglobulinemia
64
What hemolysis problem can u get in CLL?
AIHA
65
What can CLL transform into, which is distinguished by enlarging lymph node or spleen?
B-cell lymphoma (Richter transformation)
66
This is the form of chronic leukemia characterized by neoplastic proliferation of mature B cells with hairy cytoplasic processes.
Hairy Cell Leukemia (HCL)
67
What marker is + in HCL which distinguishes it form other leukemia?
TRAP
68
What happens to the spleen and boen marrow in HCL?
```
Splenomegaly
Marrow fibrosis (dry tap)
```
69
True or False: there is lymph node enalrgement in HCL.
FALSE
70
What is the drug for HCL, which allows toxic accumulaitons of adenosine in neoplastic B cells?
2-CDA
71
This is the form of chronic leukemia where there is neiplastic proliferation of mature CD4+ T cells and is seen in Japan and the Carribean.
ATLL
72
What is the virus associated with ATLL?
HTLV-1
73
What are the skin, spleen/liver, and bone findings in ATLL?
Rash
Hepatosplenomegaly with LAD
Lytic (punched-out) bone lesions with hypercalcemia
74
The lytic (punched-out) bone lesions in ATLL looks like multiple myelomas, but what characteristic distinguishes ATLL from multiple myelomas?
Rash
75
This is a form of chronic leukemia where there is neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing a localized skin rash, plaques, and nodules.
Mycosis Fungoides
76
What is the term for the aggregates of neoplastic cells in the epidermis of Mycosis Fungoides?
Pautrier microabscesses
77
What is the syndrome called in Mycosis Fungoides where the cells spread to the blood?
Sezary syndrome
78
What cells do u see on smear that is characteristic of Sezary syndrome?
Cerebriform nuclei (sezary cells)
| cerebriform means they look like a brain
79
This is the neoplastic proliferation of lymphoid cells that forms a mass.
Lymphoma
80
What are the 2 subdivisions of lymphoma?
```
Non-Hodgkins Lymphoma (NHL, 60%)
Hodgkins Lymphoma (HL, 40%)
```
81
What are the 3 different regions of a lymph node?
FOLLICLE, that's surrounded by the MANTLE, which is surrounded by the MARGINAL layer
82
What are the 4 different small B cell NHL's?
Follicular
Mantle cell
Marginal zone
Small lymphocytic (ie. CLL that involve tissue)
83
What is the 1 intermediate-size NHL?
Burkitt lymphoma
84
What is the 1 large B cell NHL?
diffuse large B-cell lymphoma
85
I'm going to give characteristics and u tell me whether they're NHL or HL. Ready?
Higher frequency
NHL
86
Malignant cells are lymphoid cells
NHL
87
Painless lymphadenopathy, in late adulthood.
NHL
88
Mass is predominantly reactive cells
HL
89
Malignant cells are Reed-Sternberg cells
HL
90
Mass is composed of lymphoid cells
NHL
91
Painless lymphadenopathy occasionally with B symptoms, in young adults.
HL
92
Diffuse spread
NHL
93
No leukemic phase.
HL
94
Staging guides therapy, radiation is the mainstay of treatment.
HL
95
Has a leukemic phase.
NHL
96
Rarely spreads
HL
97
Staging is of limited importance
NHL
98
This is the NHL where there is neoplastic prolfieration of small B cells (CD20+) that form follicle-like nodules.
Follicular lymphoma (FL)
99
At what age do u get FL?
Late adulthood
100
What is teh mutation to cause FL?
t(14;18)
101
What is on chromosome 18 that translocates to the Ig heavy chain locus on 14?
BCL2
102
The new overexpression of BCL2 in FL causes the inhibition of what process?
Apoptosis
103
Treatment for Fl is with what 2 methods, and is usualyl in thos ehwo are symptomatic?
low-dose chemo
| Rituximab (anti-CD20 Ab)
104
What is the important complication in FL, which presents as an enlarging lymph node?
progression to diffuse B cell lymphoma
105
What are the 4 ways that follicluar lymphoma is distinguished from follicular hyperplasia?
1. FL disrupts normal architecture
2. Lack of tingible body M0
3. BCL12 expression
4. Monoclonality
106
This is the form of NHl where there is neoplastic prolfieration of small B cells that expands the mantle zone.
Mantle cell lymphoma (MCL)
107
What is the transloacation in MCL?
t(11;14)
108
What is the gene on chromsoome 11 that is translocated to the Ig heavy chain locus on 14 in MCL?
Cyclin D1
109
The overexpression of cyclin D1 in MCL promotes the transition of what phases in the cell cycle?
G1/S
110
What is the NHL that is of neoplastic proliferation of small B cells (CD20+) that expands the marginal zone?
Marginal zone lymphoma (MZL)
111
What "states" is MZL associated with?
Chronic inflammatory states
like Hashimotos, Sjogrens, H pylori
112
What type of B cells form the marginal zone?
Post-germinal B cells
113
This is the form of MZL that is in mucosal sites.
MALToma
114
What Tx might regress MALToma?
H pylori treatment
115
This is the form of NHL where there is neoplastic proliferation of intermediate-sized B cells (CD20+).
Burkitt lymphoma (BkL)
116
What infection is assocaited with BkL?
EBV
117
The African form of BkL forms a mass on what area of the body?
Jaw
118
Where in the body does the sporatic form of BkL form?
Abdomen
119
What is the translocation to cause BkL?
t(8;14)
120
What is the gene that is translated from 8-->14 in BkL?
c-myc
121
The overexpression of c-myc in BkL promotes what?
Cell growth
122
What do u see on microscopy in addition to a high mitotic index in BkL?
Starry sky appearance
123
This is the NHl where there is neoplastic proliferation of large B cell (CD20+) that grow diffusely in sheets.
Diffuse Large B cell lymphoma (DLBL)
124
Is DLBL aggressive or mild?
Aggressive
125
DLBL may arise sporatically or from the transofrmation of what type of lymphoma?
a low-grade lymphoma, like follicular
126
This is the form of lymphoma whre there is neoplastic proliferation of Reed-Sternberg cells.
HL
127
What are reed-sternberg cells?
large B cells with multilobed nuclei and prominent nucleoli (owl-eye)
128
What 2 markers are HL + for?
Hint: it's not CD20, like in NHL.
CD15, CD30
129
What are the Sx of HL because they release cytokines?
B symptoms, like fever, chills, and night sweats
130
The cytokines released in HL causes the infiltartion of which cells, which makes up the bulk of the tumor?
Reactive inflammatory cells
131
What is the most common subtype of HL?
Nodular sclerosis
132
Who is at risk for nodular sclerosing HL, characterized by an enlarging cerivical tumor?
Young adult females
133
In nodular-sclerosing HL, what happens to the lymph node?
it's divided by bands of sclerosis
134
In nodular-sclerosis HL, what do u see in in the RS cells?
RS are in lake-like spaces (lacunar cells)
135
Which form of HL has the best prognosis?
Lymphocyte-rich HL
136
This is the malignant proliferation of plasma cells in the bone marrow.
Multiple Myeloma (MM)
137
True or False: MM is the most common primary maligancy of the bone.
True
138
What is the most common malignant lesion of the bone overall?
Metastatic cancer
139
Which IL is increased in MM, which stimulates plasma cell growth overall?
IL-6
140
MM can activate the RANK receptor on osteoclasts, leading to what deformity on X-ray?
Punched-out skeletal lesions (esp in the verebreae and skull)
141
What spike is seen on SPEP for MM, usually due to monoclinal IgG or IgA?
M spike
142
What happens to antigenic diversity in MM?
It drops
143
Lack of antigenic diversity in MM predisposes you to what?
infections (most common cause of death)
144
This is the weird formation of RBC's on smear in MM, where increased serum protein decreases the charge between RBCs.
Rouleaux formation
145
In MM, the overproduction of L chain causes what problem?
Amyloidosis
146
The free L chain in MM is called what in urine and kidney?
Urine- Bence Jones protein
| Kidney- myeloma kidney
147
What is it called when there is na isolated M spike and nothing else (like those seen in MM)?
Monoclonal Gammopathy of Undetermined Significance (MGUS)
148
Who gets MGUS?
Elderly
149
This is the B-cell lyphoma that is characterized by monoclonal IgM production.
Waldenstorm macroglobulinemia
150
True or False: in Waldenstorm macroglobulinemia, there is generalized lymphadenopathy with lytic bone lesions.
FALSE.
there are no bone lesions
151
True or False: in Waldenstorm macroglobulinemia, theres increased serum protein with an M spike.
True
152
What are the CNS manifestations of Waldenstorm macroglobulinemia, as a result of increased serum hyperviscosity?
Visual and neurological deficits
153
Waldenstorm macroglobulinemia can lead to bleeding because of what problem?
defectiv eplatelet aggregation
154
What is the treatment for Waldenstorm macroglobulinemia?
Plasmapharesis
155
What is the form of HL that is often assocaited with abundant E0?
Mixed cellularity HL
156
What is the most aggressive form of HL, usually seen in the elderly and HIV+ individuals?
Lymphocyte-depleted HL
157
Match the following translocations to the Diseases:
1. t(8;14)
2. t(11;14)
3. t(14;18)
4. t(9;22)
5. t(12;21)
```
A. CML
B. Mantle cell lymphoma
C. FL
D. BkL
E. ALL
```
1. D
2. B
3. C
4. A
5. E
