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Lymphoblastic Leukemia/Lymphoma Exam
Lymphoblastic Leukemia/Lymphoma Exam
370
Health Care
Undergraduate 4
04/25/2010

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Term
What age group is ALL typically seen in?
Definition
KIDS!
Term
How do cells of ALL stain with MPO?
Definition
MPO negative
Term
What are the 3 FAB classifications of ALL?
Definition
L1: Homogeneous lymphoblastic leukemia
L2: Heterogeneous lymphoblastic leukemia
L3: Burkitt's lymphoblastic leukemia
Term
ALL is treated based on what classification system>?
Definition
ALL is treated based on antigenic expression using the WHO classification system
Term
What do the blasts look like in ALL L1?
(size, cytoplasm, nucleoli, in who most commonly see this morphology?)
Definition
Blasts are small (but larger than RBCs), cytoplasm is very sparse (high N:C), nucleoli are absent or inconspicuous

This is the most common blast morphology in children

HOMOGENEOUS Blasts!!!
Term
What do the blasts look like in ALL L2?

(Size, cytoplasm, nucleoli, nucleus, resemble what other blast types?)
Definition
HETEROGENOUS blasts!!!
Are large compared to RBCs, cytoplasm is abundant. One or two large nucleoli are often present

Nucleus may be irregularily shaped

L2 morphology resembles AML blasts
Term
What do the blasts look like in ALL-L3?

(size, cytoplasm, nucleoli)
Definition
Blasts are large and uniform
Cytoplasm is moderately abundant and deeply basophilic.
Cytoplasmic vacuoliztion and prominant nucleoli are present
Term
What cell lineage is a ALL-L3 blast?
Definition
A PLASMA cell...this is the only blast morphology in which we can say with relative certainty that it is a plasma cell
Term
What is another name for ALL-L3?
Definition
ALL L3 is also known as the leukemic phase of Burkitt's lymphoma
Term
What is the diagnostic cytogenetic aberration found in ALL-L3?
Definition
t(8:14)
Term
What are the four categories of ALL classification according to WHO?
Definition
1. B-Cell Neoplasms
-Precursor B-cells-leukemias
-Mature B Cells- leukemia
and lymphoma
2.) T cell Neoplasms
-Precursor T Cells-leukemias
-mature T cells- leukemia
and lymphoma
3.)NK Cell Neoplasms
4.) Hodgkin's Disease
Term
What is the CALLA marker?
Definition
CALLA= Common ALL Antigen

Is CD10
Term
What 6 CD markers are present on B Cells?
Definition
CD10, CD19, CD20, CD21, CD22, CD23
Term
What are the 6 T Cell CD markers?
Definition
CD2, CD3, CD4, CD5, CD7, CD8
Term
What are the 3 immature hematopoietic CD markers?
Definition
CD45, CD34, and Tdt
Term
If you see a cell with BOTH CD4 and CD8 on it, what do you know?
Definition
That it is a very young cell (double positive thymocyte)
Term
At what point in cell maturation do we see surface igM and surface IgD?
Definition
At the mature B cell stage
Term
What are the 4 stages of B cell differentiation after it has been stimulated with Antigen?
Definition
Mature B Cell --> Activated B Cell --> Immunoblast --> Plasma Cell
Term
Forward scatter tells us what?
Definition
size
Term
Side scatter tells us what?
Definition
Complexity
Term
What stage of B cell development has just c-IgM?
Definition
pre-B cell stage
Term
What stage of B cell development has just s-IgM?
Definition
early B cell
Term
What markers are seen on early pre-B cells in ALL?
Definition
TdT, CD34, CD19, and CD10
Term
What markers are seen on pre-B cells in ALL?
Definition
TdT, CD10, CD20, CD19, and cIg
Term
What cell markers are seen on mature B cells in ALL?
Definition
CD19, CD20, sIg
Term
What cell markers are seen on precursor T Cells?
Definition
CD2, CD3, CD4, CD5, CD7, TCR
Term
L1 and L2 lymphoblasts are: B or T cell in origin?
Definition
Either!
Term
CLL is considered by WHO to be a different expression of what condition?
Definition
Small Lymphocytic Lymphoma
Term
What patients typically get CLL?
Definition
CLL is a "disease of older adults"...rarely does it occur in patients less than 40
Term
What are the typical symptoms associtated with CLL?
Definition
The symptoms aren't that noticeable..the Dx. is most often inadvertant
Term
how is a diagnosis of CLL made?
Definition
By observing the PBS

WBC counts range from 10K to 150K/uL

Absolute lymphocytosis is >5 x 10^9/L
Term
Describe the PBS of someone with CLL
Definition
WBC counts range from 110K to 150K

Absolute lymphocytosis is >5 x 10^9/L

Predominant PBS morphology:
-Small, round, lymphs (often >90% of WBC)
-Clumped or "crumped" chromatin that resembles "cracked Earth"
-Smudge Cells are present b/c WBC are fragile
Term
Describe the BM of someone with CLL
Definition
Focal or Diffuse with small round B-lymphs
Term
Which is more common: B or T cell CLL?
Definition
B Cell CLL
Term
Cell markers of cells in B cell CLL
Definition
CD19, CD20, CD21, CD23

Pan T-Cell Marker CD5

Fc-r, C'-r

sIgM (not quite to AB secreting stage yet but are getting there)
Term
What genetic trait is typical of the cells in B Cell CLL?
Definition
They express proto-oncogene Bcl-2
Term
Describe levels of serum immunoglobulins found in B-CLL
Definition
Initially, serum immunoglobulins are normal...but later in the disease process, patients experience Ig insufficiency (hypogammaglobulinemia)
Term
What do the lymphs look like in SLL (Small lymphocytic leukemia)?
Definition
Small, round, 'mature looking' lymphs (WHO states that CLL and SLL are the same disease)
Term
What is PLL?
Definition
Prolymphocytic leukemia
-May be a primary disorder, or secondary to CLL
-Presents with high WBC and 'younger' lymphocyte morphology.
-Is more aggressive than CLL
-May evolve from CLL to PLL
Term
What are the WBC counts in PLL?
Definition
Range from 150K-300K
Term
How can we differentiate CLL from PLL?
Definition
In PLL, the cells are missing the CD5 marker
Term
What is Large Cell Lymphoma indicative of?
Definition
Richter's syndrome
Term
What is Richter's syndrome?
Definition
A transformation of CLL into a large cell lymphoma
Term
What is Evan's Syndrome?
Definition
A transformation of CLL into autoimmune hemolytic anemia and thrombocytopenia
Term
What is the typical age/sex of someone with hairly cell leukemia?
Definition
Between 50-60 years old and MALE
Term
Which blood cell lines are deficient in hairy Cell Leukemia?
Definition
Pancytopenia in Hairy Cell Leukemia: low WBC counts, anemia, and thrombocytopenia
Term
What physical sign is characteristic of Hairy Cell Leukemia?
Definition
Splenomegaly
(Due to extramedullary hematopoiesis)
Term
Describe the morphology of the cells in Hairy Cell Leukemia (Size, cytoplasm, nucleus0
Definition
Are Large Lymphocytes

Cytoplasm: pale, light blue...may contain vacuoles...has spiny "hairy" projections

Nucleus: large with single nucleolus, diffuse chromatin pattern, round or indented (notched) nuclear membrane
Term
Describe the typical BM of a Hairy Cell patient
Definition
HCL involvement (local, diffuse)
Fibrotic--increase in reticulum...may result in dry tap
Term
What is the origin of the fibrosis in the BM of Hairy Cell Leukemia PAtients?
Definition
Hairy Cells synthesize fibrin network around themselves
Term
Explain/describe the staining of hairy cells in HCL with the Acid phosphatase stain plus Tartrate
Definition
Normally, all cells stain with acid phosphatase. Normally, when tartrate is added to the acid phosphatase stain, cells do not stain anymore and are said to be "inhibited".

Hairy Cells contain Isoenzyme 5 which prevents them from being inhibited by tartrate. Thus, Hairy cells continuse to stain even in the presence of tartrate
Term
Are Hairy Cells CD5 pos or neg?
Definition
Usually, Hairy Cells are CD5 neg
Term
Are Hairy Cells B or T cells? What markers on them signify this?
Definition
B cells...usually contain markers CD19 and CD20
Term
What is multiple myeloma...put simply
Definition
End stage B Cell or Plasma Cell Proliferation
Term
What 2 characteristic physical anomalies are seen in patients with multiple myeloma?
Definition
Multiple Osteolytic Bone Lesions
-Osteoclast activating factor is produced
-Punched out holes on X Ray
-Vertebral Collapse

Increased Serum Calcium
-Skeletal and muscle irritability
-Cardiac arrhythmias
Term
What types of patients typically present with multiple Myeloma?
Definition
More men than women

Twice as many African-Americans than Whites

Older adults
Term
What types of Ig are produced by the plasma cells in Multiple Myeloma?
Definition
IgG mostly, then IgA, IgM, IgD, and IgE
Term
What is characteristically seen on a serum protein electrophoresis of a patient with multiple myeloma?
Definition
A monoclonal Ab Spike
Term
What is hyperviscosity syndrome?
Definition
This is a condition seen in Multiple Myelomaand Waldenstrom's Macroglobulinemia where gobs of Ig make the blood more viscous
-hypergammaglobulinemia
-hyperproteinemia

Pts with this have headaches, dizziness,and blurring of vision
Term
How do we diagnose Multiple Myeloma based off a BM?
Definition
Need to see greater than 30% plasma Cells in BM to diagnose Multiple Myeloma
Term
How do we diagnose Multiple Myeloma by a urine sample?
Definition
Presence of Bence Jones Protein...

This protein exhibits unusual thermal characteristics...protein precipitates between 40-60 degrees and re-dissolves after heating to 100 degrees
Term
What is the characteristic morphology of the cells seen in multiple myeloma>?
Definition
Have eccentrically located nucleus, and perinuclear clearing, or "huff"
Term
What 3 cells markers are seen specifically on cells of multiple myeloma?
Definition
PC-1, CD38, cIg
Term
What is Waldenstrom's macroglobulinemia?
Definition
A plasma cell neoplasm which secretes monoclonal IgM...non osteolytic bone lesions, no increase in serum calcium
Term
What are some symptoms of Waldentrom's Macroglobulinemia?
Definition
Massive increase in IgM leads to hyperviscosity adn hyperproteinemia.

Also see bleeding due to increase in IgM which interferes with coagulation proteins and platelets
Term
What is typical of the RBCs on a PBS of a patient with either multiple myeloma or waldenstroms macroglobulinemia?
Definition
rouleaux
Term
What is seen on a BM of a pt. with Waldenstroms Macroglobulinemia?
Definition
The bone marrow has an infiltrate of lymphocytes, plasmacytoid lymphocytes, and plasma cells
Term
What stage of B cell development are the cells of Waldenstrom's Macroglobulinemia?
Definition
They are a malignant development between mature naive lymph and a plasma cell

Are CD20 positive and CD21 negative

Have surface and cytoplasmic Ig
Term
What is Heavy Chain Disease?
Definition
A malignant proliferation of an abnormal plasma cell that only secretes the heavy chain of Igs
Term
What are the symptoms of heavy chain disease?
Definition
lymph node enlargement, hepatosplenomegaly, fever, malaise
Term
How do we Dx. heavy chain disease?
Definition
R/O lymphoma...identify heavy chains in serum and urine (Alpha, gamma ,and mu heavy chains)
Term
In what 4 ways can we differentiate blasts?
Definition
Wright stain, cytochemical stains, immunological markers, and cytogenetics
Term
What is the gold standard for identifying blasts?
Definition
Morphologic Cell identification based upon cytoplasmic and nuclear appearance
Term
What is the principle of laminar flow in flow cytometry?
Definition
Cells travel through a fluid flow regulated so that only one cell passes through the laser light beam at a time (hydrodynamic focusing).

Ideal sample counts are ~10K/uL

A sheath fluid flows counter to the sample flow, separating the two fluids and regulating the rate of flow of the sample stream
Term
What is contained in the optical system of flow cytometry?
Definition
Laser light source, mirrors, filters to separate different wavelengths of light
Multiple detectores convert electrical emissions into electrical impulses
Term
What CD marker is found on all Cells!
Definition
CD45
Term
What are 4 myeloid CD markers
Definition
CD33, CD13, CD14, CD15
Term
what is a normal karyotype?
Definition
22 pairs of autologous chromosomes plus X and Y or XX
Term
What does a centromere probelook for?
Definition
Trisomy
Term
What does karyotype paint do?
Definition
gives each chromosome a COLOR!
Term
What does t(9;22) signify?
Definition
Philadelphia Chromosome...CML
Term
What doe t(8;14) signify?
Definition
Burkitt's lymphoma...ALL L3
Term
What does t(8;21) signify?
Definition
AML-M2
Term
What do 11q23 abnormalities signify?
Definition
AML-M5
Term
What does t(15;17) signify?
Definition
AML-M3...this is the retinoic acid receptor alpha
Term
What do CD13, CD15 signify?
Definition
myelocyte maturation
Term
What do CD13, CD14 signify?
Definition
Monocyte Maturation
Term
Where in the body is CSF found?
Definition
CSF is found in the ventricles, the neural canal of the spinal cord, and between the pia and arachnoid.
Term
How is CSF formed?
Definition
CSF is formed by the choroid plexus, through ultrafiltration of plasma and active secretion
Term
How much CSF is formed every 24 hours?
Definition
500mL
Term
What are the functions of the CSF?
Definition
The CSF functions to cushion and protect the CNS tissue, circulate nutrients, collect wastes, and lubricate. CSF protects CNS from sudden changes
Term
For what two conditions is a lumbar puncture DIAGNOSTIC?
Definition
Meningeal infection and CNS acute leukemia and lymphoma
Term
Where do the 4 tubes obtained from a lumbar puncture go?
Definition
No.1: Chemistry and Serology
No.2: Microbiology (less chance of contamination from skin NF)
No.3:/4: Hematology, Cytology (least contamination from a traumatic tap

Numbers 1 and 4 can be used as cell counts to confirm a traumatic tap
Term
Why is it so important to perform tests on CSF promptly?
Definition
To avoid cell (RBC and Neutrophil) breakdown and decreasing glucose
Term
What do you do with CSF sample tubes if there will be a delay in testing?
Definition
If delay in testing will occur, refrigerate tubes for Hematology and Chemistry and hold micro tubes at room temp
Term
What is a traumatic tap?
Definition
When blood vessels are punctured before reaching the subarachnoid space, contaminating the CSF with peripheral blood
Term
How is pressure maintained while collecting CSF sample? What pressure sould be maintained?
Definition
Pressure is measured at the time of collection be attaching a sterile manometer. Reference Range: 90-150mm water in adults and 10-100mm water in kids
Term
What are some causes of increased presssure in the CSF?
Definition
meningitis, congestive heart failure, expanding lesions (hemorrhage, tumors, and aneurysms), cerebral edema
Term
What are some causes of decreased pressure in the CSF?
Definition
Spinal subarachnoid block, dehydration, and circulatory collapse
Term
Where do proteins come from in the CSF and why are they measured?
Definition
Proteins in the CSF are derived by diffusion across the blood-CSF barrier or by synthesis within the CNS and are measured to detect increased permeability of the blood/brain barrier to plasma proteins or to detect increased secretion of Ig
Term
What are 4 causes of increased protein in the CSF?
Definition
Increased permeability of the blood-brain barrier
Mechanical obstruction of CSF flow (tumors)
Decreased resorption at the arachnoid villi
Increased synthesis of immunoglobulin
Term
What are 4 causes of decreased protein synthesis in the CSF?
Definition
CSF leaks caused by trauma or lumbar puncture
Removal of large volumes of CSF
Increased pressure
Hyperthyroidism
Term
How does glucose enter the CSF?
Definition
From plasma by active transport
Term
What is a cause of increased glucose?
Definition
hyperglycemia
Term
What are 3 causes of decreased CSF glucose?
Definition
meningitis, hemorrhage, neoplasms
Term
When do we see increases of lactate in the CSF?
Definition
Increases of lactate are more common in bacterial, tuberculosis and fungal meningitis than in viral
Term
In what patients are germinal matrix cells occasionally seen?
Definition
In neonatal patients with hydrops fetalis
Term
What CSF test is the single most useful for detection of bacterial meningitis
Definition
Gram stain on Cytospin
Term
Describe pathogenesis sequence of bacterial meningitis
Definition
Pathogenesis begins with nasopharyngeeal colonization and end with bacterial survival and replication in CSF
Term
blood cells involved/duration:Acute pahse bacterial meningitis
Definition
up to 100% neutrophils, occ. reactive lymph (1-3 days)
Term
blood cells involved/duration: proliferative phase bacterial meningitis
Definition
mixed cell population (3-6 days)
Term
blood cells involved/duration: repair Phase bacterial meningitis
Definition
Lymphocytes predominate, macrophages with ingested material (10-15 days)
Term
blood cells involved: Viral meningitis
Definition
lymphocytes with reactive forms and occ. plasma cells
Term
Blood cells seen: fungal meningitis
Definition
monocytic pleocytoses or mixed cells
Term
What is the normal viscosity of CSF>?
Definition
like water
Term
What cell count does a turbid CSF indicate>
Definition
presence of >200 WBC/uL or >400RBC/uL
Term
What is xanthochromia and what does it indicate?
Definition
Xanthochromia is a yellow, orange, or brown color after spinning cytospinning which indicates hemorrhage (RBC lysis begins 1-2 hours after CSF drawn)
Term
What are 3 ways we can differentiate a traumatic tap from a subarachnoid hemorrhage?
Definition
TRAUMATIC TAP
-progressive RBC decreases
-Clot may form upon standing
-Supernatant is clear
SUBARACHNOID HEMORRHAGE
-RBC remains constant
-Clot does not form
-Xanthochromia present
Term
What are some sources of error in counting cells off a hemocytometer?
Definition
Counting too slowly so that the fluid evaporates and recedes(false increase), too much light (cannot see cells), yeast forms resemble RBCs, difficulty distinguishing WBC from RBC
Term
What conditions are correlated with a neutrophillic infiltrate into the CSF>
Definition
Acute bacterial meningitis
Cerebral Abcess
Malignancies
CNS hemorrhage (2-4 days)
Intrathecal drugs
Early viral, TB and mycotic meningitis
Term
What conditions are associated with a lymphocytic infiltrate into the CSF?
Definition
Viral meningitis!! Fungal/tubercular meningitis, Bacterial meningitis (occ), Multiple Sclerosis
Term
What conditions are associated with a monocytic infiltrate into the CSF?
Definition
chronic bacterial meningitis, treated bacterial meningitis, CNS hemorrhage, Foreign material (chemo), Other types of meningitis
Term
What conditions are associated with Eosinophillic infiltrates into the CSF?
Definition
Parasitic meningitis, fungal infections, intracranial shunts (allergic), Drugs
Term
Significance in CSF: Basophils
Definition
little clinical significance
Term
Significance in CSF: Reactive lymphocytes
Definition
viral conditions
Term
Significance in CSF: plasma cells
Definition
Viral conditions, inflammatory reactioins, MS
Term
Significance in CSF: Lining Cells
Definition
Occasionally in normal CSF. More common following trauma, surgery and preocedures and in children with hydrocephalus and ventricular shunts
Term
Significance in CSF: Tumor Cells
Definition
primary brain tumor, metastatic tumor
Term
Significance in CSF: blasts/malignant lymphocytes
Definition
Acute leukemia/lymphoma
Term
Significance in CSF: primative cell clusters
Definition
Intracranial hemorrhage in premature infant and hydrocephalus
Term
Where is serous fluid found? What are the other terms for it?
Definition
Serous Fluid is present in small amounts between two mesothelium-lined membranes that cover the lungs, abdominal organs, and heart

It is also known as Pleural, peritoneal, and pericardial fluid
Term
What is serous fluid and what is its function>?
Definition
Serous fluid is an ultrafiltrate of plasma and facilitates the movement of two membranes against each other. One membrane lines the organ itself within the cavity and the other lines the cavity wall. Fluid is continually produed and reabsorbed
Term
What is the pleura?
Definition
The pleura is composed of a thin, double-layered membrane that separates the lung from the chest wall, diaphram, and mediastinum
Term
The presence and amount of pleural fluid is determined by what?
Definition
Hydrostatic pressure in capillaries--increases in transudates

Plasma oncotic (by plasma proteins) pressure--decreased in transudates

Lymphatic resorption--decreased in exudates

Capillary permeability--increased in exudates
Term
What are some indications for analysis of serous fluids?
Definition
Effusion of unknown etiology, malignancy, infections, and hemorrhage
Term
Describe anticoagulant use in serous fluid collection from various sites
Definition
EDTA for cell count and differential

Heparin for everything else!!
Term
Describe the nomal/abnormal appearance of serous fluid
Definition
NORmal: pale, colorless

Abnormal:
Turbid: indicates presence of cells
Milky: Chylous or pseudochylous--Chylous fluid is rich in triglycerides, caused by leakage of major thoracic duct or blockage of lymphatic vessels (lymphoma, carcinoma, or trauma)
Red: bloody or traumatic tap
Term
What does effusion mean?
Definition
Accumulation of fluid
Term
What are transudates?
Definition
Transudates are due to filtration of blood serum across a physically intact vascular wall. They are usually clear to pale yellow, do not clot, have low s.g. and protein, and have few cellular elements (usually <1000 cells/uL), and low fluid/serum ratios (protein <0.5, LD <0.6) Protein <30g/dL; LD <200 U/L
Term
What are 4 causes of transudates?
Definition
cirrhosis, congestive heart failure, hypoproteinemia (e.g. nephotic syndrome), peritoneal dialysis
Term
What are exudates?
Definition
Exudates are due to an active accumulation of fluid within the body cavity associated with damage to teh vascular wall. They are often cloudy, may clot, and have high fluid/serum ratios
Term
What are some causes of exudates?
Definition
Infections, tuberculosis, bacterial, viral, or mycoplasma pneumonia

Tumors causing exudates are commonly malignant and metastatic, pulmonary embolism, cardiovascular disease (pericardial effusions), trauma, perforated or infarcted organs, Collagen disorders (RA, SLE), pancreatitis
Term
Compare transudate/exudate: Appearance
Definition
Transudate is clear and pale yellow, while exudate is cloudy and turbid
Term
Compare transudate/exudate: number of nucleated cells
Definition
Transudate: few cells (<300/uL)
Exudate: >1000/uL
Term
Compare transudate/exudate: Specific Gravity
Definition
Transudate: <1.015
Exudate: >1.015
Term
Compare transudate/exudate: Fluid:serum protein ratio
Definition
Transudate: <0.5
Exudate: >0.5
Term
Compare transudate/exudate: LD Ratio
Definition
Transudate: <0.6
Exudate: >0.6
Term
What is the normal pH of pleural fluid?
Definition
7.4-7.6
Term
What does a pH <7.3 in pleural fluid suggest?
Definition
An inflammatory of infiltrate process
Term
What does a pH between 7.2-7.2 in pleural fluid suggest?
Definition
pneumonia that will resolve with antibiotics alone
Term
What does a pH <7.2 in pleural fluid suggest?
Definition
pneumonia that will require chest tube drainage
Term
An RBC >10,000/uL in a pleural fluid sample is suggestive of what?
Definition
malignancy, trauma, or pulmonary infarct
Term
What does a neutrophillic predominance in a pleural effusion indicate?
Definition
acute inflammations due to pneumonia, pulmonary infarct, and pancreatitis
Term
What does a neutrophillic predominance in a peritoneal effusion indicate?
Definition
spontaneous bacterial peritonitis
Term
What does a lymphocytic predominance in a pleural effusion indicate?
Definition
tuberculosis, malignncy,chylothorax, subacute inflammation, rheumatiod pleuritis, SLE, and uremia
Term
What does an eosinophilic infiltrate into the pleural fluid indicate?
Definition
non-specific reaction to pleural injury.
Term
What are LE cells? When are they seen?
Definition
LE Cells are an uncommon finding associated with disseminated lupus...they May be seen in pleural or peritoneal fluid
Term
When is a BAL indicated?
Definition
When a physician suspects opportunistic infections in immunocompromised patients--CMV, P. Jirovercii, M. avium intracellular, bacterial, viral

Or to evaluate interstitial lung disease
Term
What is synovial fluid?
Definition
Synovial fluid is an ultra filtrate of plasma combined with a mucopolysaccharide that functions to lubricate the joint space and transport nutrients.
Term
What makes synovial fluid so viscous?
Definition
Hyaluronic acid
Term
Fluid analysis of synovial fluid can provide useful information for diagnosis of what conditions?
Definition
Gout, pseudogout, and differential Dx. of arthritis
Term
What anticoagulants should be used in collection of synovial fluid?
Definition
Liquid EDTA or sodium heparin for cell count, diff., and crystals (other anticoags interfere with crystal analysis)

Sterile sodium heparin or no anticoagulant for microbiology

Red top (plain) or heparin for glucose and crystals
Term
What is the volume of normal synovial fluid?
Definition
1-4mL
Term
What is the color of normal ynovial fluid? does it clot?
Definition
Color is pale yellow or clear...does not clot
Term
What is a typical differential of synovial fluid
Definition
<25% neutrophils, mostly macrophages, some lymphocytes\

No RBCs, NO crystals,
Term
What is the name of the crystals seen in gout?
Definition
Monosodium Urates
Term
What are the crystals seen in pseudogout?
Definition
calcium pyrophosphate dihydrate
Term
How do monosodium urate crystals appeat under a microscope?
Definition
Strongly birefringent, yellow when their longitudinal axis is parallel to the slow componenet of the compensator, are needle-like with pointed ends
Term
What do calcium pyrophosphate crystals look like under a microscope
Definition
weakly birefringent, blue when parallel, rhomboid or rod-like
Term
Inflammation (increases/decreases) viscosity of synovial fluid?
Definition
Decreases!
Term
what is a normal total protein value of synovial fluid?
Definition
1-3g/dL
Term
Characteristics of malignant Cells: Cell Size
Definition
Usually larger than normal
Term
Characteristics of malignant Cells: Nucleus
Definition
Size is uaually larger than normal. Nuclear border may show irregularities, nuclear molding
Term
Characteristics of malignant Cells: N;C Ratio
Definition
Usually High. Low in adenocarcinoma
Term
Characteristics of malignant Cells: Nucleoli
Definition
May not be visible but may be irregular in shape and very large when present. May ne hyperchromic. Normal lymphocytes often show small nucleolus on cytospin slides
Term
Characteristics of malignant Cells: Cytoplasm
Definition
Often very basophilic and may show vacuolization
Term
Characteristics of malignant Cells: pleomorphism
Definition
is common vs. monomorphism in reactive mesothelial cells
Term
Characteristics of malignant Cells: Mitosis
Definition
may be seen (not diagnostic), when abnormal suspicion of malignancy is higher.
Term
Characteristics of malignant Cells: Signet ring cells
Definition
not diagnostic, they may contain mucin
Term
Characteristics of malignant Cells: clumping
Definition
Three-dimensional mass of multinucleated cells may be seen. When mesothelial cells are seen in clumps the nuclei are centrally locates, but in tumor cells the nuclei are more commonly seen near the periphery of the cell. Malignant cells may shoe nuclear molding. Benign mesothelial cells show fenestrations (openings or windows) betweeen cytoplasmic membranes of these cells. In mesothelial cells the nucleus occupies 40-70% of cell volume. Clumping is commonly seen in the peritoneal, pleual, and pericardial fluids. Tumor cells in CSF are often seen as single cells, particularily in breast cancer
Term
Characteristics of malignant Cells: Two populations in serous fluids
Definition
Exudates caused by tumors demonstrate a population of mesothelial cells and tumor cells. Look for two distinct populations
Term
What is the classic triad of symptoms for bacteril meningitis?
Definition
high fever, headache, and stiff neck...these occur in >90% of cases and altered mental status in >75. Nausea and photophobia are also common
Term
__% of bacterial meningitis cases occur in children younger than 12
Definition
75%
Term
Common causative agent of bacterial meningitis in babies 1-23 mo. and adults >60 years
Definition
Streptococcus pneumoniae
Term
Common causative agent of bacterial meningitis in kids age 2-20
Definition
Neisseria meningitidis
Term
Common causative agents of bacterial meningitis in neonates?
Definition
Group B Strep and E. Coli..Listeria monocytogenes (<1 mo. of age)
Term
What are the most frequent sources of infection leading to meningitis?
Definition
Bacteremia is the most frequent source of infection. Other ways of entering the meninges are by direct ingress from upper respiratory tract (skull fracture) via adjacent infected area (sinusitis), or by introduction during invasive procedure
Term
What are some predisposing factors for bacterial meningitis?
Definition
upper respiratory infection, alcoholism, chronically altered mental status, recent head trauma, CSF leak, pneumonia, diabetes mellitus, splenectome, and endocarditis.
Term
75-90% of cases of viral meningitis are caused by what virus?
Definition
Enteroviruses (echoviruses, coxsackieviruses, polioviruses) with a late summer seasonal peak

Diagnosis is mainly by exclusion
Term
What is the distinction between a leukemia vs. a lymphoma?
Definition
Leukemia: Acute or chronic malignant proliferation of leukocytes in the BONE MARROW, often with circulating malignant cells in the blood-AML, CML

LYMPHOMA: Malignant lymphoproliferative disorder arising as discrete tissue mass (lymph nodes, etc)...may involve marrow and have circulating malignant cells
Term
The basic breakdown of lymphomas: What are the relative percentages of Hodgkin Lymphoma vs. Non-Hodgkin lymphoma?
Definition
Hodgkin Lymphoma: 15%
Non-Hodgkin lymphoma: 85%
Term
What are the 2 major types of non-hodgkin lymphoma and what are their relative percentages?
Definition
B-Cell neoplasms 85%

T-Cell and NK-Cell Neoplasms: 15%
Term
What cells are mainly found in the follicle of the lymph node?
Definition
B cells
Term
What cells are normally found in the paracortex of the lymph node?
Definition
t cELLS
Term
What is effacement in terms of lymphoma?
Definition
The pattern that occurs in general in a lymphoma wherein the lymphoma destroys the architecture of the node
Term
What types of infiltration are normally seen in a lymph node of someone with a lymphoma?
Definition
Diffuse or nodular patterns
Term
What are the malignant cells in Hodgkin Lymphoma derived from?
Definition
Derived from mature B cells at the germinal center stage of differentiation
Term
Describe the prognosis for someone with Hodgkin lymphoma
Definition
Originally this had a very poor prognosis (<10% survival at 5 years)...but now improved staging techniques and understanding of the pattern of spread helps direct management..

Now curable in over 70% of cases through the use of radiotherapy and chemo
Term
What are the 2 subcategories of Hodgkin lymphoma? What are their relative percentages?
Definition
Classic (95%) and non-classic (5%)
Term
What are the 4 major subtypes of Classic Hodgkin lymphoma?
Definition
Nodular sclerosis, lymphocyte rich, mixed cellularity, lymphocyte depleted
Term
What is the only major subtype of non-classic Hodgkin Lymphoma?
Definition
Nodular lymphocyte predominant
Term
Describe the age distribution of Hodgkin Lymphoma
Definition
Bimodal age distribution:
young adults (20-30) and the elderrly (>50 years)

BUT MAy occur at any age
Term
Sex and Hodgkin lymphoma
Definition
M>F
Term
Describe the lymphadenopathy seen in Hodgkin lymphoma
Definition
Most often cervical region...is asymmetrical, discrete, painless, rubbery, not adherent to skin, and fluctuates in size
Term
What do pathologists look for in a nodal biopsy to Dx. Hodgkin lymphoma?
Definition
Hodgkin Cells, Reed-Sternberg Cells, mixed inflammatory infiltrates
Term
What 3 monoclonal Ab can be used to detect Hodgkin lymphoma?
Definition
CD20, CD15, CD30
Term
Describe the appearance of Reed-Sternberg Cells
Definition
Binucleated with two identical mirror image sides..prominent nucleoli ("owl's eye" nuclear inclusion-like)
Term
Reed-Sternberg Cell: Rxs with monoclonal Ab
Definition
CD20-, CD15+, CD30+
Term
Lacunar Cells: Rxn with monoclonal Ab
Definition
CD20-, CD15+, CD30+
Term
What are lacunar cells? What do they look like?
Definition
Lacunar cells are Reed-Sternberg Variants

They have a clear space around the nucleus, mononuclear or multinucleated
Term
Reed-Sternberg Cells are seen in what subtype of Hodgkin Lymphoma?
Definition
Mixed cellularity, lymphocyte rich, and lymphocyte depleted
Term
Lacunar Cells are seen in what subtype of Hodgkin Lymphoma?
Definition
Nodular sclerosis type
Term
What are the monoclonal Ab rxns of L & H Cells? ("popcorn cells")?
Definition
CD20+, CD15-, CD30-
Term
What is the characteristic appearance of L&H cells (popcorn Cells)
Definition
Multiple lobed, folded, or convoluted nucleus resembling a popcorn kernal
Term
In what subtype of Hodgkin Lymphoma is Land H cells seen?
Definition
Seen in Nodular lyphocyte subtype
Term
What is the normal function of NF-kB in relation to B cells?
Definition
Activation of NF-kB rescues germinal cell B cells that cannot express immunoglobulins from apoptosis, promoting lymphocyte survival and proliferation
Term
T or F; Activation of NF-kB is a common event in classical Hodgkin Lymphoma
Definition
TRUE!
Term
Morphologic description of node: Lymphocyte Rich
Definition
DIFFUSE pattern with lymphocytes

Classic RS cells, no fibrosis
Term
Which type of Hodgkin lymphoma is the worst to have?
Definition
Lymphocyte-Depleted...this kind is predominantly seen in elderly, HIV+ patients
Term
What is the MOST common subtype of Hodgkin Lymphoma?
Definition
Nodular sclerosis
Term
What is the second MOST commonn subtype of Hodgkin Lymphoma?
Definition
Mixed Cellularity
Term
How is nodular lymphocyte predominant HL separated from the 4 classical types of HL?
Definition
It is separated based on different morphology and immunoprofile of diagnostic RS cells

L&H variant Cells that are CD20+, CD15-, and CD30-
Term
Describe avg. patient that gets non-classic Hodgkin lymphoma
Definition
male 30-50 years old
Term
What is the prognosis of non-classic Hodgkin lymphoma?
Definition
Good prognosis!!!
Term
Describe the Ann Arbor Staging of Hodgkin Lymphoma
Definition
Stage 1: Single LN involvement..BEST prognosis
Stage2: Two or more LN regions on same side of diaphragm
Stage 3: LN regions on both sides of diaphragm plus spleen
Stage 4: Diffuse involvement of LNs and extra lymphatic organs not contiguous to lymphatic tissue, liver, BM (worst prognosis)
Term
What is the 6th major cause of death yearly?
Definition
Non-Hodgkin Lymphoma
Term
What are the 3 immunophenotypes of Non-Hodgkin Lymphoma?
Definition
B-Cell Derivation
T-Cell Derivation
Histiocytes (Very rarely)
Term
What are the 3 major catagories of non-Hodgkin Lymphoma according to WHO?
Definition
Precusor Lymphoid Neoplasms
Mature B Cell Neoplasms
Mature T Cells and NK-Cell neoplasms
Term
What stags of B-Cell Development do we see in the Bone Marrow and in the Lymphoid Tissue?
Definition
BONE MARROW
Stem CEll, lymhoid progenitor, progenitor-B, pre-B, immature B-Cell

LYMPHOID TISSUE
Mature Naive B-Cell, Germinal Center B-Bell, memory B cell, Plasma cell
Term
What is the most common form of Non-Hadgkin Lymphoma in the US?
Definition
Follicular Lymphoma
Term
What is the male:female ratio of follicular lymphoma?
Definition
1:1.7
Term
Where in the body does follicular lymphoma present?
Definition
Predominantly in the lymph nodes, but also in the spleen, peripheral blood, and GI tract
Term
What type of cells do the neoplastic cells of follicular lymphoma resemble?
Definition
Neoplastic cells resemble germinal center B-Cells
Term
What ttranslocation is associated with follicular lyphoma and what gene rearrangement does this cause? What are the consequences of this rearrangement?
Definition
t(14:18) and BCL2/IGH rearrangement

Overexpression of anti-apoptotic BCL-2 results in unregulated proliferation and malignant transformation of lymphocytes
Term
What is the prognosis of follicular lymphoma?
Definition
Indolent but incurable, median survival is 7-9 years

Histologic transformation to high grade lymphoma in 25-35% of cases
Term
Describe how diffuse large B-Cell Lymphoma arises
Definition
Usually arises de novo, but can represent progression from low grade lymphoma (FL, CLL)
Term
Where are the malignant cells of diffuse large B-Cell lymphoma from?
Definition
Derived from peripheral B-Cells of wither germinal center or post germinal center (activated B-Cell)
Term
Describe prognosis of diffuse large B-Cell lymphoma
Definition
Aggressive tumor but potentially curable with multi-agent chemotherapy
Term
Describe the malignant cells of diffuse large B-Cell lymphoma
Definition
Exhibit diffuse growth pattern, large cells with irregular large vesicular nuclei, multiple nucleoli

Show mature B-Cell markers and surface Ig

10-20% show t(14;18), arising from follicular lymphoma
Term
Chronic Lymphocytic Leukemia is essentially the same disease as what?
Definition
Small lymphocytic lymphoma

BUT CLL is much more common in US than SLL
Term
What is the most common leukemia in the US?
Definition
CLL
Term
Do more guys or girls get CLL
Definition
Guys
Term
What parts of the body usually show disease with CLL/SLL?
Definition
Marrow involvement is ALWAYS seen in CLL and is USUALLY seen in SLL

Lymph nodes, liver, and spleen are also typically infiltrated
Term
What cell type are the malignant cells of CLL/SLL derived from?
Definition
derived from naive B-Cells
Term
What is the prognosis of CLL/SLL?
Definition
Variable prognosis (median survival 4-6 years) ZAP-70 and CD38 expression is associated with a worse prognosis
Term
What does the PBS of someone with CLL/SLL look like?
Definition
monoclonal lymphocytosis, small lymphocytes with scant cytoplasm and clumped chromatin, Smudge cells or basket cells
Term
What are the IHC reactions with CD5, CD20, and CD23 in CLL/SLL cells
Definition
CD5+, CD20+, and CD23+
Term
Sex predominance: mantle cell lymphoma
Definition
more males than females
Term
What body sites are affected by mantle Cell lymphoma?
Definition
lymph nodes are the most commonly involved site, but other important sites include spleen and bone marrow with or without peripheral blood
Term
How do most patients with mantle cell lymphoma present?
Definition
present with stage 3 or 4 disease with lymphadenopathy, hepatosplenomegaly, and BM involvement
Term
what cell type are the malignant cells of mantle cell lymphoma derived from?
Definition
B-Cells of inner mantle zone, mostly of naive pre-germinal center type
Term
T or F: histological transformation to large cell lymphoma occurs in mantle cell lymphoma
Definition
FALSE
Term
Prognosis: mantle cell lymphoma
Definition
Vast majority of patients cannot be cured with a median survival of 3-5 years
Term
What is the Immunophenotype of mantle cell lymphoma with respect to CD19, CD20, and CD5?
Definition
CD19+, CD20+, and CD5+
Term
What is the characteristic translocation in mantle cell lymphoma?
Definition
t(11;14) between IGH and cyclinD1
Term
What are the 3 clinical variants of Burkitt lymphoma?
Definition
Endemic BL, Sporadic BL, and Immunodeficiency-associated BL
Term
Who get endemic Burkitt Lymphoma?
Definition
ppl in equitorial Africa, incidence peak at 4-7 years, ALL EBV related, mostly males
Term
Who gets sporadic Burkitt Lymphoma?
Definition
Mainly children and young adults...median age 30 years...mostly males, some EBV association
Term
Who gets immunodeficiency-associated Burkitt Lymphoma?
Definition
associated with HIV, EBV is also correlated
Term
In general, what age group gets Brukitt Lymphoma?
Definition
Children!!
Term
Physical symptoms: Endemic Burkitt lymphoma
Definition
jaws and other facial bones are the site of presentation in 50% of cases; distal ileum, cecum, gonads, kidneys, thyroid, salivary glands, breasts may all be involved
Term
Physical symptoms: Sporadic Burkitt Lymphoma
Definition
Abdominal masses; ovaries, kidneys, and breasts are frequently involved
Term
Physical symptoms: immunodeficiency related Burkitt Lymphoma
Definition
nodal and BM involvement
Term
prognosis: endemic and sporadic Burkitt Lymphoma
Definition
Endemic and sporadic Burkitt Lymphoma are highly aggressive but potentially curable
Term
What characteristic patttern is seen in biopsies of patients with Burkitt lymphoma
Definition
"Starry Sky" appearance...aka a diffuse monotonous pattern
Term
Appearance of lymph node in someone with Burkitt lymphoma
Definition
Medium sized lymphoid cells with squared-off cell borders, basophilic cytoplasm, round nuclei with finely clumped chromatin, adn paracentrally situated nuclei
Term
Immunotype of malignant cells in Burkitt Lymphoma: CD19, CD20, CD10, and any Ig
Definition
CD19+, CD20+, CD10+, and surface Ig positive
Term
What is the characteristic trsanslocation seen in Burkitt Lymphoma?
Definition
t(8:14) between IGH and c-MYC
Term
What is MALT lymphoma?
Definition
Extranodal Marginal Zone Lymphoma of Mucosal-associated Lymphoid Tissue
Term
What are the commmon body sites involved with MALT lymphoma?
Definition
GI tract is the most common site, while other common sites include salivary gland, lung, head and neck, ocular adnexa, skin, thyroid, and breast
Term
Many cases of MALT lymphoma are also associated with what other disorder>?
Definition
Chronic Inflammatory Disorder (H.pylori infection-->stomach, Sjogren syndrome-->salivary gland, Hashimoto thyroiditis)
Term
Many cases of MALT lymphoma are also associated with what other disorder>?
Definition
Chronic Inflammatory Disorder (H.pylori infection-->stomach, Sjogren syndrome-->salivary gland, Hashimoto thyroiditis)
Term
Cases of MALT lymphoma with what characteristic translocation are resistent to H.pylori therapy?
Definition
t(11;18)
Term
What are the 4 types of plasma cell neoplasms?
Definition
Multiple Myeloma, Plasmocytoma, Monoclonal Gammopathy of Undetermined Significance (MGUS), Waldenstrom Macroglobulinemia
Term
What is Bence Jones Protein?
Definition
It is a protein seen in multiple Myeloma...it is free light chains
Term
What are the urine and serum, BM, and organ tissue findings of Symptomatic plasma cell myeloma?
Definition
-M protein in serum or urine, Bence Jones protein
-Bone Marrow clonal plasma cells or plasmocytoma: monoclonal plasma cells usually exceed 10% of nucleated cells in the marrow but no minimal level is designated
-Related tissue or organ impairment: CRAB: hypercalcemia, renal insufficiency, anemia, and bone lesions
Term
What are the urine/serum, BM, and related organ/tissue findings of Asymptomatic (smoldering) Myeloma
Definition
M protein in serum at myeloma level

AND/OR
-10% or more clonal plasma cells in bone marrow
-No related organ or tissue impairment or myeloma-related symptoms
Term
Signs/symptoms of Multiple Myeloma
Definition
Hypercalcemia, recurrent infections due to reduced levels of normal immunoglobulin, BONE FRACTURES, hyperviscosity syndrome
Term
physical findings: plasmocytoma
Definition
localized tumor to one area
Term
Seen in SPE: MGUS
Definition
M component present, but less than myeloma levels
Term
Waldenstrom's macroglobulinemia: What type of Ig seen, symptoms?
Definition
IgM strictly seen, hyperviscosity syndrome, NO Bone involvement, prognosis OK
Term
What are the 7 types of Mature T Cell and NK-Cell neoplasms?
Definition
Adult T-Cell leukemia/lymphoma
Peripheral T-Cell lymphoma, unspecified
Anaplastic large-cell lymphoma
Extranodal NK/T-cell lymphoma
Mycosis fungoides/Sezary syndrome
Angioimmunoblastic T-cell lymphoma
Large granular Leukemia
Term
Body sites: anaplastic large cell lymphoma
Definition
involves both lymph nodes and extranodal sites (skin, bone, soft tissue, liver)
Term
What translocation is asssociated with anaplastic large cell lymphoma
Definition
t(2:5) and rearrangements of the ALK gene on chromosome 2
Term
what feature of patients with anaplastic large cell lymphoma determines theri prognosis?
Definition
ALK+ patients have a favorable prognosis (5-year survival 80%) compared with ALK- patients
Term
Describe how Hairy Cells react with the acid phosphatase stain
Definition
Hairy cells, like most other bodily cells stain positive with the acid phosphatase stain
Term
What isoenzyme do hairy cells contain which other cells in the body do not? What modification of the acid phosphatase stain can be made to reveal this specil isoenzyme?
Definition
Hairy cells have Isoenzyme 5.

Seven isoenzymes of phosphatase are present in leukocytes...but all isoenzymes but 5 are sensitive to tartrate inhibition. This is why the addition of tartrate to a blood sample can be a distinguishing test for hairy cells
Term
In rare cases of CLL, patients may develop what's called Evan's syndrome...this includes what findings?
Definition
Autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura
Term
All of the following are common findings in CLL, except:

-Smudge Cells on he PBS
-Stong Surface Ig Expression
-T-Cell antigen, CD5
-Absolute lymphocytosis
Definition
Strong Surface Ig Expression
Term
What is is about a disease like Multiple Myeloma that encourages Rouleaux formation?
Definition
In multiple myeloma, there are increased globulins...these gloulins interact with the salicilic acid on RBCs that usually maintains their zeta potential...and decreases the potential..causing rouleaux to form
Term
Clinical/laboratory findings consistent with a diagnosis of Waldenstrom's Macroglobulinemia include all of the following except:

hepatosplenomegaly
hyperviscosity syndrome
increased serum IgM levels
lytic bone lesions
Definition
LYTIC bone lesions!!
Term
Describew the appearance of hairy cells, including information about their cytoplasmic and nuclear characteristics
Definition
Hairy cells have abundant pale staining cytoplasm, cicumferential cytoplasmic projections "hairs"

Their nuclei are oval or reniform, and they have relatively fine chromatin
Term
Are hairy cells B or T cell in origin?
Definition
B cell
Term
What is the specific surface antigen seen in hairy cell leukemia specific for this disease?
Definition
CD103
Term
Patients with multiple myeloma often suffer from pathological bone fractures. Explain the pathophys. behind this
Definition
Multiple myeloma is a malignant disorder that forms multiple tumors throughout the skeletal system (lytic bone lesions). Patients often present with bone pain and/or pathologic fractures due to tumor infiltration
Term
In which age group does acute lymphoblastic leukemia occur with the highest frequency?
Definition
age 1-15 years
Term
Leukemic lymphoblasts reacting with anti-CALLa are characteristically seen in what disease?
Definition
precursor B-cell ALL
Term
Broadly differentiate between a leukemia and a lymphoma
Definition
Leukemia: acute or chronic malignant proliferation of leukocytes in the BONE MARROW often with circulating malignant cells in the blood, may be indolent

Lymphoma: tumor of lymphatic system/lymphoid tissue, more tell-tale symptoms MAY involve marrow and have circulating cells
Term
What is Terminal deoxynucleotidal transferase (Tdt)?
Definition
Tdt is a DNA polymerase found in cell nuclei...it is only present in premature T and B lymphocytes...not mature ones..Its value in ALL is to identify primitive lymphoblasts from more mature cells
Term
The diagnosis of lymphoma relies most heavily on all of the following, except:
-microscopic examination of affected lymph nodes
-immunophenotyping using immunohistochemistry or flow cytometry
-molecular/cytogenetic analysis
-peripheral blood findings in a CBC
Definition
Peripheral blood findings in a CBC
Term
The most common lymphoma occuring in young adults is
Definition
Hodgkin lymphoma
Term
In a normal lymph node, the medulla includes primarily..
Definition
plasma cells
Term
What are tingible body macrophages?
Definition
macrophages found primarily in the germinal centers of lymph nodes
Term
What is the major morphologic different between Hodgkin and other B cell lymphomas?
Definition
The presence of numerous reactive lymphocytes and only a few malignant cells in Hodgkins
Term
How do we differentiate non-classic Hodgkin's Lymphoma ( nodular Lymphocyte predominant) from the other, classical, types of Hodgkin lymphomA?
Definition
The classical types of Hodgkin Lymphoma have Reed Sternberg cells, but the non-classic lymphocyte predominant HL doesn't have Reed Sternberg Cells
Term
How can you tell the difference between nodular sclerosis and mixed cellularity Hodgkin's disease?
Definition
There are fibrotic bands of collagen in Nodular sclerosis Hodgkin's disease...but they are absent in mixed cellularity Hodgkin's disease
Term
using the terms homogeneous, heterogeneous, and basophillic, describe ALL L1, L2, and L3
Definition
ALL L1: homogeneous
ALL L2: heterogeneous
ALL L3: basophilic, heterogeneous
Term
Symptoms in an infant: listless, refusing to walk...

what might they have>?
Definition
ALL
Term
What type of WBC count do we see in patients with PLL?
Definition
EXORBITENTLY HIGH WBC COUNT!!!
Term
What is a very important abdominal finding in patients with Hairy Cell Leukemia?
Definition
SPLENOMEGALY!!
Term
Calcium/multiple myeloma connection...what is it?
Definition
See increased serum calcium in patients with multiple myeloma...this leads to muscle spasms, and heart arrythmias
Term
What is a special flow marker for multiple myeloma?
Definition
PC-1
Term
What Ig type is seen in Waldenstrom's Macroglobulinemia?
Definition
IgM strictly!
Term
What is Richter's transformation?
Definition
A transformation from CLL to diffuse large B-Cell lymphoma
Term
What types of blood cells are seen in CSF of adults more or less than in neonates?
Definition
Adults lymphocytes 60+/-20
Neonates Lymphocytes 20+/-15
Adults monocytes 30+/-15
Neonates monocytes 70+/-20
Adults neutrophils 2+/-4
Neonates neutrophils 4+/-4
Term
The FAB classification scheme for ALL subtypes is primarily based on...
Definition
morphology
Term
The WHO classification scheme most often utilizes _____to diagnose ALLs
Definition
immunophenotyping
Term
What is the PEAK age incidence of ALL?
Definition
2-5 years old
Term
What is the main reason for immunophenotyping the abnormal lymphoblasts in ALL?
Definition
To determine the cell lineage and identify the immunologic subtype of the blast (B or T cell)...this determines treatment regimen and prognosis
Term
Comment on the patient's prognosis when they have the CAllA marker on their malignant cells?
Definition
ALLs with CD10 CALLA marker have the best prognosis
Term
Where seen: CD34
Definition
pro-T, pre-T cells,, pro-B, pre-B cells
Term
Where seen: CD5
Definition
Mature t CELLS AND malignant B cells
Term
Where seen:CD7
Definition
ALL T cells
Term
Where seen: CD2
Definition
pre-t cells, T cells and common T cell
Term
Where seen: CD1
Definition
mature T cells
Term
Where seen: CD3
Definition
mature T cells
Term
Where seen: CD4 and CD8 together
Definition
common T cell
Term
Where seen: CD19
Definition
ALL B cells
Term
Where seen: CD10
Definition
pro-B, pre-B cels
Term
Where seen: CD20
Definition
pre-B cells and BEYOND!
Term
Where seen: CD21
Definition
Pre-B cells and BEYOND!
Term
Where see: JUST c-IgM
Definition
pre-B cells
Term
Where see: just s-IgM
Definition
early B cells
Term
Where see: both s-IgM and s-IgD
Definition
mature B cells
Term
Name at least 3 pan-T cell markers
Definition
CD 2, 3, 5, and 7
Term
Describe the pattern of PAS reactivity seen in ALL vs. AML
Definition
ALL: Block-like/course granular positivity--no background positivity

AML 1/3 of blasts exhibit diffuse positivity...but intensity of staining increases with maturity
Term
What would be the result of a MPO stain on an ALL patient?
Definition
Negative b/c lymphs don't have primary granules w/ myeloperoxidase
Term
True or False: All ALL-L3's are of B-cel origin
Definition
TRUE
Term
What is the diagnostic translocation seen in Burkitt's lymphoma?
Definition
t(8:14)
Term
Most cases of CLL involve what lymphocyte subtype?
Definition
B cell
Term
Why is the immunologic marker Leu1 (CD5) of interest in CLL cases?
Definition
In addition to typical B-cell surface antigens, B-Cell CLL lymphocytes express CD5, an antigen typically found on T cells. Because normal CD5+ B cells are present in the mantle zone of lymphoid follicles, B-cell CLL is most likely a malignancy of a mantle-zone-based population of lymphocytes
Term
What is Evan's syndrome?
Definition
It is something that one develops after they have had CLL for awhile...it is Autoimmune related hemolysis
Term
Is the clone of lymphocytes in CLL immunologically competent or incompetent?
Definition
Incompetent..maturation is arrested prior to them becoming plasma cells so they are unable to secrete immunoglobulins
Term
How does the BCL-2 gene rearrangement contribute to the development of a lymphoid malignancy like CLL?
Definition
Translocation of the BCL-2 gene to the region of the Ig heavy chain causes overexpression of the BCL-2 gene The resulting increase of BCL-2 protein leads to the inhibition of apoptosis and accumulation of cancerous lymphocytes in the lymph nodes
Term
Does the absence of a monoclonal immunoglobulin serum protein electrophoretic spike rule out the diagnosis of multiple myeloma? If not, explain..
Definition
NO...therthe patient may have light-chain only disease...in this case, he/she would have normal SPEP b/c the protein is excreted into the urine
Term
Why does rouleaux happen in multiple myeloma?
Definition
The large heavy chains of immunoglobulin in the plasma decrease the zeta potential arounf RBCs and cause them to settle faster
Term
What causes the increased serum calcium in multiple myeloma?
Definition
The osteoclast stimulating factor produced by malignant plasma cells causes increased osteoclast activity and increased release of calcium
Term
What is the difference between an osteoclast and an osteoblast?
Definition
Osteoblasts are responsible for bone formation. Osteoclasts remove bone tissue
Term
What is the difference between staging and grading the lymphoid malignancies?
Definition
Grading is based on clinical course and response to treatment. There are three subtypes of malignant lymphomas by morphologic appearance and by 3 grades: low, intermediate, and high. STAGING on the other hand is based on the extent and distribution of the malignancy
Term
Which non-Hodgkin's lymphoma is the most common in the US?
Definition
Follicular lymphoma
Term
Describe the pathogenesis of follicular lymphoma
Definition
Most cases arise due to the translocation of chromosomes 14, 18 involving the BCL-2 gene that leads to overexpression of BCL-2 protein and lymphocytes that are unable to undergo apoptosis. This allows follicele center cells to accumulate and produce lymphadenopathy
Term
What causes the starry sky pattern occur in Burkitts lymphoma?
Definition
Sky= blue nuclei of neoplastic lymphs
Stars= scattered pale tingible macrophages
Term
What type of leukemia is associated with Burkitt's lymphoma?
Definition
Burkitt's leukemia...also known as ALL-L3

This leukemia occurs if the lymphoma progresses from the tissues to the blood
Term
Describe the relative presence of Reed sternberg cells and lacunar cells in nodular sclerosing and mixed cellularity Hodgkin's lymphoma
Definition
Nodular Sclerosing: lacunar cells, reed sternberg cells occasional

Mixed cellularity: No lacunar cells,, moderate to many reed dternberg cells
Term
What is the association of EBV with lymphoma?
Definition
EBV infects B lymphocytes, where it remains latent under control of the immunesystem. EBV infected cells can proliferate if host becomes immunocompromised or the B lymphocytes acquire additional genetic abnormalities (c_MYC translocation) resulting in lymphoma
Term
What lymphoma type is associated with tingible body macrophages?
Definition
Follicular Lymphoma and Burkitt lymphoma (form Stars of "starry sky")
Term
In which lymphoma subtype do we see L&H popcorn cells?
Definition
IN lymphocyte predominant Hodgkin's lymphoma
Term
Are L&H cells of B or T cell origin?
Definition
B cell
Term
Prognosis:multiple myeloma
Definition
POOR..median survival only 6 months!
Term
Do transudates clot?
Definition
NO!
Term
Likelihood of remission: childhood ALL vs. adult onset ALL
Definition
Childhood ALL is much more likely to be resolve and can seem to be "cured"...adult onset is tougher to treat
Term
Describe the connection between The Philadelphia chromosome and ALL
Definition
About 10-15% of children with ALL have the Philadelphia chromosome, whichis associated with a poor prognosis
Term
In this unit, when see alot of smudge cells, think...
Definition
CLL
Term
What level of lymphocytes do we see n CLL?
Definition
>5 x 10^9/L
Term
What disease?: Abberrent expression of the T lymph marker CD5
Definition
CLL
Term
Are most cases of PLL B or T cell in origin?
Definition
B Cell
Term
What is the distinguishing factor between PLL and CLL/PL?
Definition
In PLL, greater than 55% of the lymphocytes present are prolymphocytes

In CLL/PL, 11-55% of the lymphocytes are Prolymphocytes
Term
What CD marker do cells of Burkit's and Waldenstrom's have uniquely? What type of Ig do they have?
Definition
CD25
Burkitt's s-IgM, s-IgD
Waldenstroms s-IgM
Term
What are the only 3 markers seen on Pro-T cells?
Definition
TdT, CD7, and CD34
Term
What are the 4 markers seen on Pre-T cels?
Definition
Tdt, CD2, CD7, CD34
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