Term
| What age group is ALL typically seen in? |
|
Definition
|
|
Term
| How do cells of ALL stain with MPO? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| Side scatter tells us what? |
|
Definition
|
|
Term
| What stage of B cell development has just c-IgM? |
|
Definition
|
|
Term
| What stage of B cell development has just s-IgM? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
Term
| What is Richter's syndrome? |
|
Definition
| A transformation of CLL into a large cell lymphoma |
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What are 4 myeloid CD markers |
|
Definition
|
|
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
|
|
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
|
|
Term
| What do 11q23 abnormalities signify? |
|
Definition
|
|
Term
| What does t(15;17) signify? |
|
Definition
| AML-M3...this is the retinoic acid receptor alpha |
|
|
Term
| What do CD13, CD15 signify? |
|
Definition
|
|
Term
| What do CD13, CD14 signify? |
|
Definition
|
|
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
|
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
|
|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| what is a normal total protein value of synovial fluid? |
|
Definition
|
|
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
|
|
Term
| Common causative agent of bacterial meningitis in babies 1-23 mo. and adults >60 years |
|
Definition
|
|
Term
| Common causative agent of bacterial meningitis in kids age 2-20 |
|
Definition
|
|
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
|
|
Term
| What cells are normally found in the paracortex of the lymph node? |
|
Definition
|
|
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
|
Definition
|
|
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
|
|
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
|
|
Term
| Lacunar Cells: Rxn with monoclonal Ab |
|
Definition
|
|
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
|
|
Term
| What are the monoclonal Ab rxns of L & H Cells? ("popcorn cells")? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the second MOST commonn subtype of Hodgkin Lymphoma? |
|
Definition
|
|
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
|
|
Term
| What is the prognosis of non-classic Hodgkin lymphoma? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the male:female ratio of follicular lymphoma? |
|
Definition
|
|
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
|
|
Term
| Do more guys or girls get CLL |
|
Definition
|
|
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
|
|
Term
| Sex predominance: mantle cell lymphoma |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
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
|
|
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
|
|
Term
| What is the specific surface antigen seen in hairy cell leukemia specific for this disease? |
|
Definition
|
|
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
|
|
Term
| Leukemic lymphoblasts reacting with anti-CALLa are characteristically seen in what disease? |
|
Definition
|
|
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
|
|
Term
| In a normal lymph node, the medulla includes primarily.. |
|
Definition
|
|
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 |
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Term
| How can you tell the difference between nodular sclerosis and mixed cellularity Hodgkin's disease? |
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Definition
| There are fibrotic bands of collagen in Nodular sclerosis Hodgkin's disease...but they are absent in mixed cellularity Hodgkin's disease |
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Term
| using the terms homogeneous, heterogeneous, and basophillic, describe ALL L1, L2, and L3 |
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Definition
ALL L1: homogeneous
ALL L2: heterogeneous
ALL L3: basophilic, heterogeneous |
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Term
Symptoms in an infant: listless, refusing to walk...
what might they have>? |
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Definition
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Term
| What type of WBC count do we see in patients with PLL? |
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Definition
| EXORBITENTLY HIGH WBC COUNT!!! |
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Term
| What is a very important abdominal finding in patients with Hairy Cell Leukemia? |
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Definition
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Term
| Calcium/multiple myeloma connection...what is it? |
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Definition
| See increased serum calcium in patients with multiple myeloma...this leads to muscle spasms, and heart arrythmias |
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Term
| What is a special flow marker for multiple myeloma? |
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Definition
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Term
| What Ig type is seen in Waldenstrom's Macroglobulinemia? |
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Definition
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Term
| What is Richter's transformation? |
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Definition
| A transformation from CLL to diffuse large B-Cell lymphoma |
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Term
| What types of blood cells are seen in CSF of adults more or less than in neonates? |
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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 |
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Term
| The FAB classification scheme for ALL subtypes is primarily based on... |
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Definition
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Term
| The WHO classification scheme most often utilizes _____to diagnose ALLs |
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Definition
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Term
| What is the PEAK age incidence of ALL? |
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Definition
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Term
| What is the main reason for immunophenotyping the abnormal lymphoblasts in ALL? |
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Definition
| To determine the cell lineage and identify the immunologic subtype of the blast (B or T cell)...this determines treatment regimen and prognosis |
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Term
| Comment on the patient's prognosis when they have the CAllA marker on their malignant cells? |
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Definition
| ALLs with CD10 CALLA marker have the best prognosis |
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Term
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Definition
| pro-T, pre-T cells,, pro-B, pre-B cells |
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Term
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Definition
| Mature t CELLS AND malignant B cells |
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Term
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Definition
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Term
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Definition
| pre-t cells, T cells and common T cell |
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Term
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Definition
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Term
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Definition
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Term
| Where seen: CD4 and CD8 together |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Where see: both s-IgM and s-IgD |
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Definition
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Term
| Name at least 3 pan-T cell markers |
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Definition
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Term
| Describe the pattern of PAS reactivity seen in ALL vs. AML |
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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 |
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Term
| What would be the result of a MPO stain on an ALL patient? |
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Definition
| Negative b/c lymphs don't have primary granules w/ myeloperoxidase |
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Term
| True or False: All ALL-L3's are of B-cel origin |
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Definition
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Term
| What is the diagnostic translocation seen in Burkitt's lymphoma? |
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Definition
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Term
| Most cases of CLL involve what lymphocyte subtype? |
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Definition
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Term
| Why is the immunologic marker Leu1 (CD5) of interest in CLL cases? |
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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 |
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Term
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Definition
| It is something that one develops after they have had CLL for awhile...it is Autoimmune related hemolysis |
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Term
| Is the clone of lymphocytes in CLL immunologically competent or incompetent? |
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Definition
| Incompetent..maturation is arrested prior to them becoming plasma cells so they are unable to secrete immunoglobulins |
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Term
| How does the BCL-2 gene rearrangement contribute to the development of a lymphoid malignancy like CLL? |
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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 |
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Term
| Does the absence of a monoclonal immunoglobulin serum protein electrophoretic spike rule out the diagnosis of multiple myeloma? If not, explain.. |
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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 |
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Term
| Why does rouleaux happen in multiple myeloma? |
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Definition
| The large heavy chains of immunoglobulin in the plasma decrease the zeta potential arounf RBCs and cause them to settle faster |
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Term
| What causes the increased serum calcium in multiple myeloma? |
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Definition
| The osteoclast stimulating factor produced by malignant plasma cells causes increased osteoclast activity and increased release of calcium |
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Term
| What is the difference between an osteoclast and an osteoblast? |
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Definition
| Osteoblasts are responsible for bone formation. Osteoclasts remove bone tissue |
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Term
| What is the difference between staging and grading the lymphoid malignancies? |
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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 |
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Term
| Which non-Hodgkin's lymphoma is the most common in the US? |
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Definition
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Term
| Describe the pathogenesis of follicular lymphoma |
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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 |
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Term
| What causes the starry sky pattern occur in Burkitts lymphoma? |
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Definition
Sky= blue nuclei of neoplastic lymphs
Stars= scattered pale tingible macrophages |
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Term
| What type of leukemia is associated with Burkitt's lymphoma? |
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Definition
Burkitt's leukemia...also known as ALL-L3
This leukemia occurs if the lymphoma progresses from the tissues to the blood |
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Term
| Describe the relative presence of Reed sternberg cells and lacunar cells in nodular sclerosing and mixed cellularity Hodgkin's lymphoma |
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Definition
Nodular Sclerosing: lacunar cells, reed sternberg cells occasional
Mixed cellularity: No lacunar cells,, moderate to many reed dternberg cells |
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Term
| What is the association of EBV with lymphoma? |
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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 |
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Term
| What lymphoma type is associated with tingible body macrophages? |
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Definition
| Follicular Lymphoma and Burkitt lymphoma (form Stars of "starry sky") |
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Term
| In which lymphoma subtype do we see L&H popcorn cells? |
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Definition
| IN lymphocyte predominant Hodgkin's lymphoma |
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Term
| Are L&H cells of B or T cell origin? |
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Definition
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Term
| Prognosis:multiple myeloma |
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Definition
| POOR..median survival only 6 months! |
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Term
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Definition
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Term
| Likelihood of remission: childhood ALL vs. adult onset ALL |
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Definition
| Childhood ALL is much more likely to be resolve and can seem to be "cured"...adult onset is tougher to treat |
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Term
| Describe the connection between The Philadelphia chromosome and ALL |
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Definition
| About 10-15% of children with ALL have the Philadelphia chromosome, whichis associated with a poor prognosis |
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Term
| In this unit, when see alot of smudge cells, think... |
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Definition
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Term
| What level of lymphocytes do we see n CLL? |
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Definition
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Term
| What disease?: Abberrent expression of the T lymph marker CD5 |
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Definition
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Term
| Are most cases of PLL B or T cell in origin? |
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Definition
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Term
| What is the distinguishing factor between PLL and CLL/PL? |
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Definition
In PLL, greater than 55% of the lymphocytes present are prolymphocytes
In CLL/PL, 11-55% of the lymphocytes are Prolymphocytes |
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Term
| What CD marker do cells of Burkit's and Waldenstrom's have uniquely? What type of Ig do they have? |
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Definition
CD25
Burkitt's s-IgM, s-IgD
Waldenstroms s-IgM |
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Term
| What are the only 3 markers seen on Pro-T cells? |
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Definition
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Term
| What are the 4 markers seen on Pre-T cels? |
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Definition
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