Pathoma - 6 (WBC)

arold001's version from 2015-12-27 03:02

Section 1

Question Answer
What are immature cells (left shift) characterized by?decreased Fc receptor (CD16)
CD16Fc receptor
What 3 conditions is Eosinphilia associated with?1) Hodgkins Lymphoma (increased IL-5)
2) Allergic reactions
3) Parasitic infections
What condition is BASOPHILIA associated with?CML
What bacteria causes lymphocytic leukocytosis instead of neutrophilia?Bordetlla pertussis = produces LYMPHOCYTOSIS-PROMOTING FACTOR, which blocks circulating lymphocytes from leaving the blood to enter the LN
Which bacteria causes lymphocytosis instead of neutrophilia?bordetella pertussis
which lymphoma is associated with eosinophila via increase IL-5?Hodgkins lymphoma
teenage presents with sore throat and hepatitis with hepatosplenomegaly and elevated liver enzymes?Infectious Mononucleosis (EBV)
where do T cells reside in the lymph node?paracortex
where do T cells reside in the spleen?Periarterial Lymphatic Sheath (PALS)
whats the screening test for IM? confirmatory test?Screening test = monospot test.
Confirmatory = serological testing for EBV viral capsid antigen

Section 2

Question Answer
inability of myeloblast or lymphoblast to matureACUTE leukemia
what is acute leukemia?neoplastic proliferation of BLASTS. >20% blasts in bone marrow (normal is 1-2%)
whats the marker for lymphoblasts?TdT = DNA polymerase present in the nucleus of only lymphoblasts
what are the 4 markers of B-Acute Lymphoblastic Leukemia?TdT, CD10, CD19, CD20
Whats the treatment of B-ALL?chemotherapy and prophylaxis to SCROTUM and CSF
t(12;21)B-ALL (good prognosis seen in children)
what 2 leukemias are associated with t(9;22)?B-ALL and CML
neoplastic accumulation of MYELOBLASTS (>20%) in bone marrow?Acute Myeloid Leukemia
whats the stain for myeloblast?positive cytoplasmic staining for myeloperoxidase (MPO)
what leukemia is associated with MPO and aeur rods?AML
What are aeur rods?crystal aggregated of MPO
t(15;17)Acute Promyelocytic Leukemia (APL)
What causes acute promyelocytic leukemia?t(15;17) --> translocation of RAR on chromosome 17 to chromosome 15 --> RAR blocks maturation and promyeloblasts accumulate
whats the treatment of acute promyelocytic leukemia?ATRA = binds to altered retinoic acid receptor and causes blasts to mature
which leukemia: blasts infiltrate GUMSacute MONOCYTIC leukemia = lacks MPO
which leukemia is associated with Down syndrome BEFORE the age of 5? AFTER 5 years old?Before 5 years old: Acute Megakaryoblastic Leukemia.
After 5 years: Acute Lymphoblastic Leukemia
What are the 3 high yield subtypes of Acute Myeloid Leukemia?1) Acute Promyelocytic Leukemia
2) Acute Monocytic Leukemia
3) Acute Megakaryoblastic Leukemia

Section 3

Question Answer
what is CHRONIC leukemia?neoplastic proliferation of MATURE circulating lymphocytes and HIGH WBC
smudge cellchronic lymphocytic leukemia (CLL)
what is Chronic Lymphocytic Leukemia? what CD do they express?neoplastic proliferation of NAIVE B-cells that co-express CD5 and CD20
proliferation of naive B-cellschronic lymphocytic leukemia
what is Hairy Cell Leukemia?neoplastic proliferation of MATURE B-cells
why do you get splenomegaly and dry tap on bone marrow in Hairy Cell Leukemia?Splenomegaly due to accumulation of hairy cells in RED PULP and dry tap due to MARROW FIBROSIS
whats the tx of Hairy Cell Leukemia?2-CDA = Cladribine = adenosine deaminase inhibitor = adenosine accumulates to toxic levels in neoplastic B-cells
what 2 disorders are characterized by neoplastic accumulation of mature CD4+ T cells?Adult T-cell Leukemia and Mycosis Fungoides
which leukemia is associated with lytic bone lesions with hypercalcemia + RASH?Adult T-cell Leukemia (NOT multiple myeloma!!)
name 2 conditions associated with lytic punched out bone lesions?multiple myeloma and Adult T-cell Leukemia
Pautrier Abscess? Mycosis Fungoides
aggregates of neoplastic cells in the EPIDERMIS?Pautrier microabcesses a/w mycosis fungoides
lymphocytes with cerebriform nucleisezary cells = Sezary syndrome which is mycosis fungoides that spread to blood

Section 4

Question Answer
what is a myeloproliferative disorder?neoplastic proliferation of MATURE CELLS of myeloid lineage
name the 4 subtypes of Myeloproliferative Disorders?1) Chronic Myeloid Leukemia
2) PV
3) ET
4) Myelofibrosis
what is Chronic Myeloid Leukemia?neoplastic proliferation of MATURE myeloid cell, especially BASOPHILS
whats the tx for CML?Imatinib = inhibits tyrosine kinase
what is a complication of CML?Transformation to AML (2/3) and ALL (1/3)
name 3 things that distinguishes CML from Leukomoid Reaction1) negative Leukocyte Alkaline Phosphatase (LAP) stain
3) t(9;22)
neoplastic proliferation of RBCsPV
Name 3 myeoproliferative disorders associated with JAK2 kinase mutationPV, ET, Myelofibrosis
whats the difference btw PV and reactive polycythemia?PV shows decreased Epo and SaO2 is normal. Reactive polycythemia shows increased Epo
why is essential thrombocytopenia the only myeloproliferative disorder NOT associated with hyperuricemia and gout?bc platelets dont have nucleus
name 2 disorders that cause increased platelet levels?ET and iron deficiency anemia
tear drop cellsmyelofibrosis
neoplastic proliferation of MEGAKARYOCYTESMyelofibrosis
how do megakaryocytes in myelofibrosis cause marrow fibrosis?megakaryocytes produce PDGF causes marrow fibrosis
what prevents immature cells from exiting the bone marrow?RETICULIN GATES

Section 5

Question Answer
What causes LN enlargement during inflammation?HYPERPLASIA of a particular region of LN
follicular hyperplasia (B-cell region) in the LN is a/w whcih 2 conditions?RA and HIV
during inflammation, enlargment/hyperplasia of sinus histiocytes in the LN medulla is a/w?LN draining tissue with cancer
what region of the LN enlarges during an infection with EBV?paracortex (T-cell) hyperplasia in LN
name the 4 Small B-cells NHL1) follicular NHL
2) mantle cell NHL
3) marginal zone NHL
4) small lymphocytic lymphoma
intermediate sized NHLBurkitts lymphoma
large B -cell NHLDiffuse large B cell lymphoma

Section 6

Question Answer
neoplastic proliferation of SMALL B-cells (CD20+) that form follicle-like nodulesFollicular (Non-Hodgkin) Lymphoma
whats the tx of follicular lymphoma?Rituximab = Ab against CD20
whats an important complication of follicular lymphoma?progression to diffuse large B-cell lymphoma
whats the difference btw follicular lymphoma and reactive follicular hyperplasia?follicular lymphoma: lack of tingible body macrophages in germinal centers and MONOCLONALITY
what do tingible body macrophages suggest?indicate that apoptosis is actively occurring within germinal centers
name 4 lymphomas characterized by neoplastic proliferation of small B cells (CD20+)follicular lymphoma
mantle cell lymphoma
marginal zone lymphoma
burkitts lymphoma
what region is immediately adjacent to follicle in LN?mantle
which lymphoma is associated with hashimotos?marginal zone lymphoma
what lymphoma is associated with Sjorgens and H. pylori gastritismarginal zone lymphoma
which lymphoma is associated with CHRONIC INFLMMATORY states?Marginal Zone lymphoma = hashimoto thyroiditis, sjorgens, H. pylori gastritis
what area of the body does the SPORADIC form (not african form) of Burkitts lymphoma affect?abd
starry sky appearanceburkitts lymphoma
whats the most common form of NHL?Diffuse Large B-cell Lymphoma
neoplastic proliferation of Reed Sternberg cellsHodgkins lymphoma
what are reed sternberg cells?large B cells with multilobed nuclei and owls eyes
what 2 markers are on Reed Sternberg cells?CD15 and CD30
UNLIKE NHL in which the mass is composed of malignant cells, what is the tumor made up of in Hodgkins Lymphoma?reactive inflammatory cells make up the bulk of mass in Hodgkins Lyphoma

Section 7

Question Answer
What are the 4 subtypes of Hodgkins Lymphoma?1) Nodular sclerosis 2) lymphocyte rich Hodgkins Lymphoma 3) Mixed cellularity 4) lymphocyte depleted
What makes up the bulk of the tumor in HL?reactive inflammatory cells = lymphocytes, plasma cells, macrophages, eosinophils
LN node is divided by bands of sclerosis and lacunar cells (RS in lake spaces) are presentNodular sclerosis HL
Which subtype of HL is associated with eosinophilia?Mixed cellularity HL = RS cells produce IL-5
Which HL has the best prognosis? which is most aggressive?best = lymphocyte rich HL. aggressive = lymphocyte depleted HL
Which IL is elevated in MM?IL-6 --> stimulates plasma cell growth and Ig production
what is an important growth factor for plasma cells?IL-6
M-spike in multiple myeloma is composed on which Ig?IgA or IgG
why does multiple myeloma produce hypercalcemia?neoplastic plasma cells activate RANK receptors on osteoclasts --> bone destruction
old pt presents only with isolated M-spkesMGUS
B-cell lymphoma with monoclonal IgM productionWaldenstrom Macroglobulinemia
what is the M-spike in Waldenstrom Macroglobulinemia compose of?IgM (unlike MM which shows IgG or IgA)
pt presents with M-spike and stroke and retinal hemorrhage. Diagnosis?Waldenstrom Macroglobulinemia = see retinal hemorrhag and stroke due to IgM causing hyperviscosity
CD1a+ and S100+Langerhan histiocytosis

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