Latest - (Latest / 1. *A 3-7 y/o child* with lymphadeno...

Hematologic Malignancies (PEARLS) (Smarty PANCE) (Latest /

• *A 3-7 y/o child* with lymphadenopathy, bone pain, bleeding, and fever. Bone marrow > 20%

blasts. What's the Dx?

Answer: Acute lymphocytic leukemia (ALL)

• A 60-year-old male complains of fatigue, blood tests demonstrate severe anemia,

*SMUDGE CELLS* on peripheral smear, mature lymphocytes. What's the Dx?

Answer: Chronic Lymphocytic Leukemia (CLL)

• A 54-year-old patient with anemia, nosebleeds, bruising, thrombocytopenia, and

neutropenia. Splenomegaly, gingival hyperplasia, and bone pain myeloblasts in bone marrow > 20% and *Auer Rods*. What's the Dx?

Answer: Acute Myeloid Leukemia (AML)

• A 64-year-old with strikingly increased WBC count, and hyperuricemia. Genetic testing

demonstrates *translocation of chromosomes 9 and 22*. What's the Dx?

Answer: Chronic Myeloid Leukemia (CML)

• A patient presents with fever, chills, and night sweats for 1 month. *Pain- less enlarged

posterior cervical and supraclavicular lymph nodes* bilaterally.*CXR - mediastinal adenopathy.* Excisional biopsy of lymph node shows *Reed-Sternberg cells*. What's the Dx?

Answer: Hodgkin's Lymphoma

• An HIV Patient with GI symptoms and *painless peripheral lymphadenopathy*. What's the

Dx?

Answer: Non-Hodgkin Lymphoma

• A 65-year-old with bone and back pain refractory to treatments. Serum protein

electrophoresis *monoclonal protein Spike (IgG or IgA).* Urine protein electrophoresis *Bence Jones Protein.* Skull X-ray demonstrates *lytic (punched out) bone lesions*. What's the Dx?

Answer: Multiple myeloma

• What is lymphoma?

Answer: A heterogeneous group of malignancies of lymphocytes that usually arise in lymph nodes but may originate in any organ

• What are the 2 broad categories of lymphomas?

Answer: Hodgkin disease and NHL

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• How do NHL and Hodgkin disease differ in their natural history?

Answer: NHL commonly presents with diffuse disease. Hodgkin disease presents more commonly with localized disease

• What are the typical presenting symptoms of lymphoma?

Answer: Persistent pain- less adenopathy and B symptoms. Generalized pruritus with unexplained lymphadenopathy and pain in lymph nodes after alcohol ingestion are highly suggestive of Hodgkin disease. Lymphomas can present with symptoms attributable to enlarged lymph nodes anywhere in the body.

• What are B symptoms?

Answer: Fever (>38°C × 3 consecutive days), drenching night sweats, and weight loss (>10% of body weight over 6 months)

• What are the typical physical findings in lymphoma?

Answer: Lymphadenopathy and hepatosplenomegaly are the most predominant findings.

• What are the typical presenting symptoms for CNS lymphoma?

Answer: Headache, altered mental status, and focal neurologic findings

• What is Waldeyer's ring?

Answer: The ring of lymphoid tonsillar tissue in the oropharynx.

• What are the typical presenting symptoms for lymphoma involving Waldeyer's ring?

Answer: Sinusitis and earaches

• What are the typical presenting symptoms of mediastinal lymphomas?

Answer: -Cough, shortness of breath, chest pain, and hemoptysis

• What are the typical presenting symptoms of abdominal lymphomas?

Answer: Abdominal pain, nausea, vomiting, and back pain

• What are the WHO histologic subtypes of Hodgkin disease?

Answer: Nodular lymphocyte predominant and classic Hodgkin lymphoma (classic further divided into nodular sclerosing, mixed cellularity, lymphocyte rich, and lymphocyte depleted)

• What is the name of the pathologic cell in Hodgkin disease?

Answer: Reed-Stern- berg cell

• What is the age distribution of Hodgkin disease?

Answer: There is a bimodal age distribution, with a young adult form peaking from age 16 to 34 years and an older adult form peaking from age 55 to 74 years.

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