SM_262b: Intro to Heme Malignancies

Question 1

Describe the types of hematopoietic cells

Answer 1

Types of hematopoietic cells

Question 2

Hematologic malignancies are classified by ____, ____, ____, and ____

Answer 2

Hematologic malignancies are classified by cell of origin, cell maturation, presence of genetic abnormalities, and clinical findings

Question 3

Describe hematopoietic cell differentiation

Answer 3

Hematopoietic cell differentiation

Question 4

Myeloid WBCs include ___, ___, ___, and ___

Answer 4

Myeloid WBCs include neutrophils, eosinophils, basophils and mast cells, and antigen-presenting cells (macrophages and dendritic cells)

Question 5

Lymphoid WBCs are ____, ____, and ____

Answer 5

Lymphoid WBCs are B cells, T cells, and NK cells

Question 6

Describe normal peripheral blood smear

Answer 6

Normal peripheral blood smear

Question 7

Describe tissues of the hematopoietic and immune system

Answer 7

Tissues of the hematopoietic and immune system

• Peripheral blood
• Primary lymphoid (cells originate and develop): bone marrow, thymus
• Secondary lymphoid (immune response is activated): lymph nodes, tonsils, spleen, other tissues such as MALT

Question 8

Primary lymphoid tissues are where ___

Answer 8

Primary lymphoid tissues are where cells originate and develop

• Bone marrow
• Thymus

Question 9

Secondary lymphoid tissues are where ___

Answer 9

Secondary lymphoid tissues are where immune response is activated

• Lymph nodes
• Tonsils
• Spleen
• Other tissues such as MALT

Question 10

Describe the myeloid lineage

Answer 10

Myeloid lineage

Question 11

Neutrophils are part of the ___ immune system and function to ___

Answer 11

Neutrophils are part of the innate immune system and function to ingest and kill pathogens

• 70% of all WBCs
• Called granulocytes, polymorphonuclear cells

Question 12

Myeloid classification includes ____ and ____

Answer 12

Myeloid classification includes RBC derived (erythroid) neoplasms and megakaryocytic neoplasms

Question 13

Lymphocytes are involved in ___ immunity

Answer 13

Lymphocytes are involved in adaptive immunity

Question 14

Describe the lymphoid lineage

Answer 14

Lymphoid lineage

Question 15

Describe B cells

Answer 15

B cells

• CD19+
• Humoral immunity
• Express antibody on cell surface (B cell receptor)
• Differentiate into plasma cells and memory cells

Question 16

B cells originate and mature in ___

Answer 16

B cells originate and mature in bone marrow

Question 17

Describe T cells

Answer 17

T cells

• CD3+
• CD4+ helper and CD8+ cytotoxic
• Originate in bone marrow and mature in thymus

Question 18

Describe NK cells

Answer 18

NK cells

• CD56+ and CD16+
• Directly kill infected cells and tumor cells
• Contain and secrete cytotoxic granules

Question 19

Describe histiocytic dendritic cell lineage

Answer 19

Histiocytic dendritic cell lineage

• Clonal proliferative lesions of “professional antigen presenting cells”: macrophages and dendritic cells
• Classification is somewhat unclear: some are myeloid-derived and others are thought to be derived from non-hematopoietic stromal cells

Question 20

Lymphoma is ___

Answer 20

Lymphoma is neoplasms derived from lymphoid cells and typically applied to tissue-based (lymph, spleen, etc) neoplasms

Question 21

Leukemia is ___

Answer 21

Leukemia is neoplasms originating in the blood and bone marrow, including both myeloid and lymphoid origin

Question 22

Myeloid sarcoma is ___

Answer 22

Myeloid sarcoma is myeloid neoplasms involving the tissue

Question 23

Describe ambiguity with leukemia / lymphoma terminology

Answer 23

Ambiguity with leukemia / lymphoma terminology

• No strict criteria
• Historical naming practices can apply: hairy cell leukemia, mantle cell lymphoma
• Some malignancies commonly involve both tissue and bone marrow / blood so the names are combined: chronic lymphocytic leukemia / small lymphocytic lymphoma, B lymphoblastic leukemia / lymphoma

Question 24

WHO classification of hematologic malignancy relies on a combination of ___, ___, ___, and ___ features

Answer 24

WHO classification of hematologic malignancy relies on a combination of morphologic, phenotypic, molecular / genetic, and clinical features

Question 25

Describe the approach to WHO classification for hematologic malignancy

Answer 25

Approach to WHO classification for hematologic malignancy * Lineage?: myeloid, lymphoid, histiocytic / dendritic cell * Are cells immature or mature?: acute / precursor / immature, chronic / mature * Is there recurrent cytogenetic or molecular abnormality?

Question 26

Describe broad WHO hematologic malignancy classification categories

Answer 26

WHO hematologic malignancy classification categories

Question 27

\_\_\_, \_\_\_, and ___ are used to determine lineage

Answer 27

Morphology, flow cytometry, and immunohistochemistry are used to determine lineage

Question 28

Describe categories of lymphoid neoplasms

Answer 28

Lymphoid neoplasms * Precursor lymphoid neoplasms: B lymphoblastic leukemia / lymphoma, T lymphoblastic leukemia / lymphoma * Mature lymphoid neoplasms: Hodgkin lymphoma, non-Hodgkin lymphoma (B cell type, T/NK cell type)

Question 29

Describe categories of myeloid neoplasms

Answer 29

Myeloid neoplasms * Precursor myeloid neoplasms: acute myeloid leukemiia, acute myeloid leukemia with recurrent genetic abnormalities * Mature myeloid neoplasms: myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic syndrome / myeloproliferative neoplasm

Question 30

Blast is a \_\_\_

Answer 30

Blast is a hematopoietic stem cell precursor * Open chromatin, visible nucleoli, high nuclear:cytoplasmic ratio, expression of phenotypic markers of immaturity (CD34, CD117, TdT, CD1a)

Question 31

Acute leukemia involves ____ in the peripheral blood or bone marrow

Answer 31

Acute leukemia involves ≥ 20% blasts in the peripheral blood or bone marrow * Can be less with certain defining genetic abnormalities

Question 32

Myelodysplastic syndromes and myeloproliferative neoplasms are \_\_\_

Answer 32

Myelodysplastic syndromes and myeloproliferative neoplasms are malignant neoplasms of myeloid cells with maturation

Question 33

Myelodysplastic syndromes show ___ and involve \_\_\_

Answer 33

Myelodysplastic syndromes show significant dysplasia (abnormal cell changes in myeloid lineages) and peripheral blood cytopenias * Myeloid lineages: RBCs, granulocytes, megakaryocytes

Question 34

Myeloproliferative neoplasms involve \_\_\_

Answer 34

Myeloproliferative neoplasms involve elevated peripheral blood counts

Question 35

\_\_\_ is used to evaluate for hematologic malignancy

Answer 35

Bone marrow biopsy is used to evaluate for hematologic malignancy * Aspirate (liquid) * Core biopsy (tissue)