Like this study set? Create a free account to save it.

Sign up for an account

Already have a Quizlet account? .

Create an account

Hodgkin's lymphoma

B-cell lymphoma
-Affects localized, single group of nodes (extranodal is rare); contiguous spread (stage is strongest predictor of prognosis)
-Constitutional B symptoms: low-grade fever, night sweats, weight loss
-Mediastinal lymphadenopathy
-50% of cases associated with EBV (young & old people)
-Reed-Sternberg cells: B-cell origin, CD30+, CD15+; binucleate or bilobed with 2 halves as mirror images ("owl eyes")
-Prognosis worsens with dec. lymphocytes and inc. RS cells

Hodgkin's lymphoma: nodular sclerosing type

Nodules of mixed inflammatory cells
-Some RS cells & lacunar cells surrounded by bands of sclerotic fibrous tissue (collagen banding)
-Excellent prognosis

Hodgkin's lymphoma: mixed cellularity type

Numerous RS cells, more aggressive, usually found in older patients
-EBV+ (60-70%)
-Intermediate prognosis

Hodgkin's lymphoma: lymphocyte predominant type

Found in males 30-50 years of age
-Originate in germinal center
-Large nodules of small lymphocytes & macrophages ("popcorn" cells)
-Excellent prognosis

Non-Hodgkin's lymphoma

May be associated with HIV and immunosuppression
-Multiple, peripheral nodal involvement; extranodal involvement is common; non-contiguous spread
-Majority involve B-cells
-Fewer constitutional S/S
-Peak incidence 20-40 y.o.

Burkitt's lymphoma

Non-Hodgkin's B-cell lymphoma
-Occurs in adolescents or young adults
-t(8;14): C-MYC gene moves next to heavy-chain IgG gene
-"Starry-sky" appearance (sheets of lymphocytes with interspersed macrophages)
-Associated with EBV: infectious mononucleosis (high fever, cervical lymphadenopathy, splenomegaly)
-Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form

Diffuse large B-cell lymphoma

Non-Hodgkin's B-cell lymphoma
-Usually affects older adults, but 20% in children
-Most common adult NHL
-May be mature T-cell in origin (20%)

Mantle cell lymphoma

Non-Hodgkin's B-cell lymphoma
-Occurs in older males
-t(11;14): overexpression of cyclin D1/Bcl-1 protein
-Poor prognosis

Follicular lymphoma

Non-Hodgkin's B-cell lymphoma
-Occurs in adults, most common indolent Non-Hodgkin's lymphoma
-t(14;18): overexpression of bcl-2 -> inhibition of apoptosis
-Indolent course with remissions and recurrence -> size fluctuates over time, difficult to cure
-S/S: painless lymph node enlargement, abdominal discomfort

Adult T-cell lymphoma

Non-Hodgkin's T-cell lymphoma
-Occurs in adults, especially in Japan, West Africa, and the Caribbean
-Caused by HTLV-1 infection: retrovirus integrates into T-cell DNA
-Presents with cutaneous lesions
-Aggressive course

Sezary syndrome

Non-Hodgkin's T-cell lymphoma
-Leukemic form of mycosis fungoides (cutaneous T-cell lymphoma)
-Generalized erythroderma ("red man syndrome"): hyperkeratosis of palms and soles, pruritis

Multiple myeloma

Malignant proliferation of plasma cells that replace bone marrow and secrete monoclonal IgG & IgA antibodies
-Cells have a "fried-egg" appearance & M-spike on protein electrophoresis
1. Signs/symptoms ("CRAB")
-hyperCalcemia: secondary to bone destruction
-Renal insufficiency: "myeloma kidney" with waxy Ab casts depositing in renal tubules and Ig light chains in urine (Bence-Jones proteins)
-Anemia: infiltration of marrow, dec. EPO secretion, hemolysis (rouleaux formation)
-Bone lytic lesions & Back pain: pathologic fractures, diffuse bone loss, osteoporosis (punched-out lesions on X-ray)
2. Associated with:
-Increased susceptibility to infx (encapsulated organisms)
-Primary amyloidosis (AL)

Waldenstrom's macroglobulinemia

Lymphoplasmacytic cells invade bone marrow and secrete IgM antibody (vs. IgG/IgA in MM)
-B-cell proliferation causes B-symptoms, infiltration of BM, lymph nodes, and organs
-M-protein production by plasma cells -> hyperviscosity syndrome, neuropathy, cold agglutinin disease, and Raynaud's phenomenon
-NO lytic bone lesions!

Acute lymphoblastic leukemia (ALL)

Lymphoid leukemia
-Homogeneous proliferation of precursor B-cells or T-cells (lymphoblasts) with very high mitotic activity -> bone marrow is replaced by lymphoblasts
-Bone marrow involvement in childhood (B-cells)
-Mediastinal mass in adolescent males (T-cells): compresses great vessels, esophagus, and trachea -> superior vena cava syndrome, dysphagia, dyspnea/stridor
-Markers: TdT+ (blast marker), CALLA+ (CD10), CD19+ (B-cell), CD5+ (T-cell)
-May spread to testes or CNS
-t(12;21) -> better prognosis
-Most responsive to therapy

Chronic lymphocytic leukemia (CLL)

Lymphoid leukemia
-Mature B or T-cell lymphocytosis in peripheral blood and bone marrow
-Often asymptomatic, affects older adults
-Blood smear: smudge cells
-Labs: increased neutrophil alkaline phosphatase levels (vs. CML)
-Immune complications (warm antibody autoimmune hemolytic anemia)

Hairy cell leukemia

Lymphoid leukemia
-Mature B-cell tumor in the elderly, more often in males
-Pancytopenia and splenomegaly in an elderly man
-Labs: low leukocyte count, "hairy cells" on blood smear
-Stains TRAP+ (tartrate-resistant acid phosphatase)
-Indolent, slowly progressive disease w/bleeding and infection complications
-Tx: cladribine (purine analog; resistant to adenosine deaminase -> can reach high intracellular concentrations)

Acute myelogenous leukemia (AML)

Myeloid leukemia
-Malignancy of immature hematopoietic cells that also inhibit normal hematopoietic maturation
-Commonly affects adults
-Blood smear: increased number of circulating myeloblasts with Auer rods (stain with peroxidase)

Acute promyelocytic leukemia (APL)

Myeloid leukemia
-M3 variant of ALL
-t(15,17): PML-RAR-alpha fusion protein inhibits DNA transcription via abnormal retinoic acid receptor
-Blood smear: myeloblasts w/Auer rods
-Tx: all-trans retinoic acid (ATRA)
-Treatment may release Auer rods from cells -> DIC

Chronic myelogenous leukemia (CML)

Myeloid leukemia
-All levels of maturation of granulocytic cells are represented (neutrophils, basophils, eosinophils)
-t(9;22): Philadelphia chromosome -> bcr-abl tyrosine kinase fusion protein
-May accelerate and transform into AML or ALL -> "blast crisis"
-Labs: very low leukocyte alkaline phosphatase (vs. CLL)
-Tx: Imatinib

Langerhans cell histiocytosis (histiocytosis X)

Proliferative disorder of dendritic (Langerhans) cells
-Defective cells express S-100 and CD1a
-EM: Birbeck granules ("tennis rackets")

Polycythemia vera

Chronic myeloproliferative disorder
-Absolute erythrocytosis; slight male predominance
-JAK2 V617F mutation -> tyrosine kinase is constitutively active -> BM trilineage proliferation -> hypercellular BM (erythrocytes, platelets, and leukocytes)
-S/S: aquagenic pruritus, gout, bleeding, erythromelalgia (burning, redness of the hands & feet)
-May cause abdominal vein thrombosis -> Budd Chiari Syndrome

Essential thrombocytosis

Chronic myeloproliferative disorder
-Proliferation of megakaryocytes and platelets; slight female predominance
-JAK2 V617F mutation -> tyrosine kinase is constitutively active
-Persistent thrombocytosis (>450k)
-BM: proliferating megakaryocytes with hyperlobated nuclei
-S/S: often asymptomatic; may have large vessel thrombosis, bleeding, splenomegaly, erythromelalgia


Chronic myeloproliferative disorder
-Proliferation of megakaryocytes, granulocytes, and fibroblasts -> marrow fibrosis and angiogenesis
-JAK2 V617F mutation -> tyrosine kinase is constitutively active
-S/S: fatigue, weight loss, fever, night sweats, bone pain, marrow failure -> extramedullary hematopoiesis (splenomegaly)
-Blood smear: "tear-drop" RBCs (dacryocytes), hypercellularity and clustering of atypical megakaryocytes, reticulin

Methotrexate (MTX)

-Mech: folic acid analog that inhibits dihydrofolate reductase -> dec. dTMP synthesis -> dec. DNA and protein synthesis
-Clinical: cancer (leukemia, lymphoma, choriocarcinoma, sarcoma), abortion, ectopic pregnancy, rheumatoid arthritis, psoriasis
-Tox: myelosuppression, macrovesicular fatty liver, mucositis/stomatitis, teratogenic
-Leucovorin (folinic acid) rescue: replaces THF that was lost to MTX; used to treat myelosuppression

5-fluorouracil (5-FU)

-Mech: pyrimidine analog that is bioactivated to 5F-dUMP, which covalently complexes with folic acid -> inhibits thymidylate synthase -> dec. dTMP -> dec. DNA and protein synthesis
-Clinical: colon cancer and other solid tumors, basal cell carcinoma (topical); synergy with MTX
-Tox: myelosuppression (NOT reversible with leucovorin; treat overdose with thymidine); photosensitivity

6-mercaptopurine (azathioprine)

-Mech: purine analog -> decreases de novo purine synthesis; activated by HGPRTase
-Clinical: leukemia, lymphoma (NOT CLL or Hodgkin's)
-Tox: bone marrow, GI, liver; metabolized by xanthine oxidase, so has increased toxicity with allopurinol
-6-thioguanine (6-TG): can be given with allopurinol


Antitumor antibiotic
-Mech: intercalates into DNA
-Clinical: Wilms tumor, Ewing's sarcoma, rhabdomyosarcoma ("children ACT out")
-Tox: myelosuppression

Doxorubicin (adriamycin)

Antitumor antibiotic
-Mech: noncovalently intercalates into DNA and generate free radicals -> DNA breaks -> dec. replication
-Clinical: Hodgkin's lymphoma, myelomas, sarcomas, solid tumors
-Tox: dilated cardiomyopathy, myelosuppression, alopecia


Antitumor antibiotic
-Mech: induces free radical formation -> causes breaks in DNA strands
-Clinical: testicular cancer, Hodgkin's lymphoma
-Tox: pulmonary fibrosis, skin changes; minimal myelosuppression


Antitumor antibiotic
-Mech: inhibits DNA topoisomerase II -> increased DNA degradation
-Clinical: small cell carcinoma of lung and prostate, testicular carcinoma
-Tox: myelosuppression, GI irritation, alopecia


Alkylating agents
-Mech: covalently cross-link DNA at guanine N-7; requires bioactivation by the liver
-Clinical: non-Hodgkin's lymphoma, breast/ovarian carcinomas, immunosuppression
-Tox: myelosuppression, hemorrhagic cystitis
-Partially prevented with mesna


Alkylating agents (carmustine, lomustine, semustine, streptozocin)
-Mech: require bioactivation; can cross the BBB into the CNS
-Clinical: brain tumors (e.g. glioblastoma multiforme)
-Tox: CNS toxicity (dizziness, ataxia)

Vincristine, vinblastine

Microtubule inhibitors
-Mech: bind to tubulin in M-phase and block formation of mitotic spindle
-Clinical: Hodgkin's lymphoma, Wilms' tumor, choriocarcinoma
-Tox: neurotoxicity (areflexia, peripheral neuritis) and paralytic ileus (vincristine); BM suppression (vinblastine)


Microtubule inhibitor
-Mech: hyperstabilize polymerized microtubules in M-phase to prevent breakdown of the mitotic spindle
-Clinical: ovarian and breast carcinomas
-Tox: myelosuppression, hypersensitivity

Cisplatin, carboplatin

-Mech: cross-link DNA
-Clinical: testicular, bladder, ovary, and lung carcinomas
-Tox: nephrotoxicity, ototoxicity (high-frequency hearing loss, tinnitus)
-Prevent with amifostine


Inhibits ribonucleotide reductase -> decreased pyrimidine synthesis -> decreased DNA synthesis (S-phase specific)
-Clinical: melanoma, CML, sickle cell disease (increases HbF synthesis)
-Tox: bone marrow suppression, GI upset


Most commonly used glucocorticoid in cancer chemotherapy
-Clinical: CLL, Hodgkin's lymphoma (MOPP regimen), immunosuppression
-Tox: Cushing-like symptoms, immunosuppression, cataracts, acne, osteoporosis, HTN, peptic ulcers, hyperglycemia, psychosis

Trastuzumab (Herceptin)

Monoclonal antibody
-Mech: binds and kills breast cancer cells that overexpress HER-2 (antibody-dependent cytotoxicity)
-Clinical: metastatic breast cancer
-Tox: cardiotoxicity

Imatinib (Gleevec)

Tyrosine kinase inhibitor
-Mech: inhibits Philadelphia chromosome bcr-abl tyrosine kinase fusion protein
-Clinical: CML, GI stromal tumors
-Tox: fluid retention


Monoclonal antibody
-Mech: binds to CD20 on neoplastic B-cells
-Clinical: Non-Hodgkin's lymphoma, rheumatoid arthritis (w/MTX)

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording