Podcast
Questions and Answers
Which characteristic is commonly associated with canine lymphoma?
Which characteristic is commonly associated with canine lymphoma?
- Always presents with a normal CBC
- Represents approximately 5% of all canine tumors
- Represents approximately 20% of all canine tumors (correct)
- Occurs more frequently in females.
In dogs, what is the most common anatomical location for lymphoma?
In dogs, what is the most common anatomical location for lymphoma?
- Alimentary
- Multicentric (correct)
- Mediastinal
- Extranodal
What does classifying lymphoma based on clinical stage primarily help determine?
What does classifying lymphoma based on clinical stage primarily help determine?
- The neoplasm's spread in dogs. (correct)
- The specific genetic mutations present in the lymphoma cells.
- The cell type affected by lymphoma.
- The anatomic pathologist's interpretation of the tumor’s differentiation.
What is the significance of a 'spike' formation in PCR products after performing PARR (PCR for Antigen Receptor Rearrangement)?
What is the significance of a 'spike' formation in PCR products after performing PARR (PCR for Antigen Receptor Rearrangement)?
Which of the following is NOT a typical characteristic of non-indolent lymphomas in dogs?
Which of the following is NOT a typical characteristic of non-indolent lymphomas in dogs?
Which characteristic is most indicative of 'high grade' lymphoma based on histopathology?
Which characteristic is most indicative of 'high grade' lymphoma based on histopathology?
What is a key feature of indolent lymphoma marginal zone?
What is a key feature of indolent lymphoma marginal zone?
According to the presented prognostic factors in dogs, which immunophenotype typically has a better MST (Mean Survival Time)?
According to the presented prognostic factors in dogs, which immunophenotype typically has a better MST (Mean Survival Time)?
What is a typical finding in acute leukemia?
What is a typical finding in acute leukemia?
What CBC finding is expected with acute leukemia?
What CBC finding is expected with acute leukemia?
What is usually required to diagnose acute leukemia?
What is usually required to diagnose acute leukemia?
Which statement accurately contrasts acute and chronic leukemias?
Which statement accurately contrasts acute and chronic leukemias?
A dog presents with fever, moderate leukocytosis, thrombocytopenia and >20% blasts in marrow. Which diagnostic test would be most useful to classify the leukemia?
A dog presents with fever, moderate leukocytosis, thrombocytopenia and >20% blasts in marrow. Which diagnostic test would be most useful to classify the leukemia?
What is a key difference between leukemia and 'leukemic' as described in the presentation?
What is a key difference between leukemia and 'leukemic' as described in the presentation?
What does it suggest if a horse has lymphocytosis and a monoclonal T cell receptor gene rearrangement?
What does it suggest if a horse has lymphocytosis and a monoclonal T cell receptor gene rearrangement?
Which is a diagnostic criteria for multiple myeloma?
Which is a diagnostic criteria for multiple myeloma?
What is the function of serum protein electrophoresis in diagnosing multiple myeloma?
What is the function of serum protein electrophoresis in diagnosing multiple myeloma?
When evaluating a serum protein electrophoresis, what finding is most suggestive of multiple myeloma?
When evaluating a serum protein electrophoresis, what finding is most suggestive of multiple myeloma?
What characterizes 'plasmacytosis'?
What characterizes 'plasmacytosis'?
What is a key feature of Histiocytic sarcoma?
What is a key feature of Histiocytic sarcoma?
Which feature is characteristic of histiocytic sarcoma cells?
Which feature is characteristic of histiocytic sarcoma cells?
Which diagnostic approach provides the most detailed immunophenotype?
Which diagnostic approach provides the most detailed immunophenotype?
Which of the following is most suggestive of Stage V lymphoma?
Which of the following is most suggestive of Stage V lymphoma?
Which technique is LEAST likely to be useful when distinguishing between Lymphoma (LMA) or acute leukemia?
Which technique is LEAST likely to be useful when distinguishing between Lymphoma (LMA) or acute leukemia?
Which neoplasm can secrete a single paraprotein?
Which neoplasm can secrete a single paraprotein?
What cells are affected in Histiocytic disorders?
What cells are affected in Histiocytic disorders?
A veterinary professional is presented with a blood smear exhibiting a predominance of blast cells. Which of the following should be the MOST immediate concern?
A veterinary professional is presented with a blood smear exhibiting a predominance of blast cells. Which of the following should be the MOST immediate concern?
When categorizing canine hematopoietic neoplasias, which factor decisively distinguishes between acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML)?
When categorizing canine hematopoietic neoplasias, which factor decisively distinguishes between acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML)?
Which statement accurately reflects the role of immunohistochemistry (IHC) in diagnosing lymphoma?
Which statement accurately reflects the role of immunohistochemistry (IHC) in diagnosing lymphoma?
What is the MOST critical factor in distinguishing between chronic lymphocytic leukemia (CLL) and reactive lymphocytosis?
What is the MOST critical factor in distinguishing between chronic lymphocytic leukemia (CLL) and reactive lymphocytosis?
An 8-year-old Labrador Retriever presents with fever, moderate leukocytosis, atypical mononuclear cells, and moderate thrombocytopenia. Bone marrow cytology reveals >20% blasts. Flow cytometry identifies the blasts as CD34+ and myeloperoxidase positive. The veterinarian suspects acute myeloid leukemia (AML). Which additional finding would be MOST consistent with AML in this case?
An 8-year-old Labrador Retriever presents with fever, moderate leukocytosis, atypical mononuclear cells, and moderate thrombocytopenia. Bone marrow cytology reveals >20% blasts. Flow cytometry identifies the blasts as CD34+ and myeloperoxidase positive. The veterinarian suspects acute myeloid leukemia (AML). Which additional finding would be MOST consistent with AML in this case?
A canine patient is suspected of having lymphoma. The veterinarian performs a fine needle aspirate of an enlarged lymph node. Cytological evaluation reveals a homogeneous population of large lymphocytes. How can the veterinarain confirm diagnosis?
A canine patient is suspected of having lymphoma. The veterinarian performs a fine needle aspirate of an enlarged lymph node. Cytological evaluation reveals a homogeneous population of large lymphocytes. How can the veterinarain confirm diagnosis?
Which of the following findings on a complete blood count (CBC) would MOST strongly suggest aleukemic leukemia?
Which of the following findings on a complete blood count (CBC) would MOST strongly suggest aleukemic leukemia?
A veterinary professional is reviewing the medical history of a dog diagnosed with lymphoma. The dog initially responded well to chemotherapy but is now experiencing a relapse. The veterinarian notes that the referring veterinarian used single-agent steroid therapy prior to starting chemotherapy. What is the MOST important consideration in this case?
A veterinary professional is reviewing the medical history of a dog diagnosed with lymphoma. The dog initially responded well to chemotherapy but is now experiencing a relapse. The veterinarian notes that the referring veterinarian used single-agent steroid therapy prior to starting chemotherapy. What is the MOST important consideration in this case?
What is the primary difference between cyotologic and histologic evaluation?
What is the primary difference between cyotologic and histologic evaluation?
While performing a routine CBC, a veterinary technician notices the presence of large atypical cells in the blood smear of a 6-year-old mixed breed dog. Which follow-up test would be most useful in determining prognosis?
While performing a routine CBC, a veterinary technician notices the presence of large atypical cells in the blood smear of a 6-year-old mixed breed dog. Which follow-up test would be most useful in determining prognosis?
Which of the following is a characteristic of multiple myeloma?
Which of the following is a characteristic of multiple myeloma?
When diagnosing multiple myeloma, which result indicates the disease?
When diagnosing multiple myeloma, which result indicates the disease?
What process is used to divide proteins according to different electrical charges?
What process is used to divide proteins according to different electrical charges?
What can a veterinary technician expect with a dog with canine AML?
What can a veterinary technician expect with a dog with canine AML?
An incidental finding of elevated white blood cells is seen on a CBC for a 10 year old dog. What should a veterinary thchnician consider?
An incidental finding of elevated white blood cells is seen on a CBC for a 10 year old dog. What should a veterinary thchnician consider?
What should a veterinary technician look for on a blood smear to diagnose leukemia?
What should a veterinary technician look for on a blood smear to diagnose leukemia?
A blood sample is collected from a veterinary patient with suspected multiple myeloma, a monoclonal gammopathy is noted, which is?
A blood sample is collected from a veterinary patient with suspected multiple myeloma, a monoclonal gammopathy is noted, which is?
An animal presents that is suspected to have a hematopoietic neoplasia, where do they originate?
An animal presents that is suspected to have a hematopoietic neoplasia, where do they originate?
What is the typical age range for dogs diagnosed with lymphoma?
What is the typical age range for dogs diagnosed with lymphoma?
Which of the following is a common anatomical site for lymphoma development?
Which of the following is a common anatomical site for lymphoma development?
Which of the following characteristics distinguishes lymphoma from solid tissue tumors?
Which of the following characteristics distinguishes lymphoma from solid tissue tumors?
In the histological diagnosis of lymphoma, what key feature is examined to assess tissue architecture?
In the histological diagnosis of lymphoma, what key feature is examined to assess tissue architecture?
What cytological finding is MOST indicative of lymphoma?
What cytological finding is MOST indicative of lymphoma?
What is a common, but not consistent, finding on a CBC in animals with lymphoma?
What is a common, but not consistent, finding on a CBC in animals with lymphoma?
What is the MOST common cause of hypercalcemia in dogs with T-cell lymphoma?
What is the MOST common cause of hypercalcemia in dogs with T-cell lymphoma?
Which diagnostic method is LEAST likely to be employed to classify lymphoma by location?
Which diagnostic method is LEAST likely to be employed to classify lymphoma by location?
Which anatomical location is characteristic of alimentary lymphoma in older cats?
Which anatomical location is characteristic of alimentary lymphoma in older cats?
What does the suffix 'b' appended to the stage of multicentric lymphoma generally indicate?
What does the suffix 'b' appended to the stage of multicentric lymphoma generally indicate?
What sample types can be used for PARR (PCR for Antigen Receptor Rearrangement)?
What sample types can be used for PARR (PCR for Antigen Receptor Rearrangement)?
Which diagnostic tool is most suited to determine if a patient has lymphoma and has high sensivity?
Which diagnostic tool is most suited to determine if a patient has lymphoma and has high sensivity?
When classifying lymphoma based on histology, what information does it convey?
When classifying lymphoma based on histology, what information does it convey?
What microscopic characteristic differentiates indolent lymphoma from high-grade lymphoma?
What microscopic characteristic differentiates indolent lymphoma from high-grade lymphoma?
Which of the following is characteristic of indolent T-zone lymphoma?
Which of the following is characteristic of indolent T-zone lymphoma?
According to prognostic factors, what is the expected outcome for a patient with I/II staged B cell lymphoma?
According to prognostic factors, what is the expected outcome for a patient with I/II staged B cell lymphoma?
Which parameter is most crucial to determine if it's acute leukemia?
Which parameter is most crucial to determine if it's acute leukemia?
Why are cytopenias commonly seen in acute leukemia?
Why are cytopenias commonly seen in acute leukemia?
In general terms, in what age distribution is acute leukemia seen?
In general terms, in what age distribution is acute leukemia seen?
Which of the following accurately describes a key feature in chronic leukemia?
Which of the following accurately describes a key feature in chronic leukemia?
Which of the following CBC findings is MOST indicative of chronic leukemia?
Which of the following CBC findings is MOST indicative of chronic leukemia?
What is a significant risk for the animal with leukemia?
What is a significant risk for the animal with leukemia?
In a horse presenting with lymphocytosis detected incidentally, what follow-up test would MOST strongly suggest a neoplastic process?
In a horse presenting with lymphocytosis detected incidentally, what follow-up test would MOST strongly suggest a neoplastic process?
Which characteristic is generally associated with paraproteins linked to multiple myeloma?
Which characteristic is generally associated with paraproteins linked to multiple myeloma?
What is the role of determining monoclonal gammopathy as a diagnostic criteria for multiple myeloma?
What is the role of determining monoclonal gammopathy as a diagnostic criteria for multiple myeloma?
What is the MOST important finding on protein electrophoresis that is suggestive of multiple myeloma?
What is the MOST important finding on protein electrophoresis that is suggestive of multiple myeloma?
Greater than what percentage of plasma cells of the bone marrow composition would suggest myeloma?
Greater than what percentage of plasma cells of the bone marrow composition would suggest myeloma?
Which of the following is a common finding in animals with multiple myeloma?
Which of the following is a common finding in animals with multiple myeloma?
What is the underlying cause of peripheral cytopenias in multiple myeloma?
What is the underlying cause of peripheral cytopenias in multiple myeloma?
What is known about the nature of Histiocytic disorders?
What is known about the nature of Histiocytic disorders?
Which of the following features is MOST characteristic of histiocytic sarcoma cells?
Which of the following features is MOST characteristic of histiocytic sarcoma cells?
When staging multicentric lymphoma, a dog with liver and spleen involvement, but appearing clinically normal, would be classified as which stage?
When staging multicentric lymphoma, a dog with liver and spleen involvement, but appearing clinically normal, would be classified as which stage?
A presumptive diagnosis of acute leukemia has been made based on initial bloodwork, and there is a need to differentiate between ALL and AML. Which of the following tests should be performed NEXT?
A presumptive diagnosis of acute leukemia has been made based on initial bloodwork, and there is a need to differentiate between ALL and AML. Which of the following tests should be performed NEXT?
In the context of hematopoietic neoplasia, what differentiates 'leukemia' from 'leukemic'?
In the context of hematopoietic neoplasia, what differentiates 'leukemia' from 'leukemic'?
What is the MOST critical implication of single-agent steroid therapy used prior to chemotherapy in canine lymphoma?
What is the MOST critical implication of single-agent steroid therapy used prior to chemotherapy in canine lymphoma?
In cases of suspected lymphoma, how do cytologic and histologic evaluations primarily differ?
In cases of suspected lymphoma, how do cytologic and histologic evaluations primarily differ?
A dog presents with a mildly elevated white blood cell count found incidentally. What follow-up test would be MOST relevant to assess the underlying cause and rule out neoplasia?
A dog presents with a mildly elevated white blood cell count found incidentally. What follow-up test would be MOST relevant to assess the underlying cause and rule out neoplasia?
What is the MAIN principle behind protein electrophoresis?
What is the MAIN principle behind protein electrophoresis?
A veterinary technician is assisting in the diagnosis of a dog with suspected acute myeloid leukemia (AML). Based on the information provided, which of the following clinical signs and lab findings would the technician LEAST expect to observe?
A veterinary technician is assisting in the diagnosis of a dog with suspected acute myeloid leukemia (AML). Based on the information provided, which of the following clinical signs and lab findings would the technician LEAST expect to observe?
An animal is suspected to have a hematopoietic neoplasia, where are these cell types derived from?
An animal is suspected to have a hematopoietic neoplasia, where are these cell types derived from?
Which of the following would be considered an indication of aleukemic leukemia?
Which of the following would be considered an indication of aleukemic leukemia?
A veterinary technician reviews the results of a complete blood count (CBC) and notes that a canine patient has a PCV of 34% (low), WBC 8,000 (normal), Neutrophils of 7,200/uL (normal), and 560/uL Lymphocytes (low). What can be concluded?
A veterinary technician reviews the results of a complete blood count (CBC) and notes that a canine patient has a PCV of 34% (low), WBC 8,000 (normal), Neutrophils of 7,200/uL (normal), and 560/uL Lymphocytes (low). What can be concluded?
Based on Molly's CBC, with PCV of 34% (low), WBC normal, Neutrophils Normal and Lymphocytes (low) what is a possible diagnosis?
Based on Molly's CBC, with PCV of 34% (low), WBC normal, Neutrophils Normal and Lymphocytes (low) what is a possible diagnosis?
Gertie presents with physical exam within normal limits, 30% PCV (low), Retic 24,640/uL (low), high WBC and blasts on a CBC. What diagnosis is most consistent?
Gertie presents with physical exam within normal limits, 30% PCV (low), Retic 24,640/uL (low), high WBC and blasts on a CBC. What diagnosis is most consistent?
A veterinarian suspects that Gertie has is it ALL or AML, what special stain can you use to determine the difference?
A veterinarian suspects that Gertie has is it ALL or AML, what special stain can you use to determine the difference?
Which cell type serves as the origin for multiple myeloma?
Which cell type serves as the origin for multiple myeloma?
In the classification of leukemia, what lineages are encompassed within the 'myeloid' designation?
In the classification of leukemia, what lineages are encompassed within the 'myeloid' designation?
Which characteristic distinguishes acute from chronic leukemia?
Which characteristic distinguishes acute from chronic leukemia?
What is the MOST common presenting sign in animals with lymphoma?
What is the MOST common presenting sign in animals with lymphoma?
Lymphoma is least likely to be found at which anatomical site?
Lymphoma is least likely to be found at which anatomical site?
When diagnosing lymphoma, what cellular feature is MOST indicative of the condition on a cytology sample?
When diagnosing lymphoma, what cellular feature is MOST indicative of the condition on a cytology sample?
What finding on a complete blood count (CBC) is LEAST likely in an animal with lymphoma?
What finding on a complete blood count (CBC) is LEAST likely in an animal with lymphoma?
Some types of lymphoma can cause unexplained hypercalcemia. What is the underlying cause?
Some types of lymphoma can cause unexplained hypercalcemia. What is the underlying cause?
What does a 'spike' formation indicate when interpreting the results of PCR for Antigen Receptor Rearrangement (PARR)?
What does a 'spike' formation indicate when interpreting the results of PCR for Antigen Receptor Rearrangement (PARR)?
What is a potential consequence of administering steroids to a canine lymphoma patient prior to initiating chemotherapy?
What is a potential consequence of administering steroids to a canine lymphoma patient prior to initiating chemotherapy?
Histologically, how are high-grade lymphomas characterized?
Histologically, how are high-grade lymphomas characterized?
What is generally the best prognostic indicator in dogs with lymphoma?
What is generally the best prognostic indicator in dogs with lymphoma?
In contrast to lymphoma involving a mass, what CBC abnormalities are most suggestive of acute leukemia?
In contrast to lymphoma involving a mass, what CBC abnormalities are most suggestive of acute leukemia?
What diagnostic test is MOST appropriate to differentiate between ALL and AML?
What diagnostic test is MOST appropriate to differentiate between ALL and AML?
What is the BEST approach to accurately diagnose chronic lymphocytic leukemia (CLL)?
What is the BEST approach to accurately diagnose chronic lymphocytic leukemia (CLL)?
If a veterinary professional suspects multiple myeloma, what confirmatory diagnostic test should be run?
If a veterinary professional suspects multiple myeloma, what confirmatory diagnostic test should be run?
In serum protein electrophoresis, what finding is MOST suggestive of multiple myeloma?
In serum protein electrophoresis, what finding is MOST suggestive of multiple myeloma?
What is the primary method by which histiocytic sarcoma can cause anemia?
What is the primary method by which histiocytic sarcoma can cause anemia?
Animals with a high percentage of immature precursors, should probably have how many blasts?
Animals with a high percentage of immature precursors, should probably have how many blasts?
Which of the following factors plays a role in deciding what should be done based on what multiple myeloma costs?
Which of the following factors plays a role in deciding what should be done based on what multiple myeloma costs?
What is the MOST likely diagnosis for a horse with approximately 18,000 lymphocytes that are small? There are no clinical signs.
What is the MOST likely diagnosis for a horse with approximately 18,000 lymphocytes that are small? There are no clinical signs.
Which feature is LEAST associated with non-indolent lymphomas?
Which feature is LEAST associated with non-indolent lymphomas?
Which of the following is NOT a primary location to look for lymphoma?
Which of the following is NOT a primary location to look for lymphoma?
What is the MOST specific application of flow cytometry in characterizing lymphoma beyond PARR?
What is the MOST specific application of flow cytometry in characterizing lymphoma beyond PARR?
Which of the diagnostic results is NOT typically associated with multiple myeloma?
Which of the diagnostic results is NOT typically associated with multiple myeloma?
How does the terminology 'leukemic' differ from 'leukemia' in the context of hematopoietic neoplasia?
How does the terminology 'leukemic' differ from 'leukemia' in the context of hematopoietic neoplasia?
Which strategy is LEAST helpful to differentiate between lymphoma and acute leukemia?
Which strategy is LEAST helpful to differentiate between lymphoma and acute leukemia?
Which combination of diagnostic findings would MOST strongly suggest a diagnosis of multiple myeloma?
Which combination of diagnostic findings would MOST strongly suggest a diagnosis of multiple myeloma?
You are reviewing a CBC of Gertie and you are thinking it could be either ALL or AML, and are trying to stain to differentiate. What special stain can you use?
You are reviewing a CBC of Gertie and you are thinking it could be either ALL or AML, and are trying to stain to differentiate. What special stain can you use?
Which patient is MOST likely to present with cutaneous lymphoma?
Which patient is MOST likely to present with cutaneous lymphoma?
Which of the following is stage IV lymphoma?
Which of the following is stage IV lymphoma?
When seeing many small lymphocytes, what cell type do we have a neoplasm?
When seeing many small lymphocytes, what cell type do we have a neoplasm?
Dogs with what cell type tumors will often do better than the others?
Dogs with what cell type tumors will often do better than the others?
Which of the following is the most common lymphoma in the cat?
Which of the following is the most common lymphoma in the cat?
What is the source of the term multiple in 'multiple myeloma'?
What is the source of the term multiple in 'multiple myeloma'?
What is the purpose of serum protein electrophoresis?
What is the purpose of serum protein electrophoresis?
If an animal is not feeling well and has leukemia, where is this arising from?
If an animal is not feeling well and has leukemia, where is this arising from?
When diagnosing myeloma, how many of the symptoms do they need?
When diagnosing myeloma, how many of the symptoms do they need?
What is the appropriate amount of cells needed for PARR results?
What is the appropriate amount of cells needed for PARR results?
A case should be looked at and interpreted in context, which is?
A case should be looked at and interpreted in context, which is?
Immunophenotyping using flow cytometry identifies cells with specific markers. What are these cells?
Immunophenotyping using flow cytometry identifies cells with specific markers. What are these cells?
If all the lymphocytes from T cells have one rearrangement, what cells do we have?
If all the lymphocytes from T cells have one rearrangement, what cells do we have?
What sample is needed for a flow test?
What sample is needed for a flow test?
Which of the following cell types is NOT considered a precursor for myeloid leukemia?
Which of the following cell types is NOT considered a precursor for myeloid leukemia?
What is the primary distinguishing characteristic of acute leukemia compared to chronic leukemia?
What is the primary distinguishing characteristic of acute leukemia compared to chronic leukemia?
In which animal species is lymphoma considered the most common malignant tumor?
In which animal species is lymphoma considered the most common malignant tumor?
Which of the following is the MOST typical initial clinical sign in an animal with lymphoma?
Which of the following is the MOST typical initial clinical sign in an animal with lymphoma?
What does 'effacement of normal architecture' in a lymph node biopsy MOST strongly suggest?
What does 'effacement of normal architecture' in a lymph node biopsy MOST strongly suggest?
A dog with lymphoma is described as 'Stage III'. According to the staging system discussed, what does this indicate?
A dog with lymphoma is described as 'Stage III'. According to the staging system discussed, what does this indicate?
What is the primary purpose of PCR for Antigen Receptor Rearrangement (PARR) in diagnosing lymphoma?
What is the primary purpose of PCR for Antigen Receptor Rearrangement (PARR) in diagnosing lymphoma?
What finding on a PARR test is MOST indicative of a neoplastic lymphoid population?
What finding on a PARR test is MOST indicative of a neoplastic lymphoid population?
Which of the following is a common cell surface marker used to identify B-cells in immunophenotyping of lymphoma?
Which of the following is a common cell surface marker used to identify B-cells in immunophenotyping of lymphoma?
What is the clinical significance of CD34 positivity in hematopoietic neoplasia?
What is the clinical significance of CD34 positivity in hematopoietic neoplasia?
Which histologic feature is typically associated with high-grade lymphomas?
Which histologic feature is typically associated with high-grade lymphomas?
Indolent lymphomas are characterized by which of the following?
Indolent lymphomas are characterized by which of the following?
Which subtype of indolent lymphoma is characterized by 'inside-out' follicles and CD21 positivity?
Which subtype of indolent lymphoma is characterized by 'inside-out' follicles and CD21 positivity?
What is a potential negative consequence of using single-agent steroids to treat canine lymphoma prior to chemotherapy?
What is a potential negative consequence of using single-agent steroids to treat canine lymphoma prior to chemotherapy?
In acute leukemia, what percentage of blasts in the bone marrow is generally considered diagnostic?
In acute leukemia, what percentage of blasts in the bone marrow is generally considered diagnostic?
Which of the following is a typical Complete Blood Count (CBC) finding in acute leukemia?
Which of the following is a typical Complete Blood Count (CBC) finding in acute leukemia?
What is 'myelopthesis' in the context of leukemia?
What is 'myelopthesis' in the context of leukemia?
Which of the following best describes chronic leukemia?
Which of the following best describes chronic leukemia?
In a horse with incidental lymphocytosis and no clinical signs, which follow-up test would be MOST helpful to differentiate between reactive lymphocytosis and chronic lymphocytic leukemia (CLL)?
In a horse with incidental lymphocytosis and no clinical signs, which follow-up test would be MOST helpful to differentiate between reactive lymphocytosis and chronic lymphocytic leukemia (CLL)?
What is the primary cell type involved in multiple myeloma?
What is the primary cell type involved in multiple myeloma?
Which diagnostic finding is MOST suggestive of multiple myeloma?
Which diagnostic finding is MOST suggestive of multiple myeloma?
What are Bence Jones proteins in the context of multiple myeloma?
What are Bence Jones proteins in the context of multiple myeloma?
Lytic bone lesions and hypercalcemia are clinical signs associated with multiple myeloma. What is the underlying mechanism for these findings?
Lytic bone lesions and hypercalcemia are clinical signs associated with multiple myeloma. What is the underlying mechanism for these findings?
Histiocytic sarcoma originates from which cell type?
Histiocytic sarcoma originates from which cell type?
Erythrophagia, the engulfment of red blood cells, is a characteristic feature associated with which neoplasm?
Erythrophagia, the engulfment of red blood cells, is a characteristic feature associated with which neoplasm?
Which of the following best describes the difference between 'leukemia' and 'leukemic' in the context of hematopoietic neoplasia?
Which of the following best describes the difference between 'leukemia' and 'leukemic' in the context of hematopoietic neoplasia?
An animal presents with pancytopenia on CBC. Bone marrow cytology reveals a predominance of blast cells (>20%). Which of the following is the MOST likely broad diagnostic category?
An animal presents with pancytopenia on CBC. Bone marrow cytology reveals a predominance of blast cells (>20%). Which of the following is the MOST likely broad diagnostic category?
When differentiating between Acute Lymphoid Leukemia (ALL) and Acute Myeloid Leukemia (AML), which diagnostic test would be MOST definitive?
When differentiating between Acute Lymphoid Leukemia (ALL) and Acute Myeloid Leukemia (AML), which diagnostic test would be MOST definitive?
Which of the following is LEAST likely to be a presenting clinical sign for chronic lymphocytic leukemia (CLL) in its early stages?
Which of the following is LEAST likely to be a presenting clinical sign for chronic lymphocytic leukemia (CLL) in its early stages?
What is the MOST important factor to consider when interpreting atypical lymphocytes on a blood smear?
What is the MOST important factor to consider when interpreting atypical lymphocytes on a blood smear?
Which of the following is a characteristic feature of T-zone lymphoma?
Which of the following is a characteristic feature of T-zone lymphoma?
An 8-year-old dog presents with PUPD and a chemistry panel reveals hypercalcemia. Which hematopoietic neoplasia should be a primary differential?
An 8-year-old dog presents with PUPD and a chemistry panel reveals hypercalcemia. Which hematopoietic neoplasia should be a primary differential?
Which of the following techniques is MOST sensitive and provides the most detailed immunophenotypic information for lymphoma diagnosis?
Which of the following techniques is MOST sensitive and provides the most detailed immunophenotypic information for lymphoma diagnosis?
If a dog is diagnosed with Stage IV lymphoma, what organ involvement is indicated?
If a dog is diagnosed with Stage IV lymphoma, what organ involvement is indicated?
What is the typical age distribution for animals diagnosed with acute leukemia?
What is the typical age distribution for animals diagnosed with acute leukemia?
In serum protein electrophoresis, which protein fraction is primarily composed of immunoglobulins (antibodies)?
In serum protein electrophoresis, which protein fraction is primarily composed of immunoglobulins (antibodies)?
For optimal results from PCR for Antigen Receptor Rearrangement (PARR), approximately how many cells are ideally needed?
For optimal results from PCR for Antigen Receptor Rearrangement (PARR), approximately how many cells are ideally needed?
Which of the following is the LEAST common anatomical location for lymphoma in dogs?
Which of the following is the LEAST common anatomical location for lymphoma in dogs?
If immunophenotyping of a lymphoma reveals a CD4 positive T-cell phenotype, what is the prognostic implication compared to a B-cell lymphoma?
If immunophenotyping of a lymphoma reveals a CD4 positive T-cell phenotype, what is the prognostic implication compared to a B-cell lymphoma?
In veterinary medicine, the term 'lymphosarcoma' is considered:
In veterinary medicine, the term 'lymphosarcoma' is considered:
Which of the following species is LEAST commonly affected by lymphoma?
Which of the following species is LEAST commonly affected by lymphoma?
In dogs, multicentric lymphoma is characterized by the involvement of:
In dogs, multicentric lymphoma is characterized by the involvement of:
What does a 'B' designation appended to the clinical stage of canine lymphoma indicate?
What does a 'B' designation appended to the clinical stage of canine lymphoma indicate?
PCR for Antigen Receptor Rearrangement (PARR) primarily aids in lymphoma diagnosis by:
PCR for Antigen Receptor Rearrangement (PARR) primarily aids in lymphoma diagnosis by:
In the context of lymphoma, 'effacement of normal architecture' in a lymph node biopsy refers to:
In the context of lymphoma, 'effacement of normal architecture' in a lymph node biopsy refers to:
A key feature distinguishing acute leukemia from chronic leukemia is:
A key feature distinguishing acute leukemia from chronic leukemia is:
Myelopthesis, a common consequence of leukemia, directly leads to:
Myelopthesis, a common consequence of leukemia, directly leads to:
In serum protein electrophoresis, a monoclonal gammopathy is MOST suggestive of:
In serum protein electrophoresis, a monoclonal gammopathy is MOST suggestive of:
Histiocytic sarcoma is characterized by neoplastic proliferation of:
Histiocytic sarcoma is characterized by neoplastic proliferation of:
Which of the following is LEAST likely to be a typical Complete Blood Count (CBC) finding in an animal with lymphoma?
Which of the following is LEAST likely to be a typical Complete Blood Count (CBC) finding in an animal with lymphoma?
What is the primary rationale for avoiding single-agent steroid therapy prior to initiating chemotherapy in canine lymphoma?
What is the primary rationale for avoiding single-agent steroid therapy prior to initiating chemotherapy in canine lymphoma?
In cases of suspected aleukemic leukemia, which diagnostic approach is MOST critical for diagnosis?
In cases of suspected aleukemic leukemia, which diagnostic approach is MOST critical for diagnosis?
The presence of CD34 positivity in hematopoietic neoplasia is most indicative of:
The presence of CD34 positivity in hematopoietic neoplasia is most indicative of:
T-zone lymphoma, an indolent subtype, is characterized by neoplastic cells that are typically:
T-zone lymphoma, an indolent subtype, is characterized by neoplastic cells that are typically:
Erythrophagia, the engulfment of red blood cells by neoplastic cells, is a characteristic feature most strongly associated with:
Erythrophagia, the engulfment of red blood cells by neoplastic cells, is a characteristic feature most strongly associated with:
Which combination of diagnostic findings would be MOST definitively indicative of multiple myeloma?
Which combination of diagnostic findings would be MOST definitively indicative of multiple myeloma?
To differentiate between Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML) when blast morphology is inconclusive, which ancillary diagnostic test is MOST definitive?
To differentiate between Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML) when blast morphology is inconclusive, which ancillary diagnostic test is MOST definitive?
A horse presents with an incidental finding of lymphocytosis (18,000 lymphocytes/µL) comprised of small, normal-appearing lymphocytes, and is clinically normal. PARR analysis reveals a monoclonal T-cell receptor gene rearrangement. What is the MOST likely diagnosis?
A horse presents with an incidental finding of lymphocytosis (18,000 lymphocytes/µL) comprised of small, normal-appearing lymphocytes, and is clinically normal. PARR analysis reveals a monoclonal T-cell receptor gene rearrangement. What is the MOST likely diagnosis?
An 8-year-old Labrador Retriever presents with fever, moderate leukocytosis, atypical mononuclear cells, and moderate thrombocytopenia. Bone marrow cytology reveals >20% blasts. Flow cytometry identifies the blasts as CD34+ and myeloperoxidase positive. Which additional finding would be MOST consistent with Acute Myeloid Leukemia (AML) in this case?
An 8-year-old Labrador Retriever presents with fever, moderate leukocytosis, atypical mononuclear cells, and moderate thrombocytopenia. Bone marrow cytology reveals >20% blasts. Flow cytometry identifies the blasts as CD34+ and myeloperoxidase positive. Which additional finding would be MOST consistent with Acute Myeloid Leukemia (AML) in this case?
Flashcards
Lymphoma
Lymphoma
Cancer that was formerly known as lymphosarcoma and is a common neoplasm in all species.
Lymphoma
Lymphoma
Solid tissue tumor originating outside the bone marrow, presenting as discrete tissue masses or diffuse infiltration.
Histiocytic Tumors
Histiocytic Tumors
Tumors that arise from histiocytes, including macrophages and dendritic cells.
Leukemic
Leukemic
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Aleukemic Leukemia
Aleukemic Leukemia
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Multiple Myeloma
Multiple Myeloma
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Immunophenotyping
Immunophenotyping
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PARR (PCR for Antigen Receptor Rearrangement)
PARR (PCR for Antigen Receptor Rearrangement)
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Lymphoma
Lymphoma
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Acute Leukemia General Principles
Acute Leukemia General Principles
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Protein Electrophoresis
Protein Electrophoresis
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Leukemia Terminology
Leukemia Terminology
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Acute and Chronic Leukemias
Acute and Chronic Leukemias
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Acute Leukemias
Acute Leukemias
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Chronic Leukemias
Chronic Leukemias
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Lymphoma Location
Lymphoma Location
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Lymphoma Characteristics
Lymphoma Characteristics
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Causes of Lymphopenia in Lymphoma
Causes of Lymphopenia in Lymphoma
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Lymphoma & Hypercalcemia
Lymphoma & Hypercalcemia
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Lymphoma Classification
Lymphoma Classification
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Multicentric Lymphoma
Multicentric Lymphoma
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Alimentary Lymphoma
Alimentary Lymphoma
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Stage I Lymphoma
Stage I Lymphoma
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Stage II Lymphoma
Stage II Lymphoma
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Stage III Lymphoma
Stage III Lymphoma
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Stage IV Lymphoma
Stage IV Lymphoma
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Stage V Lymphoma
Stage V Lymphoma
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"B" Designation in Canine Lymphoma
"B" Designation in Canine Lymphoma
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Clonality
Clonality
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Flow Cytometry Advantages & Disadvantages
Flow Cytometry Advantages & Disadvantages
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Immunohistochemistry
Immunohistochemistry
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CD4
CD4
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CD8
CD8
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CD34
CD34
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Histologic Grade
Histologic Grade
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Diffuse Large Cell Lymphoma
Diffuse Large Cell Lymphoma
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Indolent Tumors
Indolent Tumors
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Lymphoma: Marginal Zone
Lymphoma: Marginal Zone
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Lymphoma: T Zone
Lymphoma: T Zone
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Lymphoma flow pattern: T-Zone.
Lymphoma flow pattern: T-Zone.
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Lymphoma: Cell Type
Lymphoma: Cell Type
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Lymphoma: Steroid Given...
Lymphoma: Steroid Given...
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Pancytopenia causes
Pancytopenia causes
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Acute Leukemia
Acute Leukemia
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Acute Leukemia: In Bone Marrow
Acute Leukemia: In Bone Marrow
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Myeloid Leukemia
Myeloid Leukemia
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Cell Morphology Aids
Cell Morphology Aids
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Lymphoma Cell Type: Scary.
Lymphoma Cell Type: Scary.
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Differentiation: L or L?
Differentiation: L or L?
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Bone Marrow with Chronic Leukemia
Bone Marrow with Chronic Leukemia
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Monocolonal
Monocolonal
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Neoplastic characteristics multiple myeloma.
Neoplastic characteristics multiple myeloma.
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Bence Jones proteins
Bence Jones proteins
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Serum Protein Electrophoresis
Serum Protein Electrophoresis
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Antibodies
Antibodies
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Histiocytic Sarcoma
Histiocytic Sarcoma
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Study Notes
- Hematopoietic Neoplasia describes funny cells on blood smears
Learning Objectives
- Classify lymphoma in dogs, comparing features used to stage and grade the neoplasm
- Contrast physical exam abnormalities and CBC findings in lymphoma, acute leukemia, and chronic leukemia
- Explain why pancytopenia can arise from acute leukemia, but not chronic leukemia
- Describe adjunct methods to distinguish between different types of acute leukemia and lymphoma
- List possible reasons for large blue cells in blood smear and describe narrowing differential steps
- Identify hematopoietic neoplasms in young animals (~1-2 yr old) versus geriatric patients
- Explain the morphologic feature diversity in cells categorized as myeloid leukemia
- List findings, including serum protein electrophoresis patterns, to diagnose myeloma
- List the types of histiocytic neoplasms and describe characteristic findings
Possible Hematopoietic Neoplasms
- Lymphoma may exhibit a leukemic phase
- Acute leukemias consist of:
- Acute lymphoid leukemia (ALL)
- Acute myeloid leukemia (AML)
- Acute undifferentiated leukemia (AUL)
- Chronic lymphocytic leukemia (CLL) includes:
- Chronic lymphoid leukemia (CLL)
- Chronic myeloid leukemia (CML)
- Multiple myeloma is another possible hematopoietic neoplasm
- Histiocytic tumors are also possible
- Acute and chronic leukemia originate from precursors in the bone marrow and can be lymphocyte precursors, or non-lymphocyte precursors
Lymphoma
- Lymphoma or Lymphosarcoma is a common neoplasm in animals
- Canine lymphoma accounts for ~20% of canine tumors
- Average age of onset is 10 years, but can affect dogs as young as 1-3 years
- Feline lymphoma accounts for ~30% of feline tumors and may be FeLV-related
- It primarily affects cats aged 2-6 years
- It is slightly more common in males
- Equine lymphoma accounts for ~0.7-3.2% of equine tumors
- It is the most common malignant neoplasm, but not generally common
- It commonly affects horses aged 4-10 years
- Bovine lymphoma accounts for 0.5-0.8% of bovine tumors where incidence varies by region and BLV prevalence
- 1-5% of infected cows contract lymphoma
- Lymphoma can occur anywhere lymphocytes are present, including
- Lymph nodes
- Thymus
- Spleen
- Liver
- Kidney
- Skin
- Lymphoma (lymphosarcoma) is a solid tissue tumor originating outside the bone marrow
- It may present as discrete tissue masses or diffuse tissue infiltration
- Clinical signs are related to the site of the tumor
- It may present with systemic illness, leading to organomegaly or organ dysfunction
- Bone marrow may become secondarily involved in the disease
- Lymphoma is seen in all species
- Lymphoma may not start in the bone marrow, but can go to the bone marrow and have a leukemic phase
- Lymphoma is a tumor of tissue and originates from lymphocytes in the periphery
- The neoplastic cell may re-enter the circulation and go to the marrow, but marrow involvement is secondary
Histologic and Cytologic diagnosis of Lymphoma
- Histologic diagnosis examines tissue architecture with:
- Tissue replacement with neoplastic cells
- Abnormal follicle architecture
- Cytologic diagnosis recognizes a homogeneous population of medium to large lymphoid cells
- Small lymphocytes are smaller than neutrophils with nuclei about the size of an RBC
- Subtypes of lymphoma have a lot of appearances so can be varied
CBC and Chemistry of Lymphoma
- CBC is often normal in animals with lymphoma, but possible abnormalities include:
- Mild, nonregenerative anemia (chronic dz)
- Lymphopenia (25%)
- Lymphocytosis (~25%) with potentially abnormal cells in circulation
- Chemistry abnormalities may be absent or may reflect organ infiltration
- Infiltration of the liver or kidney can cause organ failure
- Hypercalcemia can been seen in some cases of T-cell lymphoma
- Hypercalcemia can be diagnosed clinically with PU/PD
- Hypercalcemia is often due to “PTH-rp” secretion by T lymphocytes
- Most animals with lymphoma have a normal CBC
- Sometimes lymphocytes will get hung up in an abnormal lymph node and the normal lymphocytes can't get out, leading to lymphopenia
- Lymphocytosis is relatively uncommon
- Chemistry is often normal unless there is infiltration of the kidney (azotemia) or the liver (elevated liver enzymes)
Classification of Lymphoma
- Classification schemes are based on the:
- Anatomic site, is determined by the clinician
- Clinical stage, determined by the clinician
- Histology grade, determined by the anatomic pathologist
- Immunophenotype
- Location based schemes classify lymphoma by
- Multicentric/generalized lymphoma is most common in dogs (80-85% of cases) and horses
- Lymphadenopathy in dogs is rapid, nonpainful, and generalized
- It may include malignant lymphocytes in internal organs
- Alimentary lymphoma is the most common form in older cats (usually FeLV -)
- Mediastinal lymphoma primarily affects lymph nodes and is most common in cats less than 2 years old (often FeLV +)
- Extranodal lymphoma includes sites such as renal, CNS, cutaneous (especially horses and dogs), ocular, and bone
- In horses and cats, classification is often based on location
- Multicentric lymphoma (generalized) involves lymph nodes and can be peripheral or visceral
- In cats, the most common form is alimentary which involves the intestinal tract and may also involve the liver
- Mediastinal lymphoma is often seen in younger, FeLV positive cats
- Cutaneous lymphoma is common in horses
- Location of lymphoma can arise anywhere because lymphocytes are circulating and looking for an antigen
Staging of canine multicentric lymphoma
- Staging is described for neoplastic spread in dogs
- Stage I lymphoma involves one node only
- Stage II lymphoma involves regional nodes
- Stage III lymphoma is generalized lymphadenopathy
- Stage IV lymphoma involves the liver and spleen
- Stage V lymphoma involves the bone marrow and/or extranodal sites
- "a" suffix indicates the patient does not appear clinically sick
- "b" suffix indicates systemic clinical signs and/or hypercalcemia are present
PARR and Immunophenotyping
PCR for Antigen Receptor Gene Rearrangement (PARR)
- Performed on material from stained slides, biopsy, blood, effusion, etc.
- PCR amplification of the variable regions of immunoglobulin genes (B cells) and T-cell antigen receptor genes
- PCR Products are separated by electrophoresis
- "Spike" formation indicates "clonality," meaning abnormal proliferation of a single B or T cell clone
- Canine sensitivity is ~75%, feline sensitivity is ~65%
- False negatives are associated with low numbers of neoplastic cells
- False positives can occur with infectious diseases like Ehrlichiosis
- Immunophenotyping identifies specific molecules on cell membranes using antibodies
- Can be performed on biopsy via IHC (Immunohistochemistry)
- It can be performed via Flow Cytometry (cells suspended in Ringer's solution)
- B lymphocytes: CD79a, CD20, CD21, PAX5
- T lymphocytes: CD3, CD5, CD4 or CD8 positive
- Panleukocytes: CD45
- Stem cells: CD34
- Flow cytometry can look for a panel of membrane markers and to determine cellular phenotype
- Neoplastic cells can have aberrant marker expression
- PARR is best to answer if a patient has lymphoma.
- PARR is highly sensitive, can be performed using cells with low cellularity, and does NOT require live/intact samples
- Flow is best to answer what KIND of lymphoma a patient has.
- Flow can characterize T-cells vs B-cells, is detailed, has quick turnaround and can be more cost-effective
- Immunophenotyping helps determine if the tumor is coming from T or B lymphocytes
- PARR uses probes looking for immunoglobin genes and/or T cell receptor genes, looking for rearrangements, and is done with PCR
- In PARR, clonality is a single spike and a single rearrangment
- PARR can verify malignancy and what type (B vs T)
- PARR has about 75% sensitivity in the dog and 65% sensitivity in the cat
- False positives in PARR can be caused by Ehrlichia or Leishmania
- Clonality in PARR with single spike means malignant population
- Flow uses labeled antibodies
- CD79a is the most used marker for B cells
- CD3 is a marker for T cells
- CD4 is a marker for T helper cells
- CD8 is a marker for cytotoxic T cells
- CD45 is on all leukocytes
- CD34 is a marker for a very early stem cell
Histologic Grading of Lymphoma
- Histologic grading is performed by pathologists and conveys information about tumor behavior
Grade is based on:
- Arrangement of tumor
- Lymphocyte size
- Mitotic rate
- High Grade lymphomas are rapidly progressive neoplasms and respondsive to chemotherapy
- A high grade lymphoma will Diffuse effacement of nodes by sheets of neoplastic round cells
- High grade lymphomas wipe out the architecture and have sheets of neoplastic round cells
- High grade lymphomas can be CD79A positive (B cell) or CD3 positive (T cell) and may need immunophenotyping to differentiate
- High grade tumors are often large and rapidly progressive, they do respond nicely to chemotherapy
- Indolent lymphomas are low grade
- Indolent Lymphoma:
- Proliferation of cells in particular zones of lymph node & spleen
- Low mitotic rate
- Usually slowly progressive disease
- Poorly responsive to chemotherapy so usually incurable
- Includes:
- Marginal zone
- T-zone
- Mantle zone
- Follicular
- Indolent tumors have a low mitotic rate and are slowly progressive and do not respond to chemo
- Indolent Lymphoma Marginal Zone:
- Marginal zone: cells in outer rim of follicle – creates “inside out" follicles
- Medium sized CD21+ cells (B cells)
- If in spleen, splenectomy may be curative
- If in lymph node, may be more aggressive
- Marginal zones are primarily CD21 positive now a biopsy is often skipped and just flow done as it is far less invasive
- Indolent Lymphoma – T Zone:
- Arise from T lymphocytes in paracortex, crowding out normal follicles
- Small to intermediate sized lymphocytes, often with hand-mirror appearance
- Neoplastic cells have aberrant CD expression (CD3+, CD45-)
- T zone cells are going to crowd out the follicles, look similar but less nodular.
- T-zone are is CD3 positive and CD45 negative and these correlate with T-zone lymphoma that have good prognosis
- T-zone cells often have hand mirror shape
Lymphoma Prognostic Factors
- MST= Mean survival time
- B cell(CD79a): MST 12 mo is better than T-cell tumors (CD3): MST 5-6 mo
- Patients with Stage I/II: MST 12-14 mo is better than Stage III/IV MST 5-6 mo
- "a": 12 mo is better than "b": 2-6 mo
- Low grade - indolent tumors is better than Intermediate - High tumors
- Multicentric sites is better than CNS, GI, hepatosplenic, cutaneous sites
- Resistance caused by prolonged single agent steroid treatment
- Multidrug resistance also negatively impacts prognosis
- A mix of lymphocyte phenotypes suggests reactive population = better
- A uniform phenotype suggests neoplasia = worse
- Small CD5+ cells lacking pan-leukocyte marker (CD45-) = better
- T-helper phenotype (CD4+) = worse
Acute and Chronic Leukemia Classifications
- Leukemia is lymphoid or myeloid, with predominant abnormalities in blood and bone marrow
- Acute leukemias are lymphoid or myeloid with rapid clinical course
- There is a predominance of undifferentiated (immature) cells (blasts)
- It displays a bimodal age distribution (often quite young)
- Chronic leukemias are also lymphoid or myeloid, but the process is slowly progressive
- There is a predominance of mature cells
- Distinguishing leukemia from reactive/hyperplastic processes is important
- It typically affects older patients
- Acute leukemias are lymphoid or myeloid with rapid clinical course
- Acute leukemia originates from precursors in the bone marrow
- Diagnosis requires >20% blasts in marrow
- WBC counts are often very high (often > 50,000 cells/ml)
- Myelophthisis and cytopenias are also common
- Tissue infiltration (e.g., liver and/or spleen) is possible
- In cats, acute leukemia is often associated with FeLV infection
- Prognosis is poor, especially with acute myeloid leukemia (AML)
- AML cells can arise from granulocytic, monocytic, erythroid, or megakaryocytic lines
- WHO classification in humans relies more and more on cytogenetic analysis
- Lymphoblastic tumors can be difficult to diagnose.
- AML may be underdiagnosed since neither biopsy nor cytology can readily distinguish lymphoblasts from myeloblasts
- The incidence of canine AML is unclear (~16-34%)
- Blasts are often assumed to be lymphoblasts –Treatment protocols are less effective
- One study found a median survival from diagnosis of 19 days (1-121)
- Leukemia is a disease/diagnosis that originates IN the bone marrow
- Leukemic- stage of disease in which neoplastic cells are actively in the bloodstream, Lymphoma can be leukemia
- Aleukemic leukemia:
- Leukemia in bone marrow
- No abnormal neoplastic cells in the bloodstream
- Early stage
- Cells produced in marrow
- Cells not yet in circulation in sufficient numbers to detect on CBC
- plus or minus pancytopenia
- WBC count might be quite high or normal because it's stuck in bone marrow
- Higher the cell count more likely to have tissue infiltration
- In acute leukemia (cats) it's almost always due to a FELV infection
- AML (acute myeloid leukemia) has a super bad prognosis
- To diagnose acute leukemia, you want to look at the marrow and find a lot of immature precursors
- In acute leukemia, what's important is there is poorly differentiated or undifferentiated cells in the bone marrow (maybe in the blood) they look undifferentiated hard to tell what they are like precursor but unknown
- Those cells look abnormal
Diagnostic Differences between AML and ALL
- Exact cell type of origin may require special staining
- Look for cytoplasmic enzyme activity (e.g., myeloperoxidase)
- Look at cell surface markers or enzyme activity
- Examine lymphocytes (CD3, CD79a, CD20)
- Note whether monocytes/macrophages are present (CD18, iba-1, CD204, CD14)
- Note whether neutrophils are present (myeloperoxidase)
- Chronic Leukemias:
- Hallmark is Peripheral leukocytosis with increased normal looking differentiated cells.
- CLL - Lymphocytosis -CML- Neutrophilia, monocytosis, eosinophilia -Distinguish from other causes of leukocytosis
- Fair to a good prognosis may live for extended periods of time -May terminal in blast crisis
- Chronic Leukemias
- Slowly progressive, often no clinical signs
- Cells are normal looking leading to peripheral leukocytosis
- Not usually diagnosed on bone marrow
###Horse Lymphocytosis
- Check for 18,000 small lymphocytes/uL if you also see Incidental finding and no clinical signs
- Look out for Accession: F250011558, as well as Sample Type: PERIPHERAL BLOOD, Immunoglobulin gene: POLYCLONAL
Multiple Myeloma
- Malignant plasma cell tumor that is functional and arises in bone marrow
- Protein abnormalities are a hallmark feature
- Neoplastic cells secrete a single paraprotein
- Intact Ig (usually IgG)
- Light chains or heavy chains possible
- "Non-secretory" myelomas are rare
- Diagnostic criteria include at least 3 of the following:
- Monoclonal gammopathy
- Light chain ("Bence Jones") proteins in urine
- Plasmacytosis in bone marrow or other sites
- Lytic bone lesions
- Hypercalcemia
- Negative test for E. canis
- You want to rule out E canis before doing a big workup for multiple myeloma
Protein Electrophoresis
- Used to fractionate proteins as they move through a gel
- Protein migration in an electrical field is based on size and charge
- Densitometer tracings illustrate gammopathy
- A polyclonal gammopathy shows a broad gamma peak
- A monoclonal gammopathy shows a narrow gamma peak
- Plasmacytosis includes plasma cells which can be unevenly distributed in marrow and also been with chronic antigenic stimulation
- Greater than 10-20% suggests myeloma Symptoms of multiple myeloma:
- Peripheral cytopenias of other cell types (i.e., neutropenia, anemia) due to myelophthisis
Tendency to bleed
- Thrombocytopenia
- Platelet function defect due to globulins coating platelets
- Hyperviscosity can cause organ failure
- In serum protein electrophoresis: separate proteins in sample based on size and partially on charge, albumin is negative and globulins positive
Histocytic Sarcomas
- Histiocytic disorders arise from histiocytes (macrophages and dendritic cells)
- Histiocytic sarcoma -May involve bone marrow - Localized or disseminated –Can cause a significant anemia
- Breed predilections - Bernese Mountain dog Flat-coated, golden & Labrador retriever -Rottweiler -Large round to plump spindle shaped cells, often vacuolated Binucleation or multinucleated is common. There may be Histologic criteria of malignancy
Take Home Messages
- Lymphoma is the most common hematopoietic neoplasm in most species
- Lymphoma generally will not have circulating atypical cells
- Multiple myeloma is a neoplasm of plasma cells often associated with protein abnormalities
- Leukemias can be lymphoid or myeloid, requiring special tests to differentiate.
- Acute leukemias have a worse prognosis than chronic leukemias and are more rapidly progressive
- Leukemia arises from the bone marrow but lymphoma more commonly arises from solid tissues such as a lymph node, meaning differentiation can be difficult.
- Differentials for big "blasty" cells includes Antigenic stimulation Lymphoma; stage V ALL + AML
- Rule out antigenic stimulation & immune-mediated disease
- In a pancytopenic animal the differential list should include (but not be limited to): ALL, AML, Stage V lymphoma, Multiple myeloma, Histiocytic sarcoma
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