Hematopoietic Neoplasia: Blood Smear Analysis

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Questions and Answers

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?

  • Alimentary
  • Multicentric (correct)
  • Mediastinal
  • Extranodal

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)?

<p>Suggests 'clonality,' indicating abnormal proliferation of a single B or T cell clone. (D)</p> Signup and view all the answers

Which of the following is NOT a typical characteristic of non-indolent lymphomas in dogs?

<p>Slowly progressive (B)</p> Signup and view all the answers

Which characteristic is most indicative of 'high grade' lymphoma based on histopathology?

<p>Arrangement of tumor in a diffuse pattern (B)</p> Signup and view all the answers

What is a key feature of indolent lymphoma marginal zone?

<p>Medium sized CD21+ cells (B cells) (C)</p> Signup and view all the answers

According to the presented prognostic factors in dogs, which immunophenotype typically has a better MST (Mean Survival Time)?

<p>B cell (CD79a) (B)</p> Signup and view all the answers

What is a typical finding in acute leukemia?

<p>Predominance of undifferentiated cells (blasts) (C)</p> Signup and view all the answers

What CBC finding is expected with acute leukemia?

<p>WBC counts are often very high (A)</p> Signup and view all the answers

What is usually required to diagnose acute leukemia?

<p>Greater than 20% blasts in marrow (A)</p> Signup and view all the answers

Which statement accurately contrasts acute and chronic leukemias?

<p>Acute leukemias have a rapid clinical course with a predominance of immature cells, while chronic leukemias are slowly progressive with mostly mature cells. (B)</p> Signup and view all the answers

A dog presents with fever, moderate leukocytosis, thrombocytopenia and >20% blasts in marrow. Which diagnostic test would be most useful to classify the leukemia?

<p>Immunophenotyping (B)</p> Signup and view all the answers

What is a key difference between leukemia and 'leukemic' as described in the presentation?

<p>Leukemia describes a disease/diagnosis, while 'leukemic' indicates neoplastic cells are in the bloodstream. (A)</p> Signup and view all the answers

What does it suggest if a horse has lymphocytosis and a monoclonal T cell receptor gene rearrangement?

<p>Lymphoma (B)</p> Signup and view all the answers

Which is a diagnostic criteria for multiple myeloma?

<p>Monoclonal gammopathy (D)</p> Signup and view all the answers

What is the function of serum protein electrophoresis in diagnosing multiple myeloma?

<p>To detect Monoclonal gammopathy (A)</p> Signup and view all the answers

When evaluating a serum protein electrophoresis, what finding is most suggestive of multiple myeloma?

<p>Sharp, distinct band in the gamma fraction (C)</p> Signup and view all the answers

What characterizes 'plasmacytosis'?

<p>Increased number of plasma cells in the bone marrow (A)</p> Signup and view all the answers

What is a key feature of Histiocytic sarcoma?

<p>It can involve bone marrow (A)</p> Signup and view all the answers

Which feature is characteristic of histiocytic sarcoma cells?

<p>Histiocytic sarcoma cells are large round to plump spindle shaped cells (B)</p> Signup and view all the answers

Which diagnostic approach provides the most detailed immunophenotype?

<p>Flow Cytometry (A)</p> Signup and view all the answers

Which of the following is most suggestive of Stage V lymphoma?

<p>Bone marrow and/or extranodal involvement (C)</p> Signup and view all the answers

Which technique is LEAST likely to be useful when distinguishing between Lymphoma (LMA) or acute leukemia?

<p>Serum biochemistry and complete blood count (B)</p> Signup and view all the answers

Which neoplasm can secrete a single paraprotein?

<p>Multiple myeloma (C)</p> Signup and view all the answers

What cells are affected in Histiocytic disorders?

<p>Histiocytes (C)</p> Signup and view all the answers

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?

<p>Acute leukemia (B)</p> Signup and view all the answers

When categorizing canine hematopoietic neoplasias, which factor decisively distinguishes between acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML)?

<p>Cytochemical staining and immunophenotyping (B)</p> Signup and view all the answers

Which statement accurately reflects the role of immunohistochemistry (IHC) in diagnosing lymphoma?

<p>IHC is used to identify cell surface markers and proteins within lymphoma cells, classifying the type and origin of the lymphoma. (B)</p> Signup and view all the answers

What is the MOST critical factor in distinguishing between chronic lymphocytic leukemia (CLL) and reactive lymphocytosis?

<p>Clonality of the lymphocyte population (D)</p> Signup and view all the answers

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?

<p>BCR-ABL translocation (C)</p> Signup and view all the answers

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?

<p>Histopathology and immunohistochemistry of the affected lymph node (C)</p> Signup and view all the answers

Which of the following findings on a complete blood count (CBC) would MOST strongly suggest aleukemic leukemia?

<p>Pancytopenia with no circulating neoplastic cells (A)</p> Signup and view all the answers

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?

<p>Steroid treatment (B)</p> Signup and view all the answers

What is the primary difference between cyotologic and histologic evaluation?

<p>Histologic examines tissue architecture (A)</p> Signup and view all the answers

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?

<p>Immunophenotyping (A)</p> Signup and view all the answers

Which of the following is a characteristic of multiple myeloma?

<p>Non of the above (D)</p> Signup and view all the answers

When diagnosing multiple myeloma, which result indicates the disease?

<p>Plasmacytosis in bone marrow. (D)</p> Signup and view all the answers

What process is used to divide proteins according to different electrical charges?

<p>Protein Electrophoresis (C)</p> Signup and view all the answers

What can a veterinary technician expect with a dog with canine AML?

<p>Blasts in the marrow (B)</p> Signup and view all the answers

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?

<p>Further tests should be perfmormed. (D)</p> Signup and view all the answers

What should a veterinary technician look for on a blood smear to diagnose leukemia?

<p>Blasts (A)</p> Signup and view all the answers

A blood sample is collected from a veterinary patient with suspected multiple myeloma, a monoclonal gammopathy is noted, which is?

<p>A paraprotein. (B)</p> Signup and view all the answers

An animal presents that is suspected to have a hematopoietic neoplasia, where do they originate?

<p>Hemopoietic Stem cells (C)</p> Signup and view all the answers

What is the typical age range for dogs diagnosed with lymphoma?

<p>Around 10 years old (D)</p> Signup and view all the answers

Which of the following is a common anatomical site for lymphoma development?

<p>Lymph node (D)</p> Signup and view all the answers

Which of the following characteristics distinguishes lymphoma from solid tissue tumors?

<p>Originates outside the bone marrow (B)</p> Signup and view all the answers

In the histological diagnosis of lymphoma, what key feature is examined to assess tissue architecture?

<p>Tissue replacement with neoplastic cells (C)</p> Signup and view all the answers

What cytological finding is MOST indicative of lymphoma?

<p>Homogeneous population of lymphoid cells (B)</p> Signup and view all the answers

What is a common, but not consistent, finding on a CBC in animals with lymphoma?

<p>Lymphopenia (C)</p> Signup and view all the answers

What is the MOST common cause of hypercalcemia in dogs with T-cell lymphoma?

<p>Secretion of parathyroid hormone-related protein (PTH-rp) (B)</p> Signup and view all the answers

Which diagnostic method is LEAST likely to be employed to classify lymphoma by location?

<p>Immunophenotyping (C)</p> Signup and view all the answers

Which anatomical location is characteristic of alimentary lymphoma in older cats?

<p>Gastrointestinal tract (A)</p> Signup and view all the answers

What does the suffix 'b' appended to the stage of multicentric lymphoma generally indicate?

<p>The presence of systemic clinical signs (C)</p> Signup and view all the answers

What sample types can be used for PARR (PCR for Antigen Receptor Rearrangement)?

<p>Stained slides, biopsy, blood, effusion (A)</p> Signup and view all the answers

Which diagnostic tool is most suited to determine if a patient has lymphoma and has high sensivity?

<p>PARR (B)</p> Signup and view all the answers

When classifying lymphoma based on histology, what information does it convey?

<p>Information about tumor behavior (D)</p> Signup and view all the answers

What microscopic characteristic differentiates indolent lymphoma from high-grade lymphoma?

<p>Low mitotic rate (B)</p> Signup and view all the answers

Which of the following is characteristic of indolent T-zone lymphoma?

<p>Arises from T lymphocytes in the paracortex, crowding out normal follicles (A)</p> Signup and view all the answers

According to prognostic factors, what is the expected outcome for a patient with I/II staged B cell lymphoma?

<p>MST 12-14 months (A)</p> Signup and view all the answers

Which parameter is most crucial to determine if it's acute leukemia?

<blockquote> <p>20% blasts in marrow (D)</p> </blockquote> Signup and view all the answers

Why are cytopenias commonly seen in acute leukemia?

<p>Myelophthisis (C)</p> Signup and view all the answers

In general terms, in what age distribution is acute leukemia seen?

<p>Bimodal: young and old (C)</p> Signup and view all the answers

Which of the following accurately describes a key feature in chronic leukemia?

<p>Slowly progressive with a predominance of mature cells (A)</p> Signup and view all the answers

Which of the following CBC findings is MOST indicative of chronic leukemia?

<p>Peripheral leukocytosis (C)</p> Signup and view all the answers

What is a significant risk for the animal with leukemia?

<p>May terminate in blast crisis (A)</p> Signup and view all the answers

In a horse presenting with lymphocytosis detected incidentally, what follow-up test would MOST strongly suggest a neoplastic process?

<p>PCR for antigen receptor rearrangement (PARR) (C)</p> Signup and view all the answers

Which characteristic is generally associated with paraproteins linked to multiple myeloma?

<p>Globulins (C)</p> Signup and view all the answers

What is the role of determining monoclonal gammopathy as a diagnostic criteria for multiple myeloma?

<p>Identify overproduction of a single immunoglobulin (B)</p> Signup and view all the answers

What is the MOST important finding on protein electrophoresis that is suggestive of multiple myeloma?

<p>A sharp, distinct band in the gamma fraction (B)</p> Signup and view all the answers

Greater than what percentage of plasma cells of the bone marrow composition would suggest myeloma?

<p>$&gt;10-20%$ (B)</p> Signup and view all the answers

Which of the following is a common finding in animals with multiple myeloma?

<p>Lytic bone lesions (D)</p> Signup and view all the answers

What is the underlying cause of peripheral cytopenias in multiple myeloma?

<p>Myelophthisis (A)</p> Signup and view all the answers

What is known about the nature of Histiocytic disorders?

<p>Arise from histiocytes (A)</p> Signup and view all the answers

Which of the following features is MOST characteristic of histiocytic sarcoma cells?

<p>Large, round to plump spindle-shaped cells, often vacuolated (C)</p> Signup and view all the answers

When staging multicentric lymphoma, a dog with liver and spleen involvement, but appearing clinically normal, would be classified as which stage?

<p>Stage IVa (D)</p> Signup and view all the answers

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?

<p>Flow cytometry (D)</p> Signup and view all the answers

In the context of hematopoietic neoplasia, what differentiates 'leukemia' from 'leukemic'?

<p>'Leukemia' signifies a disease diagnosis, while 'leukemic' indicates neoplastic cells are present in the bloodstream (B)</p> Signup and view all the answers

What is the MOST critical implication of single-agent steroid therapy used prior to chemotherapy in canine lymphoma?

<p>It often leads to the development of multidrug resistance (C)</p> Signup and view all the answers

In cases of suspected lymphoma, how do cytologic and histologic evaluations primarily differ?

<p>Cytology examines individual cells, while histology evaluates tissue architecture. (C)</p> Signup and view all the answers

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?

<p>Blood smear evaluation (D)</p> Signup and view all the answers

What is the MAIN principle behind protein electrophoresis?

<p>Dividing proteins according to their size and charge (B)</p> Signup and view all the answers

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?

<p>Elevated reticulocyte count (A)</p> Signup and view all the answers

An animal is suspected to have a hematopoietic neoplasia, where are these cell types derived from?

<p>Originate from precursors in bone marrow (D)</p> Signup and view all the answers

Which of the following would be considered an indication of aleukemic leukemia?

<p>Normal blood smear (B)</p> Signup and view all the answers

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?

<p>Lymphopenia due to stress (D)</p> Signup and view all the answers

Based on Molly's CBC, with PCV of 34% (low), WBC normal, Neutrophils Normal and Lymphocytes (low) what is a possible diagnosis?

<p>Anemia (D)</p> Signup and view all the answers

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?

<p>Either one is possible (C)</p> Signup and view all the answers

A veterinarian suspects that Gertie has is it ALL or AML, what special stain can you use to determine the difference?

<p>Cytoplasmic enzyme activity (D)</p> Signup and view all the answers

Which cell type serves as the origin for multiple myeloma?

<p>Plasma cell (C)</p> Signup and view all the answers

In the classification of leukemia, what lineages are encompassed within the 'myeloid' designation?

<p>All non-lymphoid hematopoietic precursors (A)</p> Signup and view all the answers

Which characteristic distinguishes acute from chronic leukemia?

<p>Degree of cell differentiation (C)</p> Signup and view all the answers

What is the MOST common presenting sign in animals with lymphoma?

<p>Enlarged lymph node or mass (A)</p> Signup and view all the answers

Lymphoma is least likely to be found at which anatomical site?

<p>Uterus (A)</p> Signup and view all the answers

When diagnosing lymphoma, what cellular feature is MOST indicative of the condition on a cytology sample?

<p>Monoclonal population of intermediate to large lymphocytes (C)</p> Signup and view all the answers

What finding on a complete blood count (CBC) is LEAST likely in an animal with lymphoma?

<p>Thrombocytopenia (C)</p> Signup and view all the answers

Some types of lymphoma can cause unexplained hypercalcemia. What is the underlying cause?

<p>Production of PTH related protein (B)</p> Signup and view all the answers

What does a 'spike' formation indicate when interpreting the results of PCR for Antigen Receptor Rearrangement (PARR)?

<p>Presence of a single neoplastic clone (D)</p> Signup and view all the answers

What is a potential consequence of administering steroids to a canine lymphoma patient prior to initiating chemotherapy?

<p>Increased risk of multi-drug resistance (B)</p> Signup and view all the answers

Histologically, how are high-grade lymphomas characterized?

<p>Rapidly progressive with high mitotic rate (A)</p> Signup and view all the answers

What is generally the best prognostic indicator in dogs with lymphoma?

<p>Immunophenotype (B)</p> Signup and view all the answers

In contrast to lymphoma involving a mass, what CBC abnormalities are most suggestive of acute leukemia?

<p>Pancytopenia and circulating blast cells (D)</p> Signup and view all the answers

What diagnostic test is MOST appropriate to differentiate between ALL and AML?

<p>Immunophenotyping (B)</p> Signup and view all the answers

What is the BEST approach to accurately diagnose chronic lymphocytic leukemia (CLL)?

<p>Exclusion of other causes of lymphocytosis (A)</p> Signup and view all the answers

If a veterinary professional suspects multiple myeloma, what confirmatory diagnostic test should be run?

<p>Protein electrophoresis (A)</p> Signup and view all the answers

In serum protein electrophoresis, what finding is MOST suggestive of multiple myeloma?

<p>Monoclonal gammopathy (D)</p> Signup and view all the answers

What is the primary method by which histiocytic sarcoma can cause anemia?

<p>Erythrophagocytosis by neoplastic cells (A)</p> Signup and view all the answers

Animals with a high percentage of immature precursors, should probably have how many blasts?

<p>around 1% (C)</p> Signup and view all the answers

Which of the following factors plays a role in deciding what should be done based on what multiple myeloma costs?

<p>how much money you're going to spend on this workup (D)</p> Signup and view all the answers

What is the MOST likely diagnosis for a horse with approximately 18,000 lymphocytes that are small? There are no clinical signs.

<p>chronic lymphocytic leukemia (A)</p> Signup and view all the answers

Which feature is LEAST associated with non-indolent lymphomas?

<p>Long survival time without treatment (D)</p> Signup and view all the answers

Which of the following is NOT a primary location to look for lymphoma?

<p>Bone (D)</p> Signup and view all the answers

What is the MOST specific application of flow cytometry in characterizing lymphoma beyond PARR?

<p>Broad characterization of cell surface markers to predict behavior (A)</p> Signup and view all the answers

Which of the diagnostic results is NOT typically associated with multiple myeloma?

<p>Hypoglobulinemia (B)</p> Signup and view all the answers

How does the terminology 'leukemic' differ from 'leukemia' in the context of hematopoietic neoplasia?

<p>'Leukemic' indicates the presence of neoplastic cells in the circulation, whereas 'leukemia' is a primary bone marrow disease. (C)</p> Signup and view all the answers

Which strategy is LEAST helpful to differentiate between lymphoma and acute leukemia?

<p>Assess presence of a fever (B)</p> Signup and view all the answers

Which combination of diagnostic findings would MOST strongly suggest a diagnosis of multiple myeloma?

<p>Monoclonal gammopathy, &gt;20% plasma cells in the bone marrow, lytic bone lesions (C)</p> Signup and view all the answers

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?

<p>Myeloperoxidase stain (A)</p> Signup and view all the answers

Which patient is MOST likely to present with cutaneous lymphoma?

<p>Horse (D)</p> Signup and view all the answers

Which of the following is stage IV lymphoma?

<p>if it's also in the liver and the spleen (C)</p> Signup and view all the answers

When seeing many small lymphocytes, what cell type do we have a neoplasm?

<p>incidental finding of 18,000 cells (C)</p> Signup and view all the answers

Dogs with what cell type tumors will often do better than the others?

<p>B-cell (C)</p> Signup and view all the answers

Which of the following is the most common lymphoma in the cat?

<p>Alimentary (C)</p> Signup and view all the answers

What is the source of the term multiple in 'multiple myeloma'?

<p>It is derived from the myeloma cells (B)</p> Signup and view all the answers

What is the purpose of serum protein electrophoresis?

<p>separating proteins based on size and charge (C)</p> Signup and view all the answers

If an animal is not feeling well and has leukemia, where is this arising from?

<p>Marrow (C)</p> Signup and view all the answers

When diagnosing myeloma, how many of the symptoms do they need?

<p>Two of the three symptoms (A)</p> Signup and view all the answers

What is the appropriate amount of cells needed for PARR results?

<p>It can be run with low cells, but 50,000 is a better result (A)</p> Signup and view all the answers

A case should be looked at and interpreted in context, which is?

<p>It should be looked at with the age and history of the animals and the number of scattered (A)</p> Signup and view all the answers

Immunophenotyping using flow cytometry identifies cells with specific markers. What are these cells?

<p>T-cells and B-cells (A)</p> Signup and view all the answers

If all the lymphocytes from T cells have one rearrangement, what cells do we have?

<p>A malignant population (C)</p> Signup and view all the answers

What sample is needed for a flow test?

<p>Live cells, tube of blood, or aspirate and send suspension of cells (D)</p> Signup and view all the answers

Which of the following cell types is NOT considered a precursor for myeloid leukemia?

<p>Lymphocyte precursors (A)</p> Signup and view all the answers

What is the primary distinguishing characteristic of acute leukemia compared to chronic leukemia?

<p>Predominance of immature, undifferentiated cells (B)</p> Signup and view all the answers

In which animal species is lymphoma considered the most common malignant tumor?

<p>Horses (B)</p> Signup and view all the answers

Which of the following is the MOST typical initial clinical sign in an animal with lymphoma?

<p>Enlarged lymph node (C)</p> Signup and view all the answers

What does 'effacement of normal architecture' in a lymph node biopsy MOST strongly suggest?

<p>Lymphoma (D)</p> Signup and view all the answers

A dog with lymphoma is described as 'Stage III'. According to the staging system discussed, what does this indicate?

<p>Generalized lymph node involvement, both sides of the diaphragm (D)</p> Signup and view all the answers

What is the primary purpose of PCR for Antigen Receptor Rearrangement (PARR) in diagnosing lymphoma?

<p>To detect clonality and immunophenotype (B-cell vs T-cell) of lymphocytes (B)</p> Signup and view all the answers

What finding on a PARR test is MOST indicative of a neoplastic lymphoid population?

<p>Monoclonal pattern with a distinct 'spike' (D)</p> Signup and view all the answers

Which of the following is a common cell surface marker used to identify B-cells in immunophenotyping of lymphoma?

<p>CD79a (B)</p> Signup and view all the answers

What is the clinical significance of CD34 positivity in hematopoietic neoplasia?

<p>Marker for a very early, bone marrow-derived stem cell tumor (D)</p> Signup and view all the answers

Which histologic feature is typically associated with high-grade lymphomas?

<p>Diffuse pattern and large cell size (D)</p> Signup and view all the answers

Indolent lymphomas are characterized by which of the following?

<p>Slowly progressive disease with low mitotic rate (B)</p> Signup and view all the answers

Which subtype of indolent lymphoma is characterized by 'inside-out' follicles and CD21 positivity?

<p>Marginal zone lymphoma (A)</p> Signup and view all the answers

What is a potential negative consequence of using single-agent steroids to treat canine lymphoma prior to chemotherapy?

<p>Development of multi-drug resistance (D)</p> Signup and view all the answers

In acute leukemia, what percentage of blasts in the bone marrow is generally considered diagnostic?

<p>Greater than 20% (B)</p> Signup and view all the answers

Which of the following is a typical Complete Blood Count (CBC) finding in acute leukemia?

<p>Pancytopenia or leukocytosis with circulating blast cells (A)</p> Signup and view all the answers

What is 'myelopthesis' in the context of leukemia?

<p>Effacement of normal hematopoietic cells in the bone marrow by neoplastic cells (A)</p> Signup and view all the answers

Which of the following best describes chronic leukemia?

<p>Slowly progressive disease with mature-looking cells in blood (C)</p> Signup and view all the answers

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)?

<p>PCR for Antigen Receptor Rearrangement (PARR) (B)</p> Signup and view all the answers

What is the primary cell type involved in multiple myeloma?

<p>Plasma cells (C)</p> Signup and view all the answers

Which diagnostic finding is MOST suggestive of multiple myeloma?

<p>Monoclonal gammopathy on serum protein electrophoresis (B)</p> Signup and view all the answers

What are Bence Jones proteins in the context of multiple myeloma?

<p>Immunoglobulin light chains excreted in urine (C)</p> Signup and view all the answers

Lytic bone lesions and hypercalcemia are clinical signs associated with multiple myeloma. What is the underlying mechanism for these findings?

<p>Direct infiltration of bone by plasma cells and osteoclastic activity (D)</p> Signup and view all the answers

Histiocytic sarcoma originates from which cell type?

<p>Histiocytes (macrophages and dendritic cells) (C)</p> Signup and view all the answers

Erythrophagia, the engulfment of red blood cells, is a characteristic feature associated with which neoplasm?

<p>Histiocytic sarcoma (C)</p> Signup and view all the answers

Which of the following best describes the difference between 'leukemia' and 'leukemic' in the context of hematopoietic neoplasia?

<p>'Leukemia' is a disease originating in the bone marrow or blood, while 'leukemic' indicates the presence of neoplastic cells in the circulation. (D)</p> Signup and view all the answers

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?

<p>Acute leukemia (D)</p> Signup and view all the answers

When differentiating between Acute Lymphoid Leukemia (ALL) and Acute Myeloid Leukemia (AML), which diagnostic test would be MOST definitive?

<p>Immunophenotyping (e.g., flow cytometry) (B)</p> Signup and view all the answers

Which of the following is LEAST likely to be a presenting clinical sign for chronic lymphocytic leukemia (CLL) in its early stages?

<p>Lethargy and anorexia (C)</p> Signup and view all the answers

What is the MOST important factor to consider when interpreting atypical lymphocytes on a blood smear?

<p>The clinical context and number of atypical cells (D)</p> Signup and view all the answers

Which of the following is a characteristic feature of T-zone lymphoma?

<p>Often CD45 negative (C)</p> Signup and view all the answers

An 8-year-old dog presents with PUPD and a chemistry panel reveals hypercalcemia. Which hematopoietic neoplasia should be a primary differential?

<p>T-cell lymphoma (D)</p> Signup and view all the answers

Which of the following techniques is MOST sensitive and provides the most detailed immunophenotypic information for lymphoma diagnosis?

<p>Flow cytometry (C)</p> Signup and view all the answers

If a dog is diagnosed with Stage IV lymphoma, what organ involvement is indicated?

<p>Liver and/or spleen involvement (A)</p> Signup and view all the answers

What is the typical age distribution for animals diagnosed with acute leukemia?

<p>Bimodal age distribution, affecting both young and older animals (B)</p> Signup and view all the answers

In serum protein electrophoresis, which protein fraction is primarily composed of immunoglobulins (antibodies)?

<p>Gamma globulins (C)</p> Signup and view all the answers

For optimal results from PCR for Antigen Receptor Rearrangement (PARR), approximately how many cells are ideally needed?

<p>50,000 cells (D)</p> Signup and view all the answers

Which of the following is the LEAST common anatomical location for lymphoma in dogs?

<p>Ovary (A)</p> Signup and view all the answers

If immunophenotyping of a lymphoma reveals a CD4 positive T-cell phenotype, what is the prognostic implication compared to a B-cell lymphoma?

<p>Generally worse prognosis (A)</p> Signup and view all the answers

In veterinary medicine, the term 'lymphosarcoma' is considered:

<p>An outdated synonym for lymphoma, referring to the same condition. (C)</p> Signup and view all the answers

Which of the following species is LEAST commonly affected by lymphoma?

<p>Guinea Pigs (D)</p> Signup and view all the answers

In dogs, multicentric lymphoma is characterized by the involvement of:

<p>Lymph nodes on both sides of the diaphragm. (A)</p> Signup and view all the answers

What does a 'B' designation appended to the clinical stage of canine lymphoma indicate?

<p>Systemic illness or hypercalcemia. (B)</p> Signup and view all the answers

PCR for Antigen Receptor Rearrangement (PARR) primarily aids in lymphoma diagnosis by:

<p>Detecting clonality of lymphocyte populations to differentiate neoplastic from reactive processes. (A)</p> Signup and view all the answers

In the context of lymphoma, 'effacement of normal architecture' in a lymph node biopsy refers to:

<p>Replacement of normal lymph node structure by a homogenous population of neoplastic cells. (A)</p> Signup and view all the answers

A key feature distinguishing acute leukemia from chronic leukemia is:

<p>The rapid progression and presence of undifferentiated blast cells in acute leukemia. (A)</p> Signup and view all the answers

Myelopthesis, a common consequence of leukemia, directly leads to:

<p>Replacement of normal bone marrow elements, resulting in cytopenias. (C)</p> Signup and view all the answers

In serum protein electrophoresis, a monoclonal gammopathy is MOST suggestive of:

<p>Multiple myeloma or other plasma cell neoplasia. (D)</p> Signup and view all the answers

Histiocytic sarcoma is characterized by neoplastic proliferation of:

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Which of the following is LEAST likely to be a typical Complete Blood Count (CBC) finding in an animal with lymphoma?

<p>Lymphocytosis (B)</p> Signup and view all the answers

What is the primary rationale for avoiding single-agent steroid therapy prior to initiating chemotherapy in canine lymphoma?

<p>Steroids can induce multi-drug resistance in lymphoma cells. (A)</p> Signup and view all the answers

In cases of suspected aleukemic leukemia, which diagnostic approach is MOST critical for diagnosis?

<p>Bone marrow cytology or histology. (C)</p> Signup and view all the answers

The presence of CD34 positivity in hematopoietic neoplasia is most indicative of:

<p>A neoplasm derived from very early hematopoietic stem cells or precursors. (C)</p> Signup and view all the answers

T-zone lymphoma, an indolent subtype, is characterized by neoplastic cells that are typically:

<p>T-cells negative for CD45. (C)</p> Signup and view all the answers

Erythrophagia, the engulfment of red blood cells by neoplastic cells, is a characteristic feature most strongly associated with:

<p>Histiocytic sarcoma. (A)</p> Signup and view all the answers

Which combination of diagnostic findings would be MOST definitively indicative of multiple myeloma?

<p>Monoclonal gammopathy, lytic bone lesions, and &gt;20% plasma cells in bone marrow. (D)</p> Signup and view all the answers

To differentiate between Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML) when blast morphology is inconclusive, which ancillary diagnostic test is MOST definitive?

<p>Histochemical staining (e.g., myeloperoxidase) and flow cytometry immunophenotyping. (D)</p> Signup and view all the answers

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?

<p>Chronic lymphocytic leukemia. (B)</p> Signup and view all the answers

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?

<p>Presence of Auer rods in blast cells on bone marrow smear. (B)</p> Signup and view all the answers

Flashcards

Lymphoma

Cancer that was formerly known as lymphosarcoma and is a common neoplasm in all species.

Lymphoma

Solid tissue tumor originating outside the bone marrow, presenting as discrete tissue masses or diffuse infiltration.

Histiocytic Tumors

Tumors that arise from histiocytes, including macrophages and dendritic cells.

Leukemic

The term for when neoplastic lymphoma or leukemia cells are found in the bloodstream.

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Aleukemic Leukemia

Bone marrow has leukemia, but no abnormal neoplastic cells are circulating.

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Multiple Myeloma

A malignant plasma cell tumor arising in bone marrow, marked by protein abnormalities.

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Immunophenotyping

Antibodies are used to find molecules on cell membranes. Used on biopsies, and in flow cytometry, for immune cell identification.

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PARR (PCR for Antigen Receptor Rearrangement)

PCR to amplify immunoglobulin and T-cell antigen receptor genes to assess clonality.

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Lymphoma

Hematopoietic neoplasm commonly found in dogs. Solid tumor originating outside the bone marrow.

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Acute Leukemia General Principles

Neoplasms originating from bone marrow precursors, indicated by >20% blasts there.

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Protein Electrophoresis

Used for fractionating serum proteins and based on size and charge. It shows if monoclonal gammopathy is present.

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Leukemia Terminology

Tumor originating in the bone marrow, or a disease stage of cells in the bloodstream. Can be aleukemic.

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Acute and Chronic Leukemias

Malignancies originating from hematopoietic precursors, either lymphoid or myeloid.

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Acute Leukemias

Rapidly progressive leukemias where cells proliferate but don't differentiate, remaining immature and blastic.

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Chronic Leukemias

Slowly progressive leukemias where cells can differentiate, resulting in high levels of near-normal cells.

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Lymphoma Location

Anywhere, including lymph nodes, thymus, spleen, liver, kidney, and skin.

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Lymphoma Characteristics

Tissue tumor where neoplastic cells efface normal architecture, diagnosed via biopsy or cytology.

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Causes of Lymphopenia in Lymphoma

Lymphocytes get trapped, stress, or other reasons.

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Lymphoma & Hypercalcemia

T-cell lymphomas sometimes produce PTHRP, which causes increased blood calcium and PUPD.

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Lymphoma Classification

Classifying lymphomas by location, clinical stage, histologic grade, and immunophenotype.

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Multicentric Lymphoma

Lymphoma that is present in multiple lymph nodes, either peripheral or visceral.

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Alimentary Lymphoma

Common lymphoma in cats, found in the intestinal tract/stomach, often in older, FeLV-negative cats.

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Stage I Lymphoma

Enlarged lymph node

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Stage II Lymphoma

Multiple regional lymph nodes affected

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Stage III Lymphoma

Both sides of the diaphragm are affected.

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Stage IV Lymphoma

Either only the liver/spleen, or liver/spleen along with lymph nodes

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Stage V Lymphoma

In bone marrow, blood or extra nodal sites

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"B" Designation in Canine Lymphoma

Indicates systemic illness or hypercalcemia.

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Clonality

Normal lymphocyte antigen markers have been rearranged. Single spike indicates malignant population

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Flow Cytometry Advantages & Disadvantages

Good test, but you need live cells, so quick time is required.

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Immunohistochemistry

Immunohistochemistry can tell you about the markers on the cells, which can give prognostic information.

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CD4

Helper T-cells, they have CD4 on them.

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CD8

Suppressor T-cells or Cytotoxic T cells, they have CD8 on them.

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CD34

Marker for early stem cells, or bone marrow derived tumor.

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Histologic Grade

Looking at the arrangement of cells in the tissues, cell size, mitotic rate, follicles or not.

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Diffuse Large Cell Lymphoma

High-grade tumors that are fast and aggressive, will often respond well to cheating.

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Indolent Tumors

Low mitotic rate and slowly progressive.

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Lymphoma: Marginal Zone

CD21 positive.

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Lymphoma: T Zone

T-cell crowding out of the follicles of the paracortex.

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Lymphoma flow pattern: T-Zone.

CD45 negative.

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Lymphoma: Cell Type

B-cell tumors do better.

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Lymphoma: Steroid Given...

Becomes multi-drug resistant.

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Pancytopenia causes

May be the result of abnormal cells replacing normal hematopoietic cells.

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Acute Leukemia

Poorly differentiated or undifferentiated cells in the bone marrow +/- blood.

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Acute Leukemia: In Bone Marrow

Neoplastic cells are stuck in marrow.

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Myeloid Leukemia

Originating from precursors in the marrow that are not lymphoid.

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Cell Morphology Aids

Can aid with classification, but have to be careful when you have these cells because you are often wrong.

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Lymphoma Cell Type: Scary.

They may have prominent nucleoli and are abnormal cells.

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Differentiation: L or L?

Immunophenotype on flow.

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Bone Marrow with Chronic Leukemia

You might see granulocytic hyperplasia because of a leukemia or because of inflammation.

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Monocolonal

Produced by one type of antibody.

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Neoplastic characteristics multiple myeloma.

Functional plasma cells with one exception, typically IgG or sometimes IgM.

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Bence Jones proteins

Immunoglobulin light chains are small enough that they can get into the urine.

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Serum Protein Electrophoresis

Used for testing antibodies that are being produced, or for serum protein electrophoresis. You put a sample into the matrix, and it is attached to the electrodes running a current through there. The proteins separate based on charge and size.

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Antibodies

The immunoglobulins in the gamma globulin area that are going to be a little bit different.

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Histiocytic Sarcoma

Macrophages or dendritic cells. Malignant tumors all over (lung, spleen, lymph node, bone marrow).

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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 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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