Snapshot A 11-year-old girl with Down syndrome presents with a few weeks of low-grade fever. She is otherwise feeling well, with no signs of infection. Blood-work shows elevated WBCs, low neutrophil count, and anemia. Blood cultures are drawn and come back positive for Pseudomonas. Introduction Acute leukemia of lymphoid precursor cells that occurs in children Crowding of bone marrow leads to bone marrow failure Subtypes B-cell ALL – 85% of all ALL CD10+ and CD19/20+ TdT+ (marker of precursor T- or B-cell) T-cell ALL CD2+, CD8+, and CD3+ TdT+ (marker of precursor T- or B-cell) commonly presents as mediastinal mass infiltration of thymus Epidemiology < 15 years most common type of cancer and leukemia in children Associated conditions Down syndrome in children > 5 years leukemia in Down syndrome children < 5 years = AML Presentation Symptoms most common symptom is fever acute onset recurrent infections bleeding fatigue Physical exam mediastinal mass from infiltration of thymus hepatosplenomegaly lymphadenopathy Evaluation Peripheral blood smear ↑ lymphoblasts (high nuclei to cytoplasm ratio) CBC reflects bone marrow failure anemia thrombocytopenia ↓ mature WBCs Bone marrow aspiration with cytogenetics ↑ lymphoblasts TdT+, a marker of pre-T and pre-B cells T-cell ALL CD2+ CD3+ B-cell AML CD10+ CD19+ negative MPO (myeloperoxidase) t(12:21) Differential Diagnosis AML B-cell lymphoma Non-hodgkin lymphoma Treatment Chemotherapy Prophylaxis to CNS (standard chemotherapy does not penetrate blood-brain barrier) intrathecal chemotherapy Prognosis, Prevention, and Complications Prognosis very responsive to therapy Complications likes to spread to CNS and testes
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.ON.15.8) A 39-year-old G1P0 female at 36 weeks gestation will give birth to an infant with the following karyotype (Figure A). Which of the following will the infant be at an increased risk of developing later in life? QID: 107000 FIGURES: A Type & Select Correct Answer 1 Testicular cancer 1% (1/74) 2 Gonadal blastoma 0% (0/74) 3 Dysgerminoma ovarian tumor 1% (1/74) 4 Acute lymphoblastic leukemia (ALL) 89% (66/74) 5 Chronic myelogenous leukemia (CML) 7% (5/74) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.ON.15.72) A 33-year-old pregnant woman undergoes a routine quad-screen during her second trimester. The quad-screen results demonstrate the following: decreased alpha-fetoprotein, increased Beta-hCG, decreased estriol, and increased inhibin A. A presumptive diagnosis is made based upon these findings and is later confirmed with genetic testing. After birth, this child is at greatest risk for which of the following hematologic malignancies? QID: 106527 Type & Select Correct Answer 1 Chronic lymphocytic leukemia 3% (4/126) 2 Hairy cell leukemia 3% (4/126) 3 Acute promyelocytic leukemia 10% (13/126) 4 Acute lymphoblastic leukemia 79% (100/126) 5 Chronic myelogenous leukemia 2% (3/126) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.ON.13.29) A mother brings her 5-year-old child to your pediatric practice for evaluation of "croup". She reports her child has a history of weight loss, fatigue, and fever over the past two weeks. On physical exam you note respirations heard in figure V and skin findings seen in Figure A. Labs reveal thrombocytopenia, anemia, and leukocytopenia with a peripheral blood smear showing abundant lymphoblasts. Given this child's physical exam findings, what cell surface marker would the blasts be expected to express? QID: 101693 FIGURES: V A Type & Select Correct Answer 1 CD1 2% (4/186) 2 CD3 53% (99/186) 3 CD10 19% (35/186) 4 CD19 12% (23/186) 5 CD20 11% (20/186) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.ON.13.72) A 5-year-old male is brought to his pediatrician after recurrent, prolonged upper respiratory infections over a period of several months. Physical exam reveals petechiae on the patient’s legs and arms. Laboratory studies show hemoglobin: 10 g/L, platelet count: 35,000/mm^3, leukocyte count: 6,600/mm^3. A bone marrow aspiration shows an abundance of lymphoblasts indicative of acute lymphoblastic leukemia (ALL). Positive immunostaining for which of the following would support a diagnosis of precursor B-cell leukemia? QID: 101382 Type & Select Correct Answer 1 TdT, HER-2 6% (11/180) 2 CD2, CD8 6% (10/180) 3 CD19, CD10 67% (120/180) 4 CD30, CD15 11% (20/180) 5 CD4, CD5 8% (15/180) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.ON.12.41) A 15-year-old adolescent boy presents to the emergency department with fever, malaise, and shortness of breath for 1 week. Further history reveals that the patient experiences swelling in his face in the morning that disappears as the day progresses. Physical exam reveals hepatosplenomegaly. A complete blood count shows WBC 84,000 cells/mL. Most of this patient's leukocytes are likely to express which of the following cell surface markers? QID: 101351 Type & Select Correct Answer 1 CD2 50% (14/28) 2 CD10 18% (5/28) 3 CD19 0% (0/28) 4 CD20 7% (2/28) 5 CD16 21% (6/28) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Stridor Meredith Curtis Laguna Oncology - Acute Lymphoblastic Leukemia (ALL) E 10/15/2013 28 views 0.0 (0)