Snapshot A 7-year-old boy presents with low-grade fever and fatigue. He is notably pale. On physical exam, he has bilateral cervical lymphadenopathy and a mediastinal mass. Blood smear shows increased lymphoblasts. He is referred for a bone marrow biopsy. Introduction Acute leukemia of lymphoid precursor cells that occurs in children Subtypes B-cell ALL – 85% of all ALL t(12;21) most common in children t(9;22) most common in adults same translocation seen in CML CD10+ and CD19/20+ TdT+ (marker of precursor T- and B-cells) T-cell ALL presents in teenagers CD2-8+ (especially CD3+) TdT+ (marker of precursor T- and B-cells) most common presentation is mediastinal mass infiltration of thymus Epidemiology < 15 years Most common type of cancer and leukemia in children Most cases with no identifiable risk factor etiology 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 Best initial test - peripheral blood smear ↑ lymphoblasts Most accurate test bone marrow biopsy with cytogenetics ↑ lymphoblasts (> 25%) TdT+, a marker of pre-T and pre-B cells T-cell ALL CD3+ B-cell ALL CD10+ CD19+ negative MPO (myeloperoxidase) CBC reflects bone marrow crowding by neoplasm anemia thrombocytopenia ↓ mature WBCs Differential Diagnosis AML B-cell lymphoma Non-Hodgkin lymphoma Treatment Chemotherapy Prophylaxis to CNS (standard chemotherapy does not penetrate blood-brain barrier) intrathecal chemotherapy Complications Likes to spread to CNS and testes DIC Tumor lysis syndrome rapid breakdown and turnover of lysed cells causes hyperuricemia hyperkalemia hypocalcemia (most common electrolyte abnormality) Prognosis Very responsive to therapy Good prognosis in t(12;21) Worse prognosis in t(9;22)
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.ON.15.4679) A 7-year-old boy is brought to his pediatrician by his mother for recent fatigue and intermittent fevers over the past month. She also reports that her son has appeared much paler recently. Vital signs at today's visit are within normal limits. Physical examination is significant for pallor, petechiae, lymphadenopathy, and hepatosplenomegaly. A complete blood count reveals anemia, thrombocytopenia, and neutropenia. A peripheral blood smear is shown in Figure A. Bone marrow aspiration reveals 47% lymphoblasts. Which of the following is associated with this patient's presenting condition? QID: 107285 FIGURES: A Type & Select Correct Answer 1 Klinefelter syndrome 5% (1/21) 2 Turner syndrome 0% (0/21) 3 Down syndrome 90% (19/21) 4 Edwards syndrome 0% (0/21) 5 Patau syndrome 0% (0/21) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M2.OMB.4870) A 5-year-old boy presents to his primary care physician for recurrent colds, fatigue, and fussiness. Over the past several weeks, the child has been more fatigued and his parents state that “he always seems to be sick.” He otherwise is healthy and up to date on his vaccinations. They state that sometimes he complains about his bones hurting and they note that he is less playful. His temperature is 102°F (38.9°C), blood pressure is 92/60 mmHg, pulse is 115/min, respirations are 23/min, and oxygen saturation is 99% on room air. Physical exam is notable for diffuse non-tender lymphadenopathy. Abdominal exam reveals hepatosplenomegaly. Laboratory studies are ordered as seen below.Hemoglobin: 8.0 g/dLHematocrit: 23%Leukocyte count: 27,500/mm^3 with 35% lymphoblastsPlatelet count: 49,000/mm^3 Serum:Na+: 139 mEq/LCl-: 101 mEq/LK+: 4.0 Eq/LHCO3-: 24 mEq/LBUN: 16 mg/dLGlucose: 100 mg/dLCreatinine: 0.7 mg/dLWhich of the following is the most likely diagnosis? QID: 216615 Type & Select Correct Answer 1 Acute lymphoblastic leukemia 0% (0/0) 2 Acute myelogenous leukemia 0% (0/0) 3 Chronic myelogenous leukemia 0% (0/0) 4 Leukemoid reaction 0% (0/0) 5 Parvovirus B19 infection 0% (0/0) M 10 Question Complexity Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (0) Oncology | Acute Lymphoblastic Leukemia (ALL) Oncology - Acute Lymphoblastic Leukemia (ALL) Listen Now 11:13 min 8/30/2022 13 plays 0.0 (0)