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Chapter 52: Cancer Biology

You are treating a 47-year-old woman who has come to you with complaints of fatigue, chronic headaches, and radiating pain and fullness on her left side. A routine blood test indicates the presence of increased immature white cells (blasts), reduced platelets, and reduced leukocytes. You order a cytogenetic analysis of the blasts and the results indicate the presence of a chromosomal abnormality consistent with a t(9:22) translocation. This patient is most likely suffering from which of the following?

A. acute lymphocytic leukemia, ALL

B. acute myelogenous leukemia, AML

C. chronic myelogenous leukemia, CML

D. Hodgkin lymphoma

E. Non-Hodgkin lymphoma, NHL

Answer C: Chronic myelogenous leukemia (CML) is a cancer associated with unregulated growth of myeloid lineage cells. The affected cells are mature granulocytes (eosinophils, basophils, and neutrophils) and granulocyte precursors. CML is most often discovered through routine blood tests (a complete blood count, CBC), not due to the presentation of overt symptoms. Detection of CML through a CBC is due to the identification of increased number of granulocytes of all types. Definitive diagnosis of CML is accomplished via the detection of a specific chromosomal translocation in metaphase cells. This translocation is referred to as the Philadelphia chromosome and its presence is denoted as Ph+. The Philadelphia chromosome results from a translocation between chromosomes 9 and 22 (t[9:22]). The t(9:22) translocation fuses the Abelson tyrosine kinase (ABL) on chromosome 9 with the BCR locus on chromosome 22. The BCR-ABL fusion protein results in constitutive activation of the tyrosine kinase activity of ABL.

You are treating a 37-year-old African-American man who has come to you complaining of abdominal distension, night sweats, and shortness of breath all of which have developed over the last 4 weeks. Physical examination decreased breath sounds in right lung base and a 2-cm lymph node appreciated on left inguinal region. Excision biopsy and culture of cells from the inguinal lymph node identified the presence of a chromosomal translocation between chromosomes 14 and 18. Your patient is most likely suffering from which of the following?

A. acute lymphocytic leukemia, ALL

B. acute myelogenous leukemia, AML

C. chronic myelogenous leukemia, CML

D. Hodgkin lymphoma

E. Non-Hodgkin lymphoma, NHL

Answer E: Non-Hodgkin lymphomas (NHLs) are a diverse group of blood cancers that include any kind of lymphoma except Hodgkin lymphomas. There are at least 16 different characterized types of NHL that vary significantly in their severity, from ...

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