Lymph Nodes
Normal	Abnormal
Soft	FIRM
Mobile	IMMOBILE
<2cm	>2cm
No systemic Sx	SYSTEMIC SX (Fever, Night Sweats, Weight loss)

AML
Features	·       MCC adult acute leukemia ·       Median age 65 👴🏻👵🏼
S/S	·       Fatigue is common (other B symptoms unusual) ·       Sx of Cytopenias: ·       Fatigue, weakness (anemia) ·       Bleeding, bruising (thrombocytopenia) ·       Infection (granulocytopenia) ·       No HSM/LN ⊖ ·       DIC (if APML)
Labs	Cytopenias (leukocytes may be ⤴️, normal or ⤵️) ⤴️ LDH Blood Smear: Myeloblasts with Auer rods
Dx	BM Bx: usually HYPERCELLULAR with myeloid blasts

ALL
Features	Most common childhood cancer Peak age: 2-5 years Male > female
S/S	Nonspecific systemic symptoms Bone pain Lymphadenopathy Hepatosplenomegaly Pallor (from anemia) Petechiae (from thrombocytopenia) Can presents w/ PANCYTOPENIA
Dx	BM BX with >25% lymphoblasts
Tx	Chemotherapy

CLL
Features	Happens in elderly 👵🏼👴🏻
S/S	·       LN ⊕ (cervical, supraclavicular, axillary) ·       HSM ·       Mild ⤵️  PLT + Anemia ·       Rx Infections (PNA) ·       Often Asx
Dx	·       CBC ·       ⤴️ WBC (>20,00) with > 80% lymphocytes ·       ⤵️ RBCs  ·       ⤵️ PLTs  ·       ⤵️ IgG in half of patients ·       Smear: Smudge Cells ·       Most accurate test: flow cytometry (CD5, 19, 20, 23)
Tx	·       If Asx → Nothing ø ·       If Sx / Rapid progression → fludarabine ·       Curative Tx → Stem Cell Transplant
Prgonosis	Median survival: 10 years Worse prognosis w/: ·       Multiple chain LN ⊕ ·       HSM ·       Anemia & thrombocytopenia

CML
#	·       Happens in adults (50 yo) ·       👨🏻 > 👩🏻
Path	·       Philadelphia chromosome translocation t(9;22)  ·       BCR-ABL fusion gene  ·       Tyrosine kinase hyperactivity
S/S	Chronic: ·       B-Sx: fatigue / night sweats / weight loss ·       Fever ·       splenomegaly / early satiety ·       Itchiness after hot baths Accelerated or blast phase ·       bony pain ·       lymphadenopathy ·       variable skin findings ·       extramedullary mass ·       rapidly enlarging spleen
Dx	CBC ·       ⤴️ WBC (⊕ Nø / Basophils) ·       ⤵️ leukocyte alkaline phosphatase BM Bx ·       ⤴️ Cellularity ·       immature granulocytes Most accurate → FISH showing ⊕ Philadelphia chromosome translocation
Tx	·       Tyrosine kinase inhibitors (Imatinib) ·       Curative → HSCT

	Leukomoid Reaction	CML
WBC #	High (50K)	REALLY HIGH (+100k)
?	Infection	BCR-ABL Fusion
LAP	⤴️	⤵️
Nø	Mature Nø (Metamyelocytes)	Immature Nø (Myelocytes)
Basophils?	⊖	⊕

Hairy Cell Leukemia
#	·       Clonal B-cell neoplasm ·       Middle-age/older adults ·       BRAF mutation (Proto-oncogene)
S/S	Pancytopenia due to BM fibrosis ·       ⤵️ WBC (infections) ·       Anemia (fatigue, weakness) ·       ⤵️ PLT (bleeding, bruising) Splenomegaly (early satiety)
Dx	·       Smear: “hairy” leukocyte ·       BM Bx w/ Flow Cytometry
Tx	Chemotherapy

Langerhans cell histiocytosis
S/S	·       Lytic bone lesions (Skull, jaw, femur) ·       Skin lesions (purplish papules, eczematous rash) ·       LN. HSM ·       Pulmonary cysts/nodules ·       Central Diabetes Insipidus
Dx	Langerhans cells on bone/skin biopsy
Tx	·       Chemotherapy (prednisone ± vinblastine) ·       Desmopressin for diabetes insipidus

Multiple myeloma
Path	Plasma cell neoplasm produces monoclonal paraprotein (immunoglobulin)
S/S	·       Bone pain, Fx ·       B Sx (weight loss, fatigue, Night Sweats) ·       Rx infections
Dx	·       Normocytic anemia ·       Renal insufficiency ·       Hypercalcemia (constipation, muscle weakness, depression) ·       Monoclonal paraproteinemia (M-spike)
X-ray	Osteolytic lesions/osteopenia (osteoclast activation)

	Multiple Myeloma	Waldenström macroglobulinemia
Clx	·        ⤴️ Ca ·       Anemia ·       Renal insufficiency ·       Osteolytic lesions	·       Hyperviscosity (clotting) ·       Bleeding ·       HSM / LN ⊕
Monoclonal antibody	IgG, IgA, light chains	IgM
Smear	Rouleaux	Rouleaux