Oncology Self-Study: Leukemia and Brain Tumors

Jul 18, 2018

Test your knowledge of leukemia and brain tumors with questions from the most recent edition of ASCO-SEP®, ASCO’s self-evaluation program in oncology.

The sixth edition of ASCO-SEP is available for purchase in the ASCO University® bookstore (university.asco.org/SEP), featuring 22 new and updated chapters and more than 190 new self-assessment questions in the book, as well as an online mock exam with 120 original self-assessment questions. Upon successful completion of both the ASCO-SEP book self-assessment questions and the mock exam, participants may request Continuing Education, American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC), Nursing, and Pharmacy credit through online modules. Visit university.asco.org for information about the latest edition of ASCO-SEP and other self-assessment resources.

Correct answers are listed at the bottom of the page.

1. A 62-year-old woman is in the emergency room complaining of fever, night sweats, fatigue, and anorexia for the last three to four weeks. A physical examination reveals conjunctival pallor and petechiae. Laboratory testing reveals moderate pancytopenia (hematocrit 28%, leukocyte count 1500/uL, absolute neutrophil count 450/uL, and platelet count 35,000 uL) and an elevated lactate dehydrogenase (LDH). On peripheral smear, there is anisopoikilocytosis, decreased neutrophils with hypogranular and hyposegmented neutrophils, and large atypical platelets. A bone marrow aspirate shows dysplastic cells with abundant cytoplasm and azurophilic granules and prominent nucleoli. Flow cytometry is positive for CD13, CD33, CD34, CD117, and HLA-DR. Bone marrow core biopsy is pending.

Which of the following is the most likely diagnosis?

  1. Acute Myeloid Leukemia (AML)
  2. Acute Lymphocytic Leukemia (ALL)
  3. Hairy Cell Leukemia (HCL)
  4. Chronic Myeloid Leukemia (CML)
  5. Chronic Lymphocytic Leukemia (CLL)

2. A 58-year-old man has acute global aphasia without seizure activity. An MRI revealed a left frontotemporal enhancing tumor with ischemic stroke in the territory of the middle cerebral artery. The brain tumor was sub totally resected and a pathology examination of the specimen confirmed the diagnosis of glioblastoma multiforme.

Which of the following is the most appropriate evidence-based depiction of the role of prophylactic anticonvulsants use in this case?

  1. It should not be used routinely since it does not improve seizure control.
  2. It should be restricted to high-risk cases for seizures.
  3. It should be used when there is no drug-drug interaction with chemotherapy.
  4. It should be used in supratentorial tumors with associated edema.

Rationale

1: A

The median age of AML is approximately 60 years old and presents with pancytopenia or increased white blood cell count with decreased hemoglobin and platelets due the involvement in the bone marrow. Due to thrombocytopenia, patients may have petechiae and are at increased risk of bleeding. Most cases of AML express antigens found on immature myeloid cells, including CD 13, CD33,` and CD34. ALL presents with either B or T cell markers such as CD19/CD20 or CD3, respectively. HCL and CML often present with splenomegaly. HCL is also positive for CD 11c/CD103 and/or CD123. CLL has an increased lymphocyte count, has B-cell surface markers, and is CD5 positive.

Suggested Readings

Döhner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010 Jan 21;115(3):453-74.

Rowe JM, Tallman MS. How I treat acute myeloid leukemia. Blood. 2010 Oct 28;116(17):3147-56.

2: A

Seizures are common in supratentorial meningioma and in tumors associated with brain edema. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures.

Suggested Readings

Englot D, et al. Seizures in supratentorial meningioma: a systematic review and meta-analysis. J Neurosurg. 2016 Jun;124(6):1552-61.

Glantz M et al. Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neurology. 2000;54:1886-1893.

Sayegh E et al. Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence. J Neurosurg. 2014;121:1139–1147.

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