00:03
Let’s take a look at ALL.
00:05
With ALL,
acute lymphoblastic leukemia is what I
prefer to call it because it’s acute.
00:12
You still expect to find
increase in blast count
in the bone marrow
of greater than 20%.
00:17
Next, it’s lympho.
00:20
Then you have two types,
pre-T/pre-B, pre-T/pre-B.
00:25
Can be extramedullary.
00:27
That’s important.
00:28
Call this lymphoblastic lymphoma.
00:30
And where it metastasized
is very important,
CNS and the testicles,
metastasis.
00:37
Acute lymphoblastic leukemia.
00:39
By definition once again, acute, you’re
going to find greater than 20% blasts.
00:43
Remember please, this time
it will be lymphoblast.
00:46
Smaller than myeloblasts with large
nuclei and scant basophilic cytoplasm.
00:51
So cytoplasm is not going to be as
abundant as what you find with myeloblast.
00:56
But nonetheless, these are blasts.
01:00
With ALL,
quickly for us, we’ll
go through tables here
to compare and contrast
pre-B and pre-T.
01:06
Let’s begin.
01:06
Thank goodness
and I say only if your
child develops ALL.
01:12
If it’s pre-B, 80% of
time, it will be this.
01:16
The reason I said that this is decent
is because of prognosis is excellent.
01:20
In pre-T, it’s devastating.
01:24
Let's walk through this
just a little bit more.
01:26
Pre-T, where does the T
cells gets educated?
Thymus, good.
01:31
So now, tons of T --
Let’s say if it was
T, type of ALL,
Tons of T cells,
the thymus is now in a child
hyperplasia, hyperplasia,
hyperplasia, hyperplasia.
01:44
Oh no.
01:45
Now what happens?
In a child, it’s going to
compromise the thoracic cavity.
01:49
Compromise perhaps the
heart or the lungs.
01:52
Your child is pretty much dead.
01:55
That’s because of death in pre-T.
01:57
Age of onset, childhood.
01:59
Adolescence, a little bit
older but still childhood.
02:02
Site: If it’s pre-B, take a look.
02:05
Blood and bone marrow.
02:08
Pre-T, mediastinal mass.
02:10
What does that mean?
The thymus.
02:14
Keep that in mind.
02:15
WBC count: Pre-B,
low to normal.
02:19
Pre-T, it will be high.
02:22
Prognosis: Pre-B, good.
02:25
Pre-T: Now I want you to connect,
mediastinal mass and poor.
02:30
If you find a mediastinal mass
in an adolescent or a child
and therefore, it will
compromise the thoracic cavity
and all the organs within it
and will kill the patient.
02:40
Poor prognosis.
02:42
Symptoms: Overall,
pancytopenia, anemia,
thrombocytopenia, leukopenia,
neurologic symptoms
and bone pain.
02:54
Let’s go into chronic leukemias.
02:56
With chronic leukemia, we’re not going to
call these lymphoblastic, myeloblastic.
03:00
No, no, no.
03:01
We will call this chronic myelocytic
leukemia and chronic lymphocytic leukemia.
03:08
Same concept as acute but chronic,
now, the cells have a little bit more
time to mature in the bone marrow.
03:14
You will not find a blast
count greater than 20%.
03:18
If anything, you’ll find a blast count
to be quite low and a bit less than 10%.
03:23
So more mature leukocyte
is the point.
03:26
Chronic mature leukemias.
03:29
We’ll talk about CML, CLL, hairy
cell and adult T cell leukemia.