WBR0930: Difference between revisions

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|MainCategory=Pathology, Pharmacology
|MainCategory=Pathology, Pharmacology
|SubCategory=Hematology
|SubCategory=Hematology
|MainCategory=Pathology, Pharmacology
|MainCategory=Pathology, Pharmacology
|MainCategory=Pathology, Pharmacology
|MainCategory=Pathology, Pharmacology
|MainCategory=Pathology, Pharmacology
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|Explanation=Acute promyelocytic leukemia (APML) is rare subset of acute myeloid leukemia (AML).  APML is characterized by a chromosomal translocation involving the retinoic acid receptor-alpha gene on chromosome 17 (RARA).  These cells undergo a differentiation arrest, which can be reversed with all-trans retinoic acid.  Arsenic is thought to act by inhibiting the enzyme thioredoxin reductase.Histologically, APML is notable for leukemic cells containing rod-like cytoplasmic inclusions called “Auer rods”.  Treatment of APML can precipitate release of these inclusion and cause DIC.   
|Explanation=Acute promyelocytic leukemia (APML) is rare subset of acute myeloid leukemia (AML).  APML is characterized by a chromosomal translocation involving the retinoic acid receptor-alpha gene on chromosome 17 (RARA).  These cells undergo a differentiation arrest, which can be reversed with all-trans retinoic acid.  Arsenic is thought to act by inhibiting the enzyme thioredoxin reductase.Histologically, APML is notable for leukemic cells containing rod-like cytoplasmic inclusions called “Auer rods”.  Treatment of APML can precipitate release of these inclusion and cause DIC.   


'''Educational Objective:''' Angiosarcoma is a potential late complication of exposure to arsenic.
|AnswerA=Gastric cancer
 
|AnswerAExp=Gastric cancer can occur as a result of nistrosamine exposure. Nitrosamines are carcinogenic chemical compounds present in various foods, notably smoked meats.
'''References: '''
|AnswerB=Leukemia
 
|AnswerBExp=Leukemia can occur as a result of previous genotoxic chemotherapy, such as alkylating agents.
First Aid 2013 page 223
|AnswerC=Transitional cell carcinoma of the bladder
|AnswerCExp=Transitional cell carcinoma of the bladder is associated with previous exposure to napthylamine compounds (used in the manufacture of aniline synthetic dyes).
|AnswerD=Hepatocellular carcinoma
|AnswerDExp=Hepatocellular carcinoma is caused by exposure to aflatoxin.
|AnswerE=Angiosarcoma
|AnswerEExp=Angiosarcoma is a potential late complication of exposure to arsenic.
|EducationalObjectives=Angiosarcoma is a potential late complication of exposure to arsenic.
|References=First Aid 2013 page 223


First Aid 2012 page 255
First Aid 2012 page 255
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The carcinogenicity of arsenic. Pershagen G. Environ Health Perspect. 1981 Aug;40:93-100. Review. PMID: 7023936
The carcinogenicity of arsenic. Pershagen G. Environ Health Perspect. 1981 Aug;40:93-100. Review. PMID: 7023936
|AnswerA=Gastric cancer
|AnswerAExp='''Incorrect:''' Gastric cancer can occur as a result of nistrosamine exposure.  Nitrosamines are carcinogenic chemical compounds present in various foods, notably smoked meats.
|AnswerB=Leukemia
|AnswerBExp='''Incorrect:''' Leukemia can occur as a result of previous genotoxic chemotherapy, such as alkylating agents.
|AnswerC=Transitional cell carcinoma of the bladder
|AnswerCExp='''Incorrect:''' Transitional cell carcinoma of the bladder is associated with previous exposure to napthylamine compounds (used in the manufacture of aniline synthetic dyes).
|AnswerD=Hepatocellular carcinoma
|AnswerDExp='''Incorrect:''' Hepatocellular carcinoma is caused by exposure to aflatoxin.
|AnswerE=Angiosarcoma
|AnswerEExp='''Correct:''' Angiosarcoma is a potential late complication of exposure to arsenic.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Cancer, Chemotherapy, Side effect, Leukemia, Acute promyelocytic leukemia, Toxin
|WBRKeyword=Cancer, Chemotherapy, Side effect, Leukemia, Acute promyelocytic leukemia, Toxin
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 13:22, 12 January 2015
Author PageAuthor::William J Gibson
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology, MainCategory::Pharmacology
Sub Category SubCategory::Hematology
Prompt Prompt::A 35 year old man is treated for acute promyelocytic leukemia with a sustained course of arsenic trioxide and All-trans-retinoic acid. If he develops a secondary malignancy due to this therapy, which of the following is most probable?
Answer A AnswerA::Gastric cancer
Answer A Explanation AnswerAExp::Gastric cancer can occur as a result of nistrosamine exposure. Nitrosamines are carcinogenic chemical compounds present in various foods, notably smoked meats.
Answer B AnswerB::Leukemia
Answer B Explanation AnswerBExp::Leukemia can occur as a result of previous genotoxic chemotherapy, such as alkylating agents.
Answer C AnswerC::Transitional cell carcinoma of the bladder
Answer C Explanation AnswerCExp::Transitional cell carcinoma of the bladder is associated with previous exposure to napthylamine compounds (used in the manufacture of aniline synthetic dyes).
Answer D AnswerD::Hepatocellular carcinoma
Answer D Explanation AnswerDExp::Hepatocellular carcinoma is caused by exposure to aflatoxin.
Answer E AnswerE::Angiosarcoma
Answer E Explanation AnswerEExp::Angiosarcoma is a potential late complication of exposure to arsenic.
Right Answer RightAnswer::E
Explanation [[Explanation::Acute promyelocytic leukemia (APML) is rare subset of acute myeloid leukemia (AML). APML is characterized by a chromosomal translocation involving the retinoic acid receptor-alpha gene on chromosome 17 (RARA). These cells undergo a differentiation arrest, which can be reversed with all-trans retinoic acid. Arsenic is thought to act by inhibiting the enzyme thioredoxin reductase.Histologically, APML is notable for leukemic cells containing rod-like cytoplasmic inclusions called “Auer rods”. Treatment of APML can precipitate release of these inclusion and cause DIC.

Educational Objective: Angiosarcoma is a potential late complication of exposure to arsenic.
References: First Aid 2013 page 223

First Aid 2012 page 255

http://ctdbase.org/detail.go?type=relationship&chemAcc=C006632&diseaseAcc=D006394&diseaseDb=MESH

The carcinogenicity of arsenic. Pershagen G. Environ Health Perspect. 1981 Aug;40:93-100. Review. PMID: 7023936]]

Approved Approved::Yes
Keyword WBRKeyword::Cancer, WBRKeyword::Chemotherapy, WBRKeyword::Side effect, WBRKeyword::Leukemia, WBRKeyword::Acute promyelocytic leukemia, WBRKeyword::Toxin
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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