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Medicine 2 - 08 Breast Cancer > 8 Lypmhomas, brain tumours, embryonal tumours and teratomas > Flashcards

8 Lypmhomas, brain tumours, embryonal tumours and teratomas Flashcards

1
Q

Define a lymphoma

A

Lymphomas are neoplastic proliferations of lymphoid cells of various types

Malignant process of mature cells - lymphoma
(T, B cell lymphomas)

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2
Q

Define leukaemia’s

A

Leukaemia’s are neoplastic proliferations of the cells of the haemopoietic bone marrow
(mainly blood, white cells and their precursors)

Tumour from blast phase (progenitors)

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3
Q

List the two main groups of lymphomas

A
  • Hodgkin’s disease: and the rest (grouped under same name)

- Non-hodgkin’s lymphoma - most common and important of these are lymphocytic lymphomas

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4
Q

Give the clinical features and behaviour of lymphomas

A
  • Most present clinically with lymphadenopathy - lymph node enlargement, localised or generalised
  • Some may also infiltrate (Hepatomegaly), spleen (Splenomegaly) or Bone Marrow (marrow replacement, with haematological consequences)
  • Bad prognosis types may diffusely infiltrate other organs
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5
Q

List the main types of Hodgkin’s disease

A
  • Lymphocyte rich Hodgkin’s
  • Mixed cellularity Hodgkin’s
  • Nodular sclerosing Hodgkin’s
  • Lypmhocyte-depleted Hodgkin’s
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6
Q

What gives rise to the different types of Hodgkin’s disease

A

The different types of Hodgkin’s disease are based on the differing proportions of:

  • Reed-Sternberg cells
  • Lymphocytes
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7
Q

What is the neoplastic cell found in Hodgkin’s lymphomas?

A

Reed-Sternberg cells

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8
Q

Describe Reed-Sternberg cells

A

Main neoplastic cell found in Hodgkin’s Disease

  • They are often multi nucleated
  • Prominent nuclei
  • Large cell
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9
Q

Describe the different types of Hodgkin’s disease based on the

A

Lymphocyte rich Hodgkin’s
- Few R-S cells, lots of lymphocytes

Lymphocyte depleted Hodgkin’s
- Lots of R-S cells, few lymphocytes

Mixed-cellularity Hodgkin’s
- Roughly equal proportions of R-S cells and lymphocytes

Nodular sclerosing Hodgkin’s
- As mixed cellularity, but different architecture

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10
Q

What is the relationship between the number of Reed-Sternberg cells and the prognosis of the type of Hodgkin’s disease

A

The more the number of R-S cells, the worse the prognosis

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11
Q

Describe a myeloma

A

A myeloma is a tumour of mature plasma cells (later stage of differentiation of B cell lymphocytes

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12
Q

Describe what myelomas can present with

A

It presents with bone tumours, osteolytic, painful, but with interesting systemic effects
- Anaemia, renal/cardiac failure, infections, hypercalcaemia - lytic bone lesions)

Pronounced cytoplasm in plasma cells (function is to release antibodies) - so immune system is seen to be compromised (suppression) - they can accumulate other immunoglobulins and can form amyloids, which can deposit themselves on organs (renal/cardiac failure)

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13
Q

What are most primary tumours of the brain derived from?

A

The most primary tumours of the brain are derived from the support cells called:
- Glial cells

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14
Q

Name some different glial cells:

A
  • astrocytes
  • Oligodendrocytes
  • ependymal cells
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15
Q

List some different tumours that can arise from glial cells

A

Gliomas:

  • Astrocytomas (most common)
  • Oligodendrocytoma
  • Ependymoma

There can be combined tumours - oligodendroastrocytomas

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16
Q

Do astrocytomas show malignant traits (if so, which ones/which ones not?)

A

All astrocytes behave in a malignant manner, but DO NOT metastasise

17
Q

How are astrocytomas graded?

A

On a 1-4 grading system

  • 1 is good
  • 4 is bad

4 is worst prognosis - glioblastoma

18
Q

Give some features of grade 2 astrocytomas

A
  • Well differentiated
  • No metastasis
    > grow locally into skull (not expandable) - so even benign tumour can show symptoms
  • There is a shift of median line, because of the growth of the tumour, and will cause compression in the ventricles, where there is CSF

So, increase in pressure in CSF = cause symptoms of cranial hypertension
- Symptoms depend on area of brain involved

Surgery must be done - to remove the tumour

19
Q

Give some features of grade 4 astrocytomas

A
  • Poorly differentiated
  • This is a glioblastoma - astrocytoma grade 4
  • Huge infiltration
  • Complete compression of the ventricles
  • So, this tumour is treated with surgery - problem is it is difficult to eradicate tumour
  • On periphery of this tumour, there are cells which infiltrate normal parenchyma
  • So, surgeon will not be able to completely excise the tumour, due to normal parenchyma, causing additional symptoms
  • External radiotherapy followed to treat remaining tumour cells

Surgery, followed by radiotherapy and chemotherapy

20
Q

Describe embryonal tumours

A

Embryonal tumours are derived from embryonic remnants of primitive ‘blast’ tissues

The tumour arises at the stage of the pluripotent embryonic stem cells:
- they will be very undifferentiated

21
Q

List the main characteristics of embryonal tumours

A
  • Mainly occurs in young children
  • Highly malignant (proliferative)
  • Spread early and widely by lymphatics and veins
  • Sensitive to chemotherapy (due to high proliferation)
  • Formerly rapidly fatal, chemotherapy has revolutionised prognosis
22
Q

Give some examples of embryonal tumours

A
  • Nephroblastoma (Wilm’s tumour) - in kidney, most common
  • Neuroblastoma - mostly in adrenal gland, derived from primitive adrenal medullary precursors (neuroblasts); next most common

Much rarer are:

  • Retinoblastoma - retina; often bilateral; genetic basis
  • Medulloblastoma - cerebellum
  • Hepatoblastoma - liver
23
Q

Give an example os a neuroblastoma

A
  • Arise from adrenal gland
  • Very advanced local invasion with lymph node spread
  • Also, extensive blood-borne spread (lung, liver, and bones)
  • This is renal vein - completely infiltrated
24
Q

Give the histology of a neuroblastoma

A
  • Small, dark staining undifferentiated cells
  • Radically, proliferating cells
  • Mitosis can be seen
  • Multi nucleated
25
Q

Give possible management options of a patient with neuroblastoma

A

Treat this patient with chemotherapy (responds well - due to high proliferative nature

  • sometimes surgery needed if possible, to eradicate disease
26
Q

Describe teratomas

A

Teratomas are tumours derived from the primordial germ cells - retain the capacity to differentiate along all 3 primitive embryological lines

Hence, teratomas should contain representatives of ectoderm, mesoderm and endoderm
- Since they are of germ cell origin, they mainly occur in the ovary and testis

27
Q

Describe a teratoma of the ovary (key facts)

A
  • They occur in young women
  • Occur as a benign tumour
  • They are invariably cystic (benign cyst of ovary)
  • Contain many tissues: Skin, hair, bronchial, and gut epithelium, thyroid, neuroglia, bone, cartilage
  • GOOD PROGNOSIS
28
Q

Describe a benign cystic teratoma of the ovary

A
  • Thin-walled cyst filled with keratin and hairs etc.

- Epidermal tissue, fat

29
Q

Describe the histology of benign cystic teratoma walls

A
  • Note - epidermis, hair follicles, sebaceous glands (fat), nerve tissue with ganglion cells
30
Q

Describe a teratoma of the testis

A
  • Occur in young women
  • Painless welling of testis (clinical presentation)
  • Malignant tumour
  • Malignancy varies according to type
  • Spreads early via blood stream ( -> lung + liver etc.)
  • Chemotherapy has revolutionised prognosis (responds between in immature form) - they are very undifferentiated, could differentiate in other parts of body - pluripotent stem cell features

Medicine 2 - 08 Breast Cancer (8 decks)

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