Acute Leukaemia and Lymphoma

Question 1

What can be used to differentiate between lymphoid and non-lymphoid cells?

Answer 1

Morphological assessment

Immunophenotyping

Question 2

Describe malignant haemopoeisis?

Answer 2

Increased number of abnormal/dysfunctional cells

Question 3

Outline the problem in acute leukaemias?

Answer 3

Normal proliferation of abnormally immature cells which then have altered differentiation

Question 4

Outline the problem in chronic myeloprolierative disorders?

Answer 4

Proliferation of abnormal progenitor cells

Question 5

What is a driver mutation?

Answer 5

A mutation in a parent cell which is present in daughter cells which gives a growth advantage

Question 6

What is a passenger mutation?

Answer 6

Mutations which do not give a growth advantage but just happens to be present in the ancestor cell when it acquired the driver mutation

Question 7

Malignant haemopoeisis is normally polyclonal true/false

Answer 7

False - it is monoclonal

Question 8

What is the type of malignancy dependent on?

Answer 8

Lineage
Developmental stage
Anatomical site

Question 9

Which cells are mostly involved in CLL?

Answer 9

B cells

Question 10

Which cells are mostly involved in myeloma?

Answer 10

Plasma cells

Question 11

What is a lymphoma?

Answer 11

Lymphoid malignancy with lymph node involvement

Question 12

Which histological features are present in acute leukaemia cells?

Answer 12

High nuclear:cytoplasmic ratio
Prominent nuclei
Rapid proliferation

Question 13

How do acute leukaemias present?

Answer 13

Bone marrow failure symptoms

Question 14

What in an acute leukaemia?

Answer 14

Rapidly progressive clonal malignancy of marrow with maturation defects

Question 15

Which group commonly gets AML?

Answer 15

> 60

Question 16

Which subtype of AML is associated with a coagulopathy?

Answer 16

T(15;17)

Question 17

What is ALL?

Answer 17

Acute lymphoblastic leukaemia

Disease of lymphoblasts

Question 18

How does ALL present?

Answer 18

Anaemia
Bleeding
Infection
Bone pain

Question 19

What does FBC show in ALL?

Answer 19

low Hb
low platelets
low neutrophils

Question 20

What are auer rods?

Answer 20

Abnormal collections of granules
Needle shaped
Within cells

Question 21

In which conditions are Auer rods seen?

Answer 21

AML

Question 22

What can be used to differentiate between AML and ALL?

Answer 22

Immunophenotyping

Question 23

Describe the morphology of bone marrow aspirate in ALL?

Answer 23

Hypercellular
Cells looks similar
Large cells
High N:C ratio

Question 24

What is a trephine biopsy?

Answer 24

Circular piece of bone sawed out when the bone marrow aspirate is shit

Question 25

How is AML treated?

Answer 25

2-4 cycles of chemo | 5-10 days of chemo followed by 2-4 weeks of recovery

Question 26

What infections are patients with marrow suppression particularly at risk of?

Answer 26

Gram neg

Question 27

When should broad spec antibiotics be given in bone marrow suppression?

Answer 27

Soon as there is a neutropenic fever

Question 28

Describe the lymphadenopathy seen in lymphoma

Answer 28

Slow onset Painless Rubbery/soft Smooth

Question 29

Describe the lymphadenopathy seen in viral infection?

Answer 29

Painful Hard Smooth

Question 30

Describe the lymphadenopathy seen in bacterial infection

Answer 30

Painful Hard Smoothed Inflamed

Question 31

How does lymphoma present?

Answer 31

``` Night sweats Weight loss Itch Alcohol induced pain Fatigue ```

Question 32

How is suspected lymphoma investigated?

Answer 32

Lymph node biopsy

Question 33

What is the role of immunohistochemistry in lymphoma investigation?

Answer 33

Confirm and sub-classify lymphoma

Question 34

Where is Burkitt's lymphoma seen most commonly?

Answer 34

Bone marrow