Concepts in Malignant Haematology

Question 1

What is lymphoma?

Answer 1

Type of cancer affecting the lymphocytes inside the lymphatic system

Question 2

What is Hodgkin’s Lymphoma?

Answer 2

Most common specific type of lymphoma
It has a bimodal age distribution with peaks around 20-25 and 80 years

Question 3

Risk factors for Hodgkin’s lymphoma include..

Answer 3

HIV
Epstein-Barr virus
Autoimmune conditions, such as rheumatoid arthritis and sarcoidosis
Family history

Question 4

What are the different types of Non-Hodgkin Lymphoma?

Answer 4

Diffuse large B cell lymphoma - rapidly growing painless mass in older patients
Burkitt lymphoma - EBV and HIV
MALT lymphoma - mucosa-associated lymphoid tissue, usually around the stomach

Question 5

Risk factors for non-Hodgkin’s lymphoma

Answer 5

HIV, EBV
H. pylori (MALT lymphoma)
Hepatitis B or C infection
Exposure to pesticides/ trichloroethylene
Family history

Question 6

Enlarged lymph nodes that are non-tender and feel firm or rubbery

Answer 6

Lymphadenopathy - lymphoma

Question 7

B symptoms refer to systemic symptoms of lymphoma. These are..

Answer 7

Fever
Weight loss
Night sweats

Question 8

Ix for lymphoma

Answer 8

Lymph node biopsy
CT/MRI/PET

Question 9

What does the lymph node biopsy show?

Answer 9

Reed-Sternberg cells - lymphoma

Question 10

What classification system is used for lymphoma?

Answer 10

Lugano:

Stage 1: Confined to one node or group of nodes
Stage 2: In more than one group of nodes but on the same side of the diaphragm (either above or below)
Stage 3: Affects lymph nodes both above and below the diaphragm
Stage 4: Widespread involvement, including non-lymphatic organs, such as the lungs or liver

Question 11

Malignant haemopoiesis is usually characterised by..

Answer 11

Increased numbers of abnormal & dysfunctional cells
Loss of normal activity

Question 12

What can cause malignant haemopoiesis?

Answer 12

Increased proliferation (in the absence of a stimulus)
Lack of differentiation/maturation and apoptosis

Question 13

Differentiate between acute leukaemia and chronic myeloproliferative disorders/neoplasm regarding haemopoiesis

Answer 13

Acute leukaemia: Proliferation of abnormal progenitors
with block in differentiation/maturation (e.g. Acute Myeloid Leukaemia)

Chronic myeloproliferative disorders/neoplasm (MPN): Proliferation of abnormal progenitors, but NO differentiation/maturation block (e.g. Chronic Myeloid Leukaemia)

Question 14

Which type of mutation which affect proliferation and cellular growth? Driver or passenger?

Answer 14

Driver

Question 15

Drive mutations can select clones. What does this mean?

Answer 15

Normal haemopoiesis is polyclonal
Malignant is monoclonal/clonal

Question 16

Clone is a population of cells derived from a single parent cell. How would you know it came from the parent cell?

Answer 16

This parent cell has a genetic marker (driver mutation or
chromosomal change) that is shared by the daughter cells

Question 17

Driver’ mutations confer growth advantage on the cells and are selected during the evolution of the cancer. This is contrast to..

Answer 17

Passenger mutations. Do not confer growth advantage, but
happened to be present in an ancestor of the cancer cell when it acquired one of its drivers

Question 18

Initial development of the lymphoid/myeloid progenitor cells take place in the..

Answer 18

Marrow/blood

Question 19

Initial development of the red cells/neutrophils/platelets/t/b cells progenitor cells take place in the..

Answer 19

Lymph nodes/other sites

Question 20

T or F: Cells at different developmental stages can undergo neoplastic transformation

Answer 20

True

Question 21

T or F: Involvement of different anatomical regions unique to the celltype, either at the point of origin, or after migration

Answer 21

True

Question 22

Classify the cancers of the haemopoietic and lymphoid systems (anatomical site)

Answer 22

Leukaemia

Question 23

Classify the cancer of the haemopoietic and lymphoid systems (anatomical site)

Answer 23

Lymphoma

Question 24

Classify the cancer of the haemopoietic and lymphoid systems (lineage)

Answer 24

Question 25

Classify the cancer of the haemopoietic and lymphoid systems (stage of development/histology)

Answer 25

Question 26

______________ & ______________ are histologically
and clinically more aggressive than chronic leukaemias & lowgrade lymphomas

Answer 26

Acute leukaemias & high-grade lymphomas are histologically
and clinically more aggressive than chronic leukaemias & lowgrade lymphomas

Question 27

Features of histological aggression

Answer 27

Large cells with high nuclear-cytoplasmic ratio, prominent nucleoli, rapid proliferation

Question 28

Classify acute lymphoblastic leukaemia

Answer 28

Bood/marrow involving primitive, lymphoid malignancy

Question 29

Classify acute myeloid leukaemia

Answer 29

Blood/marrow involving, primitive, myeloid malignancy

Question 30

Classify chronic lymphocytic leukaemia

Answer 30

Blood/marrow involving (and nodal), less primitive, lymphoid malignancy

Question 31

Classify high grade B/T cell (non Hodgkin) lymphoma

Answer 31

Nodal, lymphoid malignancy, less primitive, clinically aggressive

Question 32

Classify low grade B cell (non Hodgkin) lymphoma

Answer 32

Nodal, lymphoid malignancy, less primitive, clinically less aggressive

Question 33

Classify Hodgkin lymphoma

Answer 33

Nodal, lymphoid malignancy, less primitive, less aggressive

Question 34

Classify Myeloma

Answer 34

Plasma cell malignancy usually, not exclusively, in the bone marrow

Question 35

Classify Chronic myeloproliferative neoplasms disorders

Answer 35

Primitive, myeloid compartment, maturation preserved (e.g. chronic myeloid leukaemia)

Question 36

Classify Burkitt leukaemia/lymphoma

Answer 36

Blood/marrow involving (and nodal), less primitive, lymphoid malignancy

Question 37

Answer 37