Concepts Of Malignancy Flashcards
What two things are characteristic of malignant haemopoiesis
- increased numbers of abnormal & dysfunctional cells
- loss of normal (haemopoiesis/immune) activity
What three abnormalities lead to haematological malignancy
- Increased proliferation (in the absence of a stimulus)
- Lack of differentiation/maturation
- Lack of apoptosis
What is acute leukaemia
- Proliferation of abnormal progenitors
- With block in differentiation/maturation
What is chronic myeloproliferative disorders/ neoplasms
- Proliferation of abnormal progenitors
- But no block in differentiation/maturation
Give an example of acute leukaemia
Acute myeloid leukaemia
Give an example of chronic myeloproliferative disorders/neoplasms
Chronic myeloid leukaemia
What is a clone
Population of cells derived from a single parent cell.
Can be caused by driver mutations leading to cancer
Is normal haemopoiesis polyclonal or monoclonal
Polyclonal
Is malignant haemopoiesis polyclonal or monoclonal
Monoclonal
What are driver mutations
Acquired somatic mutations in regulatory genes (cells have growth advantage, form clones & drive cancer)
Haematological malignancy pathophysiology/aetiology
- Genetic, epigenetic, environmental - multiple ‘hits’
Why is there so many different haematological malignancy sub-types
Cells at different developmental stages can undergo neoplastic transformation
Involvement of different anatomical regions unique to the cell-type, either at the point of origin, or after migration
Different clinicopathological characteristics (clinical and biological behaviour)
Why is immunophenotyping/immunohistochemistry important when diagnosing haematological malignancies
It allows the cell type/ stage of development to be identified
What is the relevance of anatomical site when classifying haematological malignnacy
Bone marrow/blood - leukaemia
Lymph nodes - lymphoma
What is the relevance of lineage when classifying haematological malignnacy
Myeloid progenitor - myeloid
Lymphoid progenitor - lymphoid
What is the relevance of stage of development/histology when classifying haematological malignnacy
Primitive cells (HSCs & progenitors) - Blastic
Less primitive cells - ‘cytic’
What four things do you want to know when classifying haematological malignancy
Anatomical site (leukaemia vs lymphoma)
Lineage (myeloid vs lymphoid)
Stage of development/histology (blastic vs cytic)
Preservation of differentiation/maturation (high vs low grade)
What is the relevance of preservation of differentiation/maturation when classifying (i.e. grading) haematological malignnacy
Poorly differentiated - high grade (aggressive)
Well differentiated - low grade (less aggressive)
What two malignancies are more aggressive histologically & clinically:
- Acute leukaemia vs chronic leaukaemia
- High grade vs low grade lymphoma
Acute leukaemia
High grade lymphoma
List features of histological aggression
large cells,
high nuclear-cytoplasmic ratio,
prominent nucleoli,
rapid proliferation
Name a feature of clinical aggression
Rapid progression of symptoms
Are acute or chronic leukaemias more likely to affect normal blood cell production
Acute leukaemia
Summarise the terms used to describe haematological malignancy
Acute - Block in differentiation/ maturation (of cell lineage)
Chronic - Preserved differentiation/ maturation (of cell lineage)
Leukaemia - in the bone marrow/ blood
Lymphoma - in the lymph nodes
Myeloid - Myeloid lineage
Lymphoid - Lymphoid lineage
Blastic - Primitive cell (HSCs, progenitors)
Cytic - Less primitive cell
High grade (histologically) - aggressive
Low grade (histologically) - less aggressive
What is acute lymphoblastic leukaemia
Acute - block in differentiation/maturation
Lymphoblastic - primitive, lymphoid
Leukaemia - bone marrow/ blood
What is acute myeloid leukaemia
Acute - block in differentiation/maturation
Myeloid - primitive, myeloid
Leukaemia - bone marrow/ blood
What is chronic lymphocytic leukaemia
Chronic - differentiation/maturation preserved
Lymphocytic - Less primitive, lymphoid
Leukaemia - bone marrow/ blood
Note - despite name, can also affect lymph nodes
What is high grade B/T cell (non Hodgkin) lymphoma
High grade, non Hodgkin - (clinically) aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes
What is low grade B cell (non Hodgkin) lymphoma
Low grade, non Hodgkin - less (clinically) aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes
What is Hodgkin lymphoma
Hodgkin - less aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes
What is chronic myeloproliferative neoplasms/disorders
Chronic - differentiation/maturation preserved
Proliferative - uncontrolled myeloid production
Myelo - primitive, myeloid compartment
What is myeloma
Plasma cell malignancy
Usually in bone marrow
