Concepts Of Malignancy

Question 1

What two things are characteristic of malignant haemopoiesis

Answer 1

• increased numbers of abnormal & dysfunctional cells
• loss of normal (haemopoiesis/immune) activity

Question 2

What three abnormalities lead to haematological malignancy

Answer 2

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

Question 3

What is acute leukaemia

Answer 3

• Proliferation of abnormal progenitors
• With block in differentiation/maturation

Question 4

What is chronic myeloproliferative disorders/ neoplasms

Answer 4

• Proliferation of abnormal progenitors
• But no block in differentiation/maturation

Question 5

Give an example of acute leukaemia

Answer 5

Acute myeloid leukaemia

Question 6

Give an example of chronic myeloproliferative disorders/neoplasms

Answer 6

Chronic myeloid leukaemia

Question 7

What is a clone

Answer 7

Population of cells derived from a single parent cell.
Can be caused by driver mutations leading to cancer

Question 8

Is normal haemopoiesis polyclonal or monoclonal

Answer 8

Polyclonal

Question 9

Is malignant haemopoiesis polyclonal or monoclonal

Answer 9

Monoclonal

Question 10

What are driver mutations

Answer 10

Acquired somatic mutations in regulatory genes (cells have growth advantage, form clones & drive cancer)

Question 11

Haematological malignancy pathophysiology/aetiology

Answer 11

• Genetic, epigenetic, environmental - multiple ‘hits’

Question 12

Why is there so many different haematological malignancy sub-types

Answer 12

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)

Question 13

Why is immunophenotyping/immunohistochemistry important when diagnosing haematological malignancies

Answer 13

It allows the cell type/ stage of development to be identified

Question 14

What is the relevance of anatomical site when classifying haematological malignnacy

Answer 14

Bone marrow/blood - leukaemia
Lymph nodes - lymphoma

Question 15

What is the relevance of lineage when classifying haematological malignnacy

Answer 15

Myeloid progenitor - myeloid
Lymphoid progenitor - lymphoid

Question 16

What is the relevance of stage of development/histology when classifying haematological malignnacy

Answer 16

Primitive cells (HSCs & progenitors) - Blastic
Less primitive cells - ‘cytic’

Question 17

What four things do you want to know when classifying haematological malignancy

Answer 17

Anatomical site (leukaemia vs lymphoma)
Lineage (myeloid vs lymphoid)
Stage of development/histology (blastic vs cytic)
Preservation of differentiation/maturation (high vs low grade)

Question 18

What is the relevance of preservation of differentiation/maturation when classifying (i.e. grading) haematological malignnacy

Answer 18

Poorly differentiated - high grade (aggressive)
Well differentiated - low grade (less aggressive)

Question 19

What two malignancies are more aggressive histologically & clinically:
- Acute leukaemia vs chronic leaukaemia
- High grade vs low grade lymphoma

Answer 19

Acute leukaemia
High grade lymphoma

Question 20

List features of histological aggression

Answer 20

large cells,
high nuclear-cytoplasmic ratio,
prominent nucleoli,
rapid proliferation

Question 21

Name a feature of clinical aggression

Answer 21

Rapid progression of symptoms

Question 22

Are acute or chronic leukaemias more likely to affect normal blood cell production

Answer 22

Acute leukaemia

Question 23

Summarise the terms used to describe haematological malignancy

Answer 23

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

Question 24

What is acute lymphoblastic leukaemia

Answer 24

Acute - block in differentiation/maturation
Lymphoblastic - primitive, lymphoid
Leukaemia - bone marrow/ blood

Question 25

What is acute myeloid leukaemia

Answer 25

Acute - block in differentiation/maturation
Myeloid - primitive, myeloid
Leukaemia - bone marrow/ blood

Question 26

What is chronic lymphocytic leukaemia

Answer 26

Chronic - differentiation/maturation preserved
Lymphocytic - Less primitive, lymphoid
Leukaemia - bone marrow/ blood

Note - despite name, can also affect lymph nodes

Question 27

What is high grade B/T cell (non Hodgkin) lymphoma

Answer 27

High grade, non Hodgkin - (clinically) aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes

Question 28

What is low grade B cell (non Hodgkin) lymphoma

Answer 28

Low grade, non Hodgkin - less (clinically) aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes

Question 29

What is Hodgkin lymphoma

Answer 29

Hodgkin - less aggressive
B/T cell - less primitive, lymphoid
Lymphoma - lymph nodes

Question 30

What is chronic myeloproliferative neoplasms/disorders

Answer 30

Chronic - differentiation/maturation preserved
Proliferative - uncontrolled myeloid production
Myelo - primitive, myeloid compartment

Question 31

What is myeloma

Answer 31

Plasma cell malignancy
Usually in bone marrow