General Principles of Malignant Hematopathology Dr. Krafts 5/9/14

Question 1

Leukemia

Answer 1

• Malignancy of hematopoietic cells
• Starts in bone marrow**, can spread to blood, nodes
• Myeloid or lymphoid
• Acute or chronic (acute can kill in days or weeks)

Question 2

Lymphoma

Answer 2

• Malignancy of hematopoietic cells
• Starts in lymph nodes**, can spread to blood, marrow
• Lymphoid only
• Hodgkin or non-Hodgkin

Question 3

Plasma cell disorders

Answer 3

Multiple myeloma (starts in bone marrow but doesn’t act like leukemia. Doesn’t act like lymphomas. It can be in lymph nodes but doesn’t start there)

Question 4

Myeloid malignancies

Answer 4

• AML

- CML

Question 5

Lymphoid malignancies

Answer 5

• Acute lymphoblastic leukemia
• Chronic lymphocytic leukemia
• Hodgkin lymphoma
• Non-hodgkin lymphoma
• Multiple myeloma

Question 6

How is a diagnosis made

Answer 6

• Appearance of patient
• First thing you do is blood smear/bone marrow biopsy
• Many time cells look bland and not sure what they are so other studies can be used including immunophenotyping, molecule studies, and cytogenetics (takes days so not used as much for diagnosis but prognostic).

Question 7

Bone marrow biopsy

Answer 7

• Jamshidi needle
• Stylus pulled out when in marrow -Superior iliac crest
• Tree find biopsy tells you how cellular it is. When baby basically no fat cells but as get older the amount of fat cells increase (middle age about 50% fat cells).
• Other thing that you look for is aggregates.
• Look at lymphoid/myeloid ratio

Question 8

Bone marrow aspiration

Answer 8

• Next to where bone marrow biopsy occurred.
• Instead of marrow removal attach syringe and pull (painful due to negative pressure). In syringe will get thick blood looking that will make slide with.
• Will see precursor cells that you will count like a blood smear (count 500-1000 cells). Also looking for weird things (such as weird nucleus or a lot of blasts etc).

Question 9

Composed of mostly blast cells

Answer 9

• Actue leukemias
• Big nucleus compared to cytoplasm
• Myeloid or lymphoid

Question 10

Composed of mostly mature cells

Answer 10

• Chronic leukemias

- Myeloid or lymphoid

Question 11

Reed Sternberg cell ( sp)

Answer 11

• Hodgkin lymphoma

- Two eyes looking out at you

Question 12

Composed of plasma cell precursors

Answer 12

Myeloma

Question 13

Cytochemical stain

Answer 13

• Will pick up on chemicals in particular cells
• non-specficic esterase–>picks up things in monocyte only
• One also available for neutrophil series

Question 14

Immunophenotyping

Answer 14

• CD3 present on all T cells
• CD8 CTLs
• Usually compare at least two markers.
• Sometimes see subpopulations that you normally can’t tell apart.
• In example a subset that doesn’t appear to have CD3 or CD8
• Typically used for HIV
• High CD3 but low CD8 might be indicative of helper T cells instead of CTLs

Question 15

Cytogenetic studies

Answer 15

• Provides a great overview (especially if don’t know what you are looking for)
• Not great if you have a change that is so small that it doesn’t show up (e.g. point mutation) or you don’t have enough cells
• PCR is good when you have only a few cells w/ change (however you need to know what you are looking for to use appropriate primers)