Haematological Malignancy

Question 1

What type of age distribution is observed in new cases of Hodgkin lymphoma?

Answer 1

Twin peaks:

1st peak - 15-35

2nd peak - 60+

Question 2

What is the age distribution for Non-hodgkin lymphoma?

Answer 2

Peaks in middle to older age

Question 3

What are the pathological steps involved in haematological malignancies?

Answer 3

1 - Multiple mutations occur

2 - The mutated cell has a proliferative/survival advantage

3 - The mutated cell produces a malignant clone

4 - The malignant cell begins to dominate the tissue (bone marrow or lymph nodes)

Question 4

From what cell types can myeloid malignancies develop from?

Answer 4

RBC’s

Platelets

Granulocytes

Monocytes

Question 5

From which cells do lymphoid malignancies develop?

Answer 5

B-cells

T-cells

Question 6

What is Acute Myeloid Leukaemia?

Answer 6

1 - Myeloid cells progenerate but do not differentiate

Question 7

What are the myeloproliferative disorders?

Answer 7

Myeloid cells do differentiate and produce too many myeloid differentiated cells e.g.

• Neutrophils
• Eosinophils

Question 8

With which mutation are the myeloproliferative disorders associated?

Answer 8

Philadelphia mutation

Question 9

What is ALL?

Answer 9

Acute Lymphoblastic Leukaemia

• Lymphoblasts proliferate but do not differentiate

Question 10

In which age group are ALL’s most common?

Answer 10

Children

Question 11

What is CLL?

Answer 11

Chronic Lymphocytic Leukaemia

• Too many B-cell lymphocytes are produced

Question 12

What is mutiple myeloma?

Answer 12

A type of blood cancer in which plasma cells produce abnormal antibodies

Question 13

What is the key difference between leukaemia and lymphoma?

Answer 13

Leukeamia = bone marrow

Lymphoma = Lymphoid tissue

Question 14

What are the most common acute leukaemias?

Answer 14

Acute Lymphoblastic Leukaemia

Acute Myeloid Leukaemia

Question 15

What are the most common chronic leukaemias?

Answer 15

Chronic Myeloid Leukaemia

Chronic Lymphocytic Leukaemia

Question 16

What are the categories of malignant lymphomas?

Answer 16

Non-Hodgkin Lymphoma

Hodgkin Lymphoma

Question 17

Apart from acute, chronic and malignant leukaemias/lymphomas what other types of haemtaological malignancies are there?

Answer 17

Multiple myeloma

Myelodysplastic syndromes

Chronic myeloproliferative diseases

Question 18

What are the features that differentiate acute leukaemias from chronic leukaemias?

Answer 18

Acute:

• Leukaemic cells do not differentiate
• Bone marrow failure
• Fatal if left untreated

Chronic:

• Leukaemic cells differentiate
• Cells proliferate without bone marrow failure

Question 19

What are the clinical features of acute leukaemia?

Answer 19

1) Bone Marrow Failure:
- Anaemia
- Thrombocytopenic bleeding (purpura + mucosal membrane bleeding)
- Infections caused by neutropenia (bacterial & fungal - aspergillosis common))

Question 20

Where in lymph nodes do most lymphomas originate?

Answer 20

Germinal centre

Question 21

Where do B cells mature?

Answer 21

Germinal centre of lymph nodes

Question 22

What are the most common systemic symptoms of lymphomas?

Answer 22

1 - Fever

2 - Drenching night sweats

3 - Weight loss

4 - Itchy skin

5 - Fatigue

Question 23

What is a key clinical feature of lymphomas?

Answer 23

Lymphadenopathy

Question 24

Is lymphadenopathy more common in hodgkins or non hodgkins lymphoma?

Answer 24

Hodgkins lymphoma

Question 25

What does this x-ray show?

Answer 25

Sternal lymphadenopathy on Hodgkins Lymphoma

Question 26

What is the most likely cause of localised and painful lymphadenopathy?

Answer 26

Bacterial infection in draining site

Question 27

What is the most likely cause of localised and painless lymphadenopathy?

Answer 27

Tuberculosis

Question 28

What is the most likely cause of generalised and painful lymphadenopathy?

Answer 28

Epstein-Barr Virus

Hepatitis

HIV

Question 29

What is the most likely cause of localised and painless lymphadenopathy?

Answer 29

Lymphoma

Leukaemia