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Rory's Year 5 pathology > Haematology: Haem malignancies, proliferative and dysplastic blood disorders (From Module 2 exam) > Flashcards

Haematology: Haem malignancies, proliferative and dysplastic blood disorders (From Module 2 exam) Flashcards

Mainly SAQ revision

1
Q

What disease does this blood film suggest?

A
  • ALL
  • Could also possibly be AML M0-1
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2
Q

What disease does the following immunophenotype suggest? Sig+, CD5+, Cyclin D1+, CD20+, CD10-, CD23-, BCL6-, MUM1-

A
  • Mantle cell lymphoma
  • (abnormal CD5 and Cyclin D1 expression)
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3
Q

What disease does this blood film suggest?

A

CLL

  • Lymphocytosis
  • Smear cells
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4
Q

What is the treatment for APML (Acute promyelocytic leukemia)?

A

-ATRA and arsenic

/////////////////////////////////////////////

-ATRA is All trans retinoic acid

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5
Q

What is the main genetic cause of Burkitt lymphoma?

A

-Lost regulation of c-myc

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6
Q

Outline clinical presentation of MDS (Myelodysplastic syndrome)

A
  • Signs of bone marrow failure
  • fatigue, infections, easy bruising
  • Bone marrow hypercellular
  • Cytopenia (a dysplastic change of a particular lineage causes the cytopenia of that lineage, i.e anaemia in erythroid dysplasia)
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7
Q

What disease does the following immunophenotype suggest? CD45+, CD13+, CD33+, CD117+, CD34+, HLA-DR+, CD19-, Tdt-

A
  • AML M0/M1/M2
  • CD34+, HLA-DR+, (Both markers of immaturity)
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8
Q

-What viruses can cause infectious mononucleosis?

A

EBV and CMV

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9
Q

What disease does this blood film show?

A

CML, in chronic phase

Myelocytes and basophils can be present

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10
Q

Outline the pathophysiology of CML

A
  • Translocation occurs between chromosome 9 and 22, forming BCR-ABL1 fusion gene
  • BCR-ABL1 molecule is a constitutively active tyrosine kinase
  • Causes downstream activation of oncogenes, such as JAK, PI3K and RAS
  • Leading to increased proliferation, survival and clonal expansion of cells with the initial t(9;22) mutation.
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11
Q

Outline the clinical presentation of Adult T-cell laeukaemia/lymphoma (ATL)

A
  • Human T-cell lymphotrophic virus 1 (HTLV-1)
  • Hypercalcaemia (Stones, bones, groans etc.)
  • Skin rash
  • Other things pertaining to ALL or NHL
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12
Q

How does Multiple myeloma lead to bone weakness?

A
  • Multilpe myeloma (MM) cells overproduce RANK ligand
  • Leads to activation of osteoclasts
  • Imbalance of osteoblast/osteoclast activity leads to osteolytic lesions and bone weakness

Extra info://///////////////////////////////////////////////////////

  • Osteoprotegerin (OPG, regulator of normal bone formation) is downregulated (MM endocytosis)
  • MM cels produce Dkk-1 which inhibit osteoblasts
  • produces sclerostin, which inhibits osteoblasts
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13
Q

Case: A 51 year old woman was admitted to hospital showing: Asthenia(weakness), anorexia, weight loss. No significant findings on physical examination. Haemoglobin 83, WBC 6.5, platelets: 245. ESR 138 (high). IgA 14.1(high). Creatine 290 (high). See serum protein electrophoresis. CD38+, CD56+. What is the most likely diagnosis?

A

Multiple myeloma

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14
Q

Outline the causes of Marginal zone lymphoma

A
  • Hep C
  • H pylori
  • Autoimmune causes
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15
Q

What disease does the following immunophenotype suggest? CD30+, CD15+, CD79a-, SmIg-, CD45-, CD34-, Tdt-

A

Hodgkin lymphoma

(CD30+, CD15+)

///////////////////

You see CD30+ and CD15+, you know its hodgkins lymphome

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16
Q

What disease oes this immunophenotype suggest?CD45-, no SCC, CD19-, CD33+, CD7-, CD13+

A

-AML M0-M1

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17
Q

What disease does this blood film suggest?

A

Multiple myeloma

-Characteristic, pushed off to one side, extended cytoplasm

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18
Q

What are the viruses that can contribute to lymphoma?

A

EBV (Burkitt, Hodgkin)

HIV (Hodgkin, High grade B-cell lymphoma)

HTLV-1 (ATLL)

Hep C (Marginal zone lymphoma)

Human Herpes Virus (HHV8)

Hep B

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19
Q

What are the most common cytogenetic abnormalities associated with ALL?

A
  • High hyperdiploidy (good prognosis)
  • t(12;21)/ETV6-RUNX1 (Childhood, Good prognosis)
  • t(9;22)/BCR-ABL1/Ph (older adults, bad prognosis)
  • T-ALL: t(10;14)

/////////////////////////////////////////////////

  • 11q23 rearrangements/KMT2A (infants, bad prognosis)
  • t(1;19)/TCF-PBX1
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20
Q

What is the mechanism of action of Imatinib?

A
  • Imatinib is a tyrosine kinase inhibitor
  • It binds to the ATP binding site of BCR-ABL1, preventing ATP from binding and donating it’s phosphate.
  • Therefore no activation of oncogenic proteins
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21
Q

What disease does this blood film suggest?

A

Mantle cell lymphoma

-Characteristic morphology?

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22
Q

Outline the main subtypes of myelodysplastic syndrome

A
  • So it’s classified into these 5 subtypes though a condition can belong to more than one I suppose
  • Single lineage dysplasia
  • Erythroid dysplasia
  • Granulocytic dysplasia
  • Megakaryocytic dysplasia
  • Multiple lineage dysplasia
  • Adult
  • Childhood
  • Ring Sideroblasts (Single lineage erythroid dysplasia)
  • 5q deletion
  • Excess blasts
  • Excess blasts type 1 (5-9% blasts)
  • Excess blasts type 2 (10-19% blasts)
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23
Q

What genes are involved in multiple myeloma?

A
  • IGH gene can be fused with:
  • Cyclin D1
  • MMSET gene
  • Maf
  • All leading to overproduction of Ig
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24
Q

Describe the myeloid maturation sequence

A

Myeloblast,

Promyelocyte,

Myelocyte,

Metamyelocyte,

Band,

granulocyte (e.g Neutrophil)

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25
Q

What blood parameters are associated with CML?

A
  • High white cell count
  • Anaemia (Sometimes)
  • platelets can be either high or low (Mostly high)
  • Basophiliia
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26
Q

What disease does this immunophenotype suggest? CD8-, CD4+, CD7-, CD3+, CD25+, CD5+, CD19-, CD34-, Tdt-

A
  • Adult T-cell leukaemia/lymphoma (ATLL)
  • CD25+

//////////////////////////////////////////////////

CD25+: ATLL

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27
Q

Describe the typical blood film of multiple myeloma

A
  • Plasma cells (lymphocytes with extended cytoplasm, usually shifted in one direction.
  • Granulation with pale are of ‘golgi zone’
  • Roleaux formation
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28
Q

Case: See blood film. Immunophenotype: CD19+, CD5+, CD79b+/-, CD20+, CD2+/-, CD22+. What is the most likely diagnosis?

A
  • CLL
  • Smear cells, lymphocytosis
  • CD5+, CD79b+,
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29
Q

What are the nucleated cells here?

A

Nucleated red cells/erythroblasts

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30
Q

What is the main clinical presentation of CML?

A
  • Weight loss,
  • Low grade fever
  • Abdominal enlargement
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31
Q

What is the characteristic feature of multiple myeloma in a bone marrow aspirate?

A

>10% plasma cells

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32
Q

outline the pathophysiology of AML M2

A
  • RUNX1-RUNX1T fusion causes the ineffectiveness of CBFalpha
  • This leads to decreased differentation and maturation
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33
Q

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20-, CD22-, CD10-, CD19-, CD7+, CD3+, CD2+, CD13-, CD33-, cytoplasmic m-.

A

T-ALL (T acute lymphoblastic leukaemia)

(CD7 is a t cell thing)

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34
Q

What disease does the following immunophenotype suggest? CD19+, CD20+, CD22+, CD79a+, CD79b+, BCL6+, CD10+(/-), Tdt-, Sig+, CD5-, CD23-, MUM1-, Monoclonal mature IgM (based on kappa:Lambda)

A
  • Burkitt lymphoma.
  • Monoclonal mature IgM (kappa 75% of cases/lambda 25% of cases)
  • BCL6+ (maintains cells at germinal centre stage of development)
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35
Q

What disease does this lymph node histology suggest?

A
  • ATLL
  • Large T lymphocytes
  • Reactive cell population (most likely eosinophils)
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36
Q

What are the most common cytogenetic abnormalities associated with MDS

A
  • Del(11q) or –Y (Very good prognosis)
  • Normal karyotype or del(5q) (Good prognosis)
  • Del(7q) or double independent clones (intermediate)
  • Inv(3) or double including -7 or 1del(7q) (Poor prognosis)
  • Complex: >3 abnormalities (Very poor prognosis)

/////////////////////////////////////////////////

This is really fringe knowledge you probably dont need to know for path. Just understand that particular cytogenetic abnormalities are associated with/ cause MDS

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37
Q

Case: 66 year old woman, 2 week history of fatigue and pallor. Full blood count showing pancytopenia: Hb 98, WBC 4, platelets 16. No family history. No hepatomegaly or lymphadenopathy. Abdominal CT, mild splenomegaly. Blood film, immature granulocytes, occasional circulating blasts, with granules. Flow cytometry: High FSC, low SCC, cCD79, MPO-, HLA-DR+, CD34+, CD19+, CD20(mostly -), CD10+, CD38-, CD19+, CD45+/-, Tdt+, CD33-, CD13 (mostly-). What is the most likely diagnosis?

A
  • CLL, B-lineage.
  • granules rule out MDS
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38
Q

Case: See blood film: Immunophenotype: high FCC, moderate SCC. CD19+, CD5-, CD79b+, CD20+, CD2+/-, CD22+, CD23-, CD10+, monoclonal Ig (Lambda:kappa). t(14;18). What is the most likely diagnosis?

A

Follicular lymphoma

(Coffee bean/ butt cells)

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39
Q

Herpes zoster can increase incidence of:

A

-CLL or Hodgkin lymphoma

////////////////////////////////////////////

Don’t ask me how, something to do with constantly stimulating the immune cells to proliferate

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40
Q

The white cell shown is:

A

A normal large granular lymphocyte.

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41
Q

What is the normal range of haemoglobin?

A
  • Male: 130-180 g/L
  • Female: 115-165 g/L

/////////////////////////////////

Major Key Alert

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42
Q

What disease does the following lymph node histology suggest?

A
  • Hodgkin lymphoma
  • Sclerosis
  • Reed-sternberg cells
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43
Q

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10(+/-), CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m+.

A

B-ALL, specifically PreB-ALL

//////////////////////////////////////////////

One of these markers make it a ‘PreB-ALL’ rather than a regular B-ALL but this is beyond path.

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44
Q

What disease does this blood film suggest?

A
  • ATLL
  • Pleomorphism. Flower cell morphology
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45
Q

How does multiple myeloma cause kidney failure?

A

Excess Ig (normally IgG) leads to precipitation of light chains in the renal tubules of the kidney

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46
Q

What haematologial malignancy is Coxiella Burnetti linked to?

A

Diffuse large B-cell lymphoma (Non-Hodgkin)

//////////////////////////////////

no idea how or why really other than the whole ‘infection causes chronic stimulation and proliferation of immune cells leading to malignancy of those cells’ principle.

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47
Q

What disease does this blood film suggest

A
  • Large cell lymphoma
  • large and pleomorphic cell
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48
Q

What disease does this immunophenotype suggest? Large FCC, large SCC, CD117-, CD3-, CD34-, HLA-DR-, CD13+, CD33+, CD45+, CD14-

A

CML

//////////////////////////

Myeloid cells are CD13+, CD33+

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49
Q

What disease does this blood film suggest?

A
  • Burkitt lymphoma
  • mature blasts, with no granules (lymphoid cells)
  • Characteristic prominent vacuolation

///////////////////////////////////

This vacuolation is pathognomonic of Burkitt’s Lymphoma

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50
Q

Outline presentation of MALT lymphoma

A
  • Extranodal sites (Bascially a GI cancer)
  • Caused by infection (H. Pylori) or autoimmune causes (Coeliacs)
  • Immunophenotype: SIg+, CD20+, CD5-, CD10-, CD23+/-, BCL6-, MUM1+/-
  • Cytogenetics: t(11;18). Activation of NFkB pathway.
51
Q

Hypogranular neutrophil, blast cell, stomatocytes. Most likely diagnosis?

A

MDS

/////////////////////////////////

If no evidence of proliferation

52
Q

This white cell shows what?

A

Toxic granulation and vacuolisation.

53
Q

What disease does the following immunophenotype suggest? CD7-, CD13-, CD19-, CD33+, HLA-DR-, CD117+, CD15-, CD34+

A
  • AML M3 (APML)
  • Could also be AML M0, M1, M2
54
Q

What is the typical presentation of multiple myeloma?

A
  • Back pain
  • Fatigue, pallor (anaemia)
  • Infections (eg pneumonia)
  • Signs of acute renal failure (polydipsia)
55
Q

What disease does the following immunophenotype suggest? CD11c+, CD103+

A

Hairy cell leukaemia (A type of CLL)

//////////////////////////////////////

Very fringe, probably not needed for path

56
Q

The white cell shown is:

A

An eosinophil

57
Q

What are the clinical signs and symptoms of CLL?

A
  • Lymphadenopathy
  • features of anaemia (fatigue, pallor) (From Bone marrow failure)
  • Bruising/purpura from thrombocytopenia (Also from Bone marrow failure)
  • rarely hepatosplenomegaly
  • Features of immune suppression (Infection)
58
Q

What is the normal range of red cell count?

A
  • Male: 4.5-6.5 1012/L
  • Female: 3.8-4.8 1012/L
59
Q

What haematological malignancy can coeliacs lead to?

A

-(non-hodgkin), of M.A.L.T lymphoma,

60
Q

What are the most common cytogenetic abnormalities associated with CLL?

A
  • Del(6q)
  • Trisomy 12
  • Del(13q)/miR-15a

-Del(13q)/retinoblastoma gene

  • Del(17p)/TP53 loss
  • Del(11q)/ATM

//////////////////////////////////////////////////////

This may be a bit too nische for path.

Maybe just remember the retinoblastoma one cause it sounds important.

61
Q

What disease does this blood film show?

A

CML

(Left shift, a shift to immature cells)

Myelocyte > promyelocyte > metamyelocyte > Band forms

62
Q

What kind of white cell is this?

A

Atypical lymphocyte

  • Minimal chromatin condensation, lots of cytoplasm
  • Large cell with no granulation
63
Q

Describe the typical laboratory findings of Hodgkin lymphoma

A
  • Normochromic, normocytic anaemia (without later bone marrow involvement)
  • neutrophilia (1/3 of patients)
  • ESR raised, CRP raised.
  • Raised serum LDH
  • Also characteristic histology
64
Q

What disease is associated with a bone marrow trephine biopsy showing a marked increase in marrow lymphocytes, a nodular pattern of lymphoid accumulation and interstitial infiltration?

A

CLL

65
Q

What disease does this blood film suggest?

A
  • MDS
  • White cells showing psudeo-pelger cells, agranular myelocytes an neutrophils

//////////////////////////////////////////

In MDS:

  • Red cells are usually macrocytic but can be hypochromic.
  • Granulocytes reduced in number and show lack of granulation
  • Pelger abnormality (single or bilobed nucleus)
  • Platelets unusual (usually reduced)
66
Q

Case: A 38 year old woman of Caribbean origin. Rash of several years duration. Family history of ‘leukaemia’. Shortly before she had developed marked cervical lymphadenopathy and hypercalcaemia. Her skin showed plaque-like infiltrates. Flow cytometry: High SCC, CD2+, CD5+, CD7-, CD4+, CD8+, CD25+, CD71. She had also recently broken her clavicle

A

ATLL

/////////////////////////////////////////////////

I think of this as ‘Contagious leukaemia’

67
Q

What is the most prominent cytogenetic abnormality associated with Burkitt lymphoma?

A
  • t(8;14) C-MYC and IgH locus (90%)
  • Other translocations of chromosome 8
68
Q

What disease does this blood film suggest?

A
  • MDS
  • Mononuclear megakaryocyte

///////////////////////////////////////////////

  • Red cells are usually macrocytic but can be hypochromic.
  • Granulocytes reduced in number and show lack of granulation
  • Pelger abnormality (single or bilobed nucleus)
  • Platelets unusual (usually reduced)
69
Q

What disease does this blood film suggest?

A
  • One of the myelodysplastic syndromes
  • Hypogranular neutrophil
  • blast cell
  • stomatocytes
70
Q

Outline the clinical presentation of Burkitt lymphoma

A
  • Painless lymphadenopathy, normally on jaw or abdomen
  • History of Epstein Barr virus
  • Can affect abdominal organs (Sporadic Burkitt lymphoma)
  • Signs of pancytopenia in advanced disease
71
Q

What disease does this blood film suggest?

A
  • Follicular lymphoma
  • Cleft/coffee bean/butt cells pathognomonic
72
Q

What are the main cytogenetic abnormalities associated with multiple myeloma?

A
  • Del(13q)
  • mutations of telomere end of chromosome 14q32 (location of heavy chains, IgH)
  • eg. t(4;14) IGH-MMSET1
73
Q

Describe the typical blood count of a patient with CLL

A
  • Lymphocytosis
  • Anaemia
  • Thrombocytopenia

/////////////////

Lots of white cells but bone marrow failure

74
Q

What disease is the following karyotype associated with? 46, XX, inv(16)(p13q22)

A

AML M4

75
Q

What are the main sub-types of CLL?

A
  • CLL, regular
  • Prolymphocytic leukaemia (PLL)
  • Hairy cell leukaemia (HCL)
  • Plasma cell leukaemia
  • T cell:
  • Large granular lymphocytic leukaemia
  • T-PLL
  • ATLL (Can be classed as a type of CLL or lymphoma)
76
Q

What is the normal range of white cell count?

A

3.6-11.0 109/L

////////////////////////////////

Major Key Alert

77
Q

What is the clinical presentation of CML (symptoms and signs)?

A
  • Fatigue
  • Night sweats
  • Malaise and weight loss
  • Left upper quadrant pain
  • Splenomegaly
  • Less common (in advanced diseas)
  • Bone pain
  • Lymphadenopathy
  • Skin infiltration
  • Extra medullary mass
78
Q

What is the major complication of CLL?

A
  • Autoimmune haemolytic anaemia: shown by spherocytes and polychromasia
  • Direct antiglobulin test would be positive in this case

////////////////////////////////////

Good niche bit of knowledge that I reckon could get you a good extra mark somewhere in the exam

79
Q

What bacteria can contribute to the development of lymphoma?

A

Helicobacter pylori (MALT lymphoma)

Campylobacter jejuni

Mycobacterium tuberculosis

Borrelia burdorferi

Chlamydophila psittaci

80
Q

Outline the treatment for ATLL

A

Interferon and zidovudine. It’s as good as chemotherapy

////////////////////////

I think this is because of viral cause

81
Q

What is the normal range of platelet count?

A

140-400 109/L

///////////////////////////////////////////////////

Major Key Alert

82
Q

Outline the clinical presentation of Hodkin lymphoma

A
  • Painless lymphadenopathy, more often localised to a single nodal site
  • Splenomegaly
  • History of Epstein Barr virus or HIV-1
  • Consitutional symptoms in widespread disease: weight loss, night sweats, weight loss, etc.
83
Q

What disease does the following lymph node histology suggest?

A

-Hodgkin lymphoma

///////////////////////////////////

  • Sclerosis
  • Reed-sternberg cells
84
Q

Which is the most common haematological malignancy in children?

A

ALL

///////////////////////////////////////

It is what it is

85
Q

What are the genes most commonly involved in CLL?

A
  • P53 (bad prognosis)
  • Retinoblastoma gene (bad prognosis)
  • MiR15a
  • ATM gene
  • Loss of P53/del(17p) (bad prognosis)

////////////////////////////////////////////////

Arbitrarily picked the top two to remember since this is a bit to detailed

86
Q

A child with mediastinal mass, weight loss, anaemia. Most likely diagnosis?

A

-T-ALL

(thymus enlargement)

87
Q

What disease does this blood film suggest?

A

-MDS

////////////////////////////////////////

  • Monocytoid cells and an agranular neutrophil
  • Red cells are usually macrocytic but can be hypochromic.
  • Granulocytes reduced in number and show lack of granulation
  • Pelger abnormality (single or bilobed nucleus)
  • Platelets unusual (usually reduced)
88
Q

What is the main cytogenetic abnormality associated with follicular lymphoma?

A

t(14;18) involving BCL-2 gene (Causing abberrant expression)

//////////////////////////////////////////////////////////

Quite fringe for path

89
Q

What disease does this lymph node histology suggest?

A

-Mantle cell lymphoma

///////////////////////////////////////////////////////////

  • Characteristic deformed pattern of small lymphocytes with angular nuclei
  • Expression of cyclin D1 can also show up
  • Located in mantle zone

//Niche but could be useful

90
Q

What disease does the following immunophenotype suggest? CD45+, CD34-, CD2-, CD13+, CD33+, CD117+, CD235a/Glycophorin+, CD19-

A
  • AML M6 acute erythroid leukaemia
  • CD235a/Glycophorin (erythroid marker)
91
Q

In what disease may CAR-T cell therapy be effective?

A

-B-ALL (Specific for CD19)

///////////////////////////////////////////////////

But I think this therapy could be adapted to target any malignancy that has a distinguishing CD cell marker

92
Q

Describe the typical blood count of a non-Hodgkin lymphoma

A

-In advanced disease there may be anaemia, neutropenia or thrombocytopenia

93
Q

Describe the pathophysiology of APML

A
  • PML-RARA fusion protein binds NCoR-HD complex
  • This leads to inhibition of transcription and in turn a block in cell differentiation
  • Retinoic acid (Vitamin A) is unable to exert it’s effect of continuing transcription
94
Q

Describe how t(12;21) leads to ALL

A
  • RUNX1 encodes CBFalpha, which binds to HAT (Activating transcription)
  • In ETV6-RUNX1 fusion, the protein cannot bind to HAT.
  • Therefore transcription is not activated (Causing a loss of differentiation?)
95
Q

What disease does this immunophenotype suggest? CD45-, no SCC, CD10 (mostly+), CD19+, CD34(mostly+), CD5-, HLA-DR(+/-)

A

B-ALL

/////////////////////////////////////////////////

CD19+ means B cell

96
Q

What disease does this blood film suggest?

A

AML

-M2. 1 Aur rod present

//////////////////////////

Aur rods means AML

1 Aur rods means AML M2

many aur rods means AML M3

97
Q

Outline the symptoms of acute lymphoblastic/Myeloid leukaemia.

A
  • Fever, sweats, weight loss (Systemic malignant symptoms)
  • Caused by Bone marrow failure:
  • tiredness, bruising and bleeding, infections/sepsis
  • Caused by tissue infiltration
  • Pulmonary infiltrates -> Shortness of breath, hepatomegaly, splenomegaly, gum hypertrophy
98
Q

What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD7-, CD2- CD34-, CD41+, CD42+, CD61+.

A

-AML M7. Acute myeloid megakaryoblastic leukaemia

//////////////////////////////////////////////////////////

-CD41+, CD42+, CD61+ are platelet antigens.

99
Q

Describe the typical node biopsy of Hodgkin lymphoma

A
  • Sclerosis
  • Reed-Sternberg cells/Owl cells
100
Q

What disease does this lymph node histology (with BCL-6 staining) suggest?

A
  • Follicular lymphoma
  • Germinal centre cell origin
  • BCL-6 stain +ve
  • Also BCL-2 stain +ve in follicles
  • Also diffusely CD10 +ve
101
Q

What disease does the following immunophenotype suggest? CD19-, CD20- CD34-, Tdt- CD38+, CD138+, SIg-, CD7-, CD3-

A

-Multiple myeloma

////////////////////////////////////////////////////

  • CD38, CD138 classic plasma cell markers
  • MM cells don’t have SIg
102
Q

What is the difference between MGUS, smouldering myeloma and multiple myeloma?

A
  • MGUS:
  • Monoclonal serum protein: <30g/L
  • BM plasma cells: <10% of BM cells
  • Multiple Myeloma

-Monoclonal serum protein: >/=30g/L

  • BM plasma cells: >10% of BM cells
  • Smouldering myeloma:
  • Is just asymptomatic multiple myeloma
103
Q

What disease does this blood film suggest?

A
  • CLL
  • Lymphocytosis, smear cells, thrombocytopenia
104
Q

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10+, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-

A

B-ALL

////////////////////////////////////////////////

Not sure why other than CD19+ and CD20+ means B cells

105
Q

What are the lab findings associated with multiple myeloma?

A
  • Calcium raised
  • Renal impairment (raised creatinine)
  • Anaemia (reduced Hb)
  • Bone lesions (osteolytic) on x-ray

Also: /////////////////////////////

  • monoclonal protein >/=30mg/L
  • Abnormal immunoglobulins on electrophoresis (Monoclonal gammopathy). Excessive amounts of gammaglobulin
  • increased serum immunoglobulin-free light chains
  • Increased ESR
106
Q

What disease does this blood film suggest?

A

ALL

-Could also possibly be AML M0-1

107
Q

What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD15+, CD11c+, CD14+, CD64+, CD34-, CD19-, CD22-, Tdt-

A

-AML M5 acute myeloid monocytic leukaemia

///////////////////////////////////////

  • CD13, CD33+ are myeloid markers
  • CD15, CD11c, CD14, CD64 are monocyte markers
108
Q

What is the main cytogenetic abnormality associated with Mantle Cell lymphoma?

A

-t(11;14), Cyclin D1 overexpression (also TP53 mutation)

////////////////////////////////////////

Probably too detailed for path

109
Q

What is the typical immunophenotype of AML?

A

CD13+, CD33+, CD117+, -CD 34+ (if immature cells)

110
Q

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10-, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-

A

B-ALL, specifically ProB-ALL

////////////////////////////////////////////

111
Q

What disease does this lymph node histology (with cyclin D1 stain) suggest?

A
  • Mantle cell lymphoma
  • expression of cyclin D1
  • Located in mantle zone
  • Characteristic deformed pattern of small lymphocytes with angular nuclei
112
Q

Outline the treatment of Multiple myeloma

A

-Steroids

-Alkylating agents (melphalan)

///-Adds alkyl group to guanine residues, blocks replication, causes lymphopenia.////

-Proteosome inhibitors

///-proteosome required for protein degredation into oligopeptides/amino acids.

  • Blocking proteasome leads to decreased amino acids in cell, leading to decreased protein synthesis
  • Effective in MM as there is lots of protein production////

-Monoclonal Abs (daratumumab: anti CD38 antibody)

-Immunomodulatory drugs (IMIDS)

113
Q

What disease does the following immunophenotype suggest? CD34-, Tdt-, CD19+, CD20+,CD23+, CD5+, CD13-, CD33-, CD7-, CD10-, CD79b-, light chain restriction (large disparity between Lambda:kappa)

A

CLL

/////////////////////////////////

-Not to be confused with mantle cell lymphoma (CD23-, Cyclin D1+)

114
Q

What complications can arise from TKI therapy?

A
  • Renal impairment
  • Nausea and vomiting
  • Pancytopenia
  • Pleural effusion (From dasatinib)
115
Q

What is the main translocation associated with CML?

A

t(9;22)/BCR-ABL1/Philadelphia chromosome

116
Q

What diseases are caused by Epstein-Barr Virus?

A
  • Burkitt’s lymphoma
  • Hodgkin lymphoma
117
Q

Presentation of tonsillar enlargement and cervical lymphadenopathy. Atypical lymphocytes and atypical mononuclear cells on blood film. Most likely diagnosis?

A

infectious mononucleosis.

118
Q

What disease does this blood film suggest?

A

Multiple myeloma

  • Plasma cell. Paler area is golgi zone.
  • Roleux formation
119
Q

Describe the typical blood count of a patient with ALL

A
  • Anaemia
  • Thrombocytopenia
  • Neutropenia
120
Q

What disease does this immunophenotype suggest? SIg+, CD20+, CD5-, CD10+, CD23+/-, BCL6+, MUM1-

A
  • Follicular lymphoma (NHL)
  • CD10+ main give away
121
Q

What disease does this lymph node histology suggest?

A
  • Burkitt lymphoma
  • Germinal centre cell
  • ‘starry sky appearance’
122
Q

What disease does this immunophenotype suggest? CD45+, some SCC, Tdt-, MPO+, CD13+, CD33+, CD117+, CD34-, HLA-DR-, CD2(+/-)

A
  • APML
  • Suggested by abberant T-cell marker expression

/////////////////////////

CD2 is a T cekll marker, so that with Myeloid markers (CD13 and CD33) suggest APML.

123
Q
A

Rory's Year 5 pathology (39 decks)

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