Hematological Patho II

Question 1

What is a leukaemia and what does it lead to

Answer 1

massive proliferation of leukaemia cells eventually causes suppression of myelogenes which lead to:

• decreased RBC
• decreased mature leukocytes
• decreased platelets

Question 2

what are the signs and symptoms of bone marrow pathology

Answer 2

Lymphoma
leukemias
immune disorders
diffuse boen bane
lymphadenopathy/splenomegaly
blood vessels occlusion

Question 3

What are myeloid cells of chronic myeloid leukaemia characterized by

Answer 3

By the philidlphia chromosome on karyotyping

Question 4

What is the translocation of the philadelphia chromosome that causes CML

Answer 4

translocation of q arm of chromosome 22 to the q arm of chromosome 9 t(9:22)

Question 5

what is leukemia generaly + what is their origin

Answer 5

Neoplastic process which represents a monoclonal proliferation of one transformed precursor cell

80-85% of leukemias and lymphomas are B cell in origin

Question 6

what is acute vs chronic leukemia

Answer 6

Acute: composed of immature cells, sudden onset few months from symptoms to dx

Chronic- composed of mature cells (myelocytes)

Question 7

What is acute lymphoid leukemia, dx criteria and age

Answer 7

• Neoplastic monoclonal proliferation of lymphoid cells predominantly in blood (lymphoblasts)
• bone marrow > 30% blasts

ALL occurs mc in children (70% of all childhood leukemias)

Question 8

What does ALL usually happen w

Answer 8

Down syndrome

Question 9

What is chronic lymphoid leukemia and epidemiology

Answer 9

neoplastic proliferation of mature lymphocytes in peripheral blood and bone marrow

-pts older than 50 (2:1 M:F)

Question 10

What is a major marker of T cell

Answer 10

CD5 is a t cell marker

Question 11

What is the microscopic presentation of CLL

Answer 11

Smudge cells

Question 12

What is acute myeloid leukemia characterized by + epidemiologu

Answer 12

clonal proliferation of myeloid precursors

predominantly older pts (40 isH)

Question 13

markers and pres of AML

Answer 13

T(15;17)

classic clinical case is a younger pt (40ish) with symptoms of leukemia (anemia, bruising) who presents w disseminated intravascular coagulation

Question 14

What is chronic myeloid leukemia, epidemiology and associated abnormality

Answer 14

Neoplastic monoclonal proliferation of granulocytes
older pts

Associated with philadelphia chromosome t(9;22)

Question 15

clinical s/s of CML

Answer 15

• up to 40% asymptomatic
• fatgue/letheragy
• SOB

Signs- markedly elevated WBC, low leukocyte alkaline phospjatase, high uric acid level and lactate dehydrogenase

Question 16

Course of CML (indolent and chronic phase)

Answer 16

Idolent phase- lasts 3-5 years and can be asymptomatic

Chronic phase- leads to an accelerated phase characterized by fever, weight loss, night sweats etc

Finally pts progess to blast cells

Question 17

What is timor lysis syndrom, when does it happen and what does it release

Answer 17

Group of metabolic complications can occur after tx of neoplastic disorder
-caused b massive tumor lysis w release fo large amounts of potassium, phosphate and nucleic acids

Question 18

What is hodgkin lymphoma generally

Answer 18

tumor of germinal centre or post germinal centre of B cells

-Contains a minority of neoplastic cells (Reef sternberg cells) in an inflammatory background d

Question 19

Epidemiology of HL

Answer 19

10% of all lymphomas

-one peak in young adults and one in older adults

Question 20

mc type of HL

Answer 20

Nodular sclerosis (60-80%)

Question 21

HL vs non HL

Answer 21

Hodgkin- Reed sternberg cells, Sigle group of axial nodes, contiguous spread, constitutional symtoms, bimodal age distribution

non HL- No reed sternberg, multiple groups of peripheral nodes, non continues spread, fewer constitutional symptoms, 20-40yold

Question 22

what is something that presents in 80% of HL cases

Answer 22

Cervical or supraclavicular lymph nodes

Question 23

Symptoms of HL

Answer 23

(only 1/3 have symptoms)

Consituitional symptoms
Generalized pruritus
Lymphadenopathy
Pain in the lymph nodes w ingestion of alcohol

Question 24

What is contiguous spread in HL

Answer 24

HL appears to spread or grow my contiguous extension (spreading from one lymph node to adjacent nodes)

Non HL is more difuse

Question 25

Staging of Hodgkins Lymphoma (4)

Answer 25

1. Only a single lymph site
2. two or more lymph nodes on one side of diaphragm
3. Lymph nodes on both sides of the diaphragm are involved
4. Extensive involvement of extra nodal sites

Question 26

What are the 2 major categories of plasma cell lesions

Answer 26

Involving single bones (plasmacytoma)
Multiple bones (multiple myeloma)

Question 27

what will you measure in a plasma cell lesion

Answer 27

Overproduction of one clone of Ig-> produces M spike in gamma (y) region of electrophoresis

Question 28

Multiple myeloma- age, presentation

Answer 28

50-60yold

Path fx
Hypercalemia (due to bone resorption)
Decreased functional Ig
Increased light chains

Question 29

What is a plasmacytoma

Answer 29

osseous solitary plasmacytoma of bone is localized in bone tumor of plasma cells without evidence of plasma cell myeloma or marrow plasmacytosis

Question 30

What is monoclonal gammopathy of undetermined sig

Answer 30

Presence of M spike without osteolytic lesions, waldenstrom macroglobulinemia, amyloidosis, or lymphoproliferative disorders

Question 31

What % of in with monoclonal gammopathy of undermined sig go on to MM

Answer 31

20%

Question 32

What is lymphoplasmacytic lymphoma

Answer 32

uncommon form of non HL

Question 33

what is waldenstrom macroglobulinemia and what does it overproduce

Answer 33

type of Non HL that produces large amount s of IgM

- too much of the IgM causes slugging of cells in the vessels (hyper viscosity)

Question 34

What are heavy chain diseases

Answer 34

rare B cell proliferative disorders characterized by the production of monoclonal protein consisting of portion of the imunogllobulin heavy chain without a bound light chain