Hematopoietic Neoplasia Flashcards
Hematopoietic Neoplasias
Myeloid Neoplasia
Lymphoid Neoplasia
Preleukemia
Neoplastic cells proliferating in the bone marrow w/out being released into peripheral blood
“Leukemic Phase”
primary hemopoietic neoplasm is a solid, extramedullary tumor but releases neoplastic cells into the circultion.
i.e. lymphoma, plasma cell, mast cell tumors that arise outside the marrow.
Lymphocytic Leukemia
- Acute lymphocytic / lymphoblastic
- High numbers of immmature lymphocytes in bone marrow and peripheral blood.
- Chronic
- Increased numbers of small lymphocytes in marrow and peripheral blood.
- These lymphs are small and appear morphologically normal. They are presumed to be mature.
- PARR may help differentiate a polyclonal (normal, reactive) proliferation of lymphocytes from a monoclonal (neoplastic) proliferation of lymphocytes
Bone marrow involvement in the lymphoid neoplasias
Only ALL, CLL, plasma cell leukemia have BM as the primary site.
Lymphosarcoma, Large granular lymphosarcoma, Plasmacytoma may have abnormal cells showing up in the marrow, but the BM is not the primary site.
LSA in juvenile cattle
Not virally assoc., not transmissible.
- Multicentric
- Thymic
- Cutaneous
BLV
- LSA in adult cattle.
- 4-8 yrs of age; typically dairy cattle
- Horizontal spread
- Most infected cattle do not develop neoplastic disease.
- Solid tumors >>> leukemia. Leukemia and BM involvement can occur late in the disease.
- 30% have a persistent lymphocytosis.
- 5-10% develop lymphoid neoplasia including solid tissue tumors, lymphocytic leukemia, or both.
- If only bone marrow affected, need clonality to differentiate lymphocytic leukemia from a persistent lymphocytosis.
- AGID for gp 51
FeLV
- high rate of LSA and myeloid neoplasms
- Older cats may not be viremic at time of detection of the neoplasm and therefore are ELISA negative for group specific antigen p27
- Viral antigen will be detected w/in tumor tissue using immunohistochemistry, PCR, or both.
Large granular lymphocytic leukemia
- rare
- large, irregular, magenta colored cytoplasmic granules
- probably cytotoxic T cells, or NK cells
Plasma cell neoplasms
- Plasmacytoma
- Cutaneous
- typically benign despite frequent pleomorphism, heterogeneity, anisocytosis, ansokaryosis, multinucleation
- “plasmacytoma” appropriate
- Soft tissue / Internal
- Malignant
- intestine, spleen, kidneys, nervous system
- “systemic malignant plasma cell tumor” or “plasma cell sarcoma”
- Cutaneous
- Plasma Cell Sarcoma/ Multiple Myeloma / Plasma cell myeloma
- Plasma Cell Leukemia
Plasma cell sarcoma - criteria for Dx
aka “plasma cell myeloma” and “multiple myeloma”
Need 2 of the 4
- Osteolysis
- Plasma cells comprise > 20% of the bone marrow cells (??? 10% in cats)
- Monoclonal gammopathy (usually IgG, IgA, uncommonly IgM)
- Bence Jones proteinuria (light chains from the globulins)
Hyperglobulinemia sequelae
- hyperviscosity
- incrased rouleaux
- impaired platelet function
- bleeding
- CNS signs
- renal failure
Myeloid neoplasms
Clonal proliferations in the lineage of
- erythrocytes
- granulocytes
- monocytes
- magakaryocytes
- mast cells
MN
MPN
MDS
Myeloid Neoplasms
Myeloproliferative Neoplasms
Myelodysplastic Syndromes
Acute Myeloid Neoplasms
Acute Myeloid Neoplasms
Neoplasm
FAB
Bone Marrow Features
Undifferentiated
AUL
Blasts of unknown lineage
Granulocytic
M1
Granulocytic myeloblasts > 90%
M2
Granulocytic myeloblasts > 30% to < 90%
Granulomonocytic
M4
Granulocytic myeloblasts & monoblasts > 30%
Monocytic
M5a
Monoblasts and promonocytes >80%
M5b
Monoblasts and promonocytes >30% to < 80%
Erythrogranulocytic
M6
Rubriblasts and granulocytic myeloblasts >30%
Erythrocytic
M6Er
Rubriblasts >30%
Megakaryocytic
M7
Megakaryoblasts > 30%
Mastocytemia
The presence of mast cells in the peripheral blood. Same term used for neoplastic or non-neoplastic.
Mastocytemia DDx
- Reactive (Non-neoplastic)
- parvoviral enteritis
- cutaneous hypersensitivities
- parasitic infections
- IMHA
- bacterial peritonitis
- pancreatic necrosis
- pleuritis
- Neoplastic
- progression of systemic mast cell neoplasia (either visceral or cutaneous)
- 1’ BM mast cell leukemia
Chronic Myeloid Neoplasma
aka
Myeloproliferative Neoplasms
Chronic Myeloid Neoplasms
Neoplasm
Bone Marrow Features
Granulocytic (neutrophilic)
Neutrophilic myeloblasts < 30%
Granulocytic (eosinophilic)
Eosinophilic myeloblasts < 30%
Granulocytic (basophilic)
Basophilic myeloblasts < 30%
Granulomonocytic
Myeloblasts and monoblastss < 30%
Monocytic
Monoblasts < 30%
Thrombocytic (essential thrombocythemia)
All platelet precursors increased with orderly maturation.
Erythrocytic (primary erythrocytosis)
All erythroid precursors increased with orderly maturation.
MDS
Myelodysplastic Syndrome
Clonal proliferative disorder characterized by abnormal development and maturation of hemopoietic cells. May result in ineffective hemopoiesis and peripheral cytopenias (anemia, thrombocytopenia, neutropenia).
BM usually hypercellular, but dyshemopoiesis results in impaired maturation and abnormal morphologic findings in the affected cell lines. (nuclear fragmentation, abnormal megakaryocyte lobulation, asynchronous nuclear maturation, increased apoptosis, hypersegmentation of granulocyte nuclei.)
