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Unit 2 SPATH UFCOM > K. Neoplastic Hematology Intro (L11, L12 & Hematopoesis SS) > Flashcards

K. Neoplastic Hematology Intro (L11, L12 & Hematopoesis SS) Flashcards

1
Q

What is leukemia? What are the main classifications of leukemia?

A

= neoplastic proliferation of WBCs in the blood
• Acute vs. chronic
• Mylogenous vs. lymphoid –> AML, CML, ALL & CLL

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2
Q

What is lymphoma? What are the main classifications of lymphoma?

A

= neoplastic proliferation of WBCs in the lymph nodes that forms mass
• Hodgkins vs. non-hodgkins

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3
Q

What are the 3 main areas within a lymph node and what are the main cells that live there?

A
  • Follicle = B
  • Parafollicular = T
  • Medulla = Sinus Histiocytes
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4
Q

What cell is the “starting point” of all hematopoiesis?

A

• Hematopoetic stem cell

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5
Q

What can a hematopoetic stem cell directly turn into? (Next step(s))

A
  • Myeloid Progenitor

* Lymphoid Progenitor

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6
Q

What can the lymphoid progenitor turn into?

A
  • B lymphoblast –> Naïve B –> plasma cell

* T lymphoblast –> Naïve T –> mature CD4 or CD8 T

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7
Q

What lives in a primary follicle?

A

• Naïve B cells that have not yet seen antigen

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8
Q

What 2 things can the myeloid progenitor directly turn into?

A
  • Granulocyte/Macrophage Progenitor

* Megakaryocyte/Erythrocyte Progenitor

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9
Q

Ultimately what does the myeloid progenitor turn into?

A
  • Erythroblast –> RBC
  • Myelobast –> Granulocytes (Nuetrophils, eosinophils, basophils)
  • Monoblast –> monocyte (macrophage)
  • Megakaryoblast –> megakaryocyte –> platelets
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10
Q

If nucleated RBCs are seen in blood what is it mostly likely?

A

Orthochromatic Erythroblast

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11
Q

What is the normal ration of myeloid to erythroid cells in the bone marrow?

A

3:1 (not intuitive)

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12
Q

Are undifferentiated/precursor cancers more or less aggressive than differentiated/peripheral cancers?

A

• Undifferentiated = more aggressive

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13
Q

Do B or T cells cause more lymphomas?

A

• B = 85%

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14
Q

Where are Tingible Body Macrophages found? What is their function?

A
  • Germinal Center
  • Remove the naive B cells that are not presented with antigen

In follicular hyperplasia, not follicular lymphoma

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15
Q

What are the 3 main zones of a follicle (most easily differentiated during follicular hyperplasia)?

A
  • Germinal Center
  • Mantel
  • Marginal Zone (prominent during follicular hyperplasia)
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16
Q

Where on the body are bone marrow aspirates & biopsy most often performed?

A

• Superior iliac crest

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17
Q

What will be the main difference in appearance of a lymph node during reactive lymphadenopathy and lymphoid proliferation?

A
  • During reactive hyperplasia the normal architecture is preserved (can see open medulla and follicles with heterogenous cells)
  • During lymphoid proliferation normal architecture is replaced by proliferating lymphoid cells (monomorphic cells)
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18
Q

Can lymphoid proliferation always be seen morphologically?

A

• No, sometimes heterogenous proliferation with relatively intact architecture –> need immunophenotypic and genetic studies

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19
Q

What are the 2 main types of immunophenotyping when diagnosing hematological cancers? Why are they useful?

A
  • Immunohistochemistry
  • Flow cytometry
  • Cells retain the markers of the normal cells which they are mimicking –> can determine where in the cycle things went wrong
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20
Q

When you find enlarged lymph nodes what are the 2 main things you should keep in mind for possible causes?

A
  • Reactive hyperplasia

* Neoplastic disorder

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21
Q

What are the 2 main types of neoplastic disorders that cause enlarged lymph nodes?

A
  • Neoplastic metastasis from somewhere else in the body

* Lymphoma (HL & NHL)

22
Q

What causes reactive lymphadenopathy?

A
  • Infections (bacterial, viral or fungal)
  • Autoimmune diseases
  • Drugs
  • Foreign Matter
23
Q

What regions of the lymph node can be enlarged in reactive lymphadenopathy?

A

• Can have enlargement of all areas or selective enlargement of individual areas such as follicular hyperplasia, Interfollicular Hyperplasia or Sinus histiocytosis

24
Q

If lymph nodes are tender that generally points to what sort of cause?

A

• Reactive hyperplasia, not neoplasm

25
Q

What does BCL-2 staining signify?

A
  • BCL-2 is an anti-apoptotic protein
  • Presence in follicle (Rather than around it) signifies follicular lymphoma

BCL-2 keeps Bax gate closed –> no Cyt C leaks out –> no apoptosis –> cells build up

26
Q

If lymph nodes are enlarging is a reactive or neoplastic disorder most likely?

A

Neoplastic

27
Q

How does likelihood of lymphadenopathy being related to neoplasm change with age?

A

• Chances of neoplastic cause increase dramatically after the age of 50 (very low for people under 30)

28
Q

What does Ki67 staining signify? Is it seen in reactive hyperplasia or lymphoma?

A
  • Cell proliferation
  • Hyperplasia, not lymphoma (In lymphoma cells stay around for a long time, don’t undergo apoptosis & don’t get replaced)
29
Q

Is flow cytometry performed on a fresh sample or a paraffin embedded sample? What about immunohistochemistry?

A
  • Fresh

* Paraffin embedded

30
Q

How does immunohistochemistry work?

A
  • Have specific Ab to the surface marker you are testing
  • Then have general Ab to the specific Ab that has an enzyme attached
  • Enzymatic reaction causes a brown color in tissues where the enzyme is concentrated
31
Q

How does flow cytometry work?

A
  • Use Ab to specific surface markers that fluoresce a certain color which is detected
  • Also use side scatter (granularity) & forward scatter (size) to differentiate cells
32
Q

If a monoclonal Ab population is found, what cell type is neoplastically affected?

A

B cells

33
Q

What serological test is used most often to screen for suspected mononucleosis? What is it testing for?

A
  • Monospot

* Heterophile Ab which can coagulate horse blood

34
Q

What morphological finding is suggestive of Mono?

A

Atypical lymphocytes

35
Q

In a healthy adult what is the ratio of RBCs to WBCs?

A
  • 1000:1

* 5 million RBCs per micro liter verse 5k for WBCs

36
Q

Normal Platelet count?

A

• 150-400 thousand per mm^3

37
Q

Are reactive/atypical lymphocytes unique to mono?

A
  • No, a small number of these are normally found in healthy person
  • But a large percentage of them is relatively unique to mono
38
Q

What type of antibody causes a positive monospot test?

A

IgM heterophile

39
Q

If monospot test is normal, what more specific test can be performed for mono?

A

• Serologic tests for IgM against EBV viral capsid

40
Q

What type of infection is most likely for patients that present with mono, but are negative for specific EBV serologic tests?

A

CMV

41
Q

Why do lymph nodes enlarge in reactive lymphadenopathy?

A

Body is producing more WBCs to fight infection (or whatever else triggered it)

42
Q

Why do lymph nodes hurt when reactive lymphadenopathy is present?

A

Pain signifies inflammation

43
Q

Lymph node enlargement in somebody that is younger than 30 y.o. is most likely benign or neoplastic?

A

benign

44
Q

What is the most likely cause of local reactive lymphadenopathy? What about systemic lymphadenopathy?

A

Infection

Systemic disease like autoimmune Lupus

45
Q

What are the most likely cause of painless local lymphadenopathy?

A

Mets to lymph node draining area of cancer

Hodgkins Lymphoma

46
Q

What is the most likely cause of painless systemic lymphadenopathy?

A

Mets of leumkemia

Follicular B cell lymphoma

47
Q

What region of the lymph node undergoes hyperplasia in response to viral infections? What cell type increases in number?

A

Paracortex

T cells

48
Q

Is NHL treatment based mainly on morphology or classification?

A

Classification

49
Q

What type of reactive hyperplasia results in expansion of the sinus histiocytes?

A

metastatic tumors

50
Q

What type of reactive hyperplasia results in expansion of the follicle?

A

Autoimmune
Toxoplasmosis
Syphilis

51
Q

What is effacement of a lymph node?

A

When the normal architecture is lost & proliferative cells replace normal cells

52
Q

Are the abnormal proliferative cells in the lymph node always monomeric?

A

No sometimes they are polymorphic

Unit 2 SPATH UFCOM (17 decks)

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