Leukaemia and Lymphadenopathy

Question 1

What is leukaemia?

Answer 1

A neoplastic condition of the bone marrow in which neoplastic cells of lymphoid or non-lymphoid stem cells or their progeny undergo clonal expansion with or without cellular differentiation

Question 2

What are the clinical signs of leukaemia due to?

Answer 2

–Failure of normal marrow function

–Infiltrated organ dysfunction

–Hyperviscosity

–Paraneoplastic syndromes (IMHA, hypercalcaemia)

Question 3

What is the classification for acute leukaemia?

Answer 3

• Neoplastic transformation during stem cell proliferation
• Large numbers of immature (undifferentiated) cells
• Aggressive rapid disease
• Cytopenia is very common

–Marrow disruption by neoplastic expansion

Question 4

What is characteristic of chronic leukaemia?

Answer 4

• Neoplastic transformation following differentiation
• Giving rise to large numbers of mature (differentiated) cells
• Slow progression and less aggressive in comparison to acute disease
• Cytopenia is rare

Question 5

Define cytopenia?

Answer 5

•When there is marrow disruption, lineage kinetics result in disappearance of neutrophils first, then platelets then RBC’s

Question 6

Which of the following has A) the least duration of marrow disruption and B) the most?

Answer 6

A) Neutrophil

B) RBC

Question 7

What are the 2 forms of acute leukaemia?

Answer 7

• ALL (acute lymphoid leukaemia)
• AML (acute myeloid leukaemia)

Question 8

Lymphoma involving BM:

A) How many blast cells in marrow?

B) What is the circulating blast count?

C) What is the cytopenia like?

D) What is the lymphadenopathy like?

E) Is there systemic illness?

Answer 8

A) <40%

B) Low

C) Mild or absent

D) Massive

E) May not be

Question 9

Acute lymphoblastic leukaemia:

A) How many blast cells in marrow?

B) What is the circulating blast count?

C) What is the cytopenia like?

D) What is the lymphadenopathy like?

E) Is there systemic illness?

Answer 9

A) > 40%

B) High

C) Severe

D) Mild to moderate

E) Usually

Question 10

What is acute leukaemia and how do we identify?

Answer 10

–Neoplastic transformation during stem cell proliferation, large numbers of immature (undifferentiated) cells

–Identification of lineage by microscopic morphology difficult and often wrong

Question 11

How can we look at Acute leukaemia morphology?

Answer 11

• Immunophenotyping
• Clonality testing (PARR)

Question 12

What is immunophenotyping?

Answer 12

–Immuno-cytology/histology of marrow aspirates or biopsies

–Immuno-labelled flow cytometry of EDTA blood or marrow

Question 13

What is PARR?

Answer 13

•PCR for antigen receptor rearrangements

Question 14

What is this?

Answer 14

Chronic leukaemia morphology

Question 15

What is this?

Answer 15

Acute leukaemia morphology

Question 16

What can cause lymphadenopathy?

Answer 16

• Reactive hyperplasia
• Lymphadenitis
• Metastatic neoplasia
• Lymphoma

Question 17

What drugs might affect lymph node FNA/CS?

Answer 17

Steroids

Question 18

What is in each of these FNA samples?

Answer 18

Top - lymphoblast

Middle - macrophages

Bottom - plasma cell

Question 19

What is this?

Answer 19

Reactive hyperplasia

Question 20

What is seen in reactive hyperplasia?

Answer 20

• Heterogeneous cell pop
• 75-95% small
• Low %age medium and large cells (up to 15% in reactive)
• Occ plasma cells
• Occ macrophages (>2% in reactive)
• V few neutrophils, eosinophils, mast cells

Question 21

What is this?

Answer 21

Lymphadenitis

Question 22

What is seen in Lymphadenitis?

Answer 22

• Increased neutrophils (>5%) or eosinophils (>3%)
• Macrophages (>3%)

–Incl epithelioid and multinucleate giant cells in granulomatous inflammation

• Inflammatory cells may be mildly increased or completely replace normal structure
• Drained pathology

–Eosinophilic – allergic

–Granulomatous or pyogranulomatous – fungal and protozoal

Question 23

What is this?

Answer 23

Metastatic neoplasia

Question 24

What can cause metastatic neoplasia?

Answer 24

• Carcinoma cells
• Myeloproliferative disorders
• Mast cells (>3%)
• Melanoma cells

Question 25

What is this?

Answer 25

Lymphoma

Question 26

What is seen in lymphoma? What is required to diagnose?

Answer 26

•Increased %age of large immature lymphocytes

–Confident at >50%

• More mitoses than reactive
• More tingible body macrophages
• More lymphoglandular bodies (cell fragility – not pathognomic)
• Histology usu required

Question 27

Reactive of neoplastic?

Answer 27

Reactive hyperplasia

Question 28

Neoplastic or reactive?

Answer 28

Neoplastic