Lymphoma & Leukaemia - an introduction

Question 1

Leukaemia vs lymphoma

Answer 1

Leukaemia: malignancy arising from bone marrow stem cells. Leukaemic cells replace most of BM (crowding out normal haematopoiesis), enter the peripheral blood and metastatise throughout the body

Lymphoma: solid tumour/mass in lymphoid tissue i.e. LNs, MALT, spleen, BM

They may overlap

Question 2

SLL?

Answer 2

Small lymphocytic lymphoma

Question 3

Essential investigations in leukaemia & lymphoma?

Answer 3

Peripheral blood smear

& bone marrow biopsy

Question 4

Proliferative disorders (7)

Answer 4

MYELOID:

• CML
• Polycythaemia rubra vera
• Essential thrombocytosis
• Mastocytosis
• Primary myelofibrosis

LYMPHOID:

• Multiple myeloma
• Waldenstrom

Features are raised blood cells

Question 5

Haematological malignancies

Answer 5

1. Leukaemia (ALL, AML, CLL, CML)
2. Lymphoma
3. Myeloma

Features are raised WBCs

Question 6

Marrow failure (2)

Answer 6

1. Aplastic anaemia (hypocellular marrow)
   » Subset PRCA (parvo B19)
2. Myelodysplasia (hypercellular marrow with dysplastic cells)

Features are pancytopenia

Question 7

B cell immunoglobulin light chains & ratios?

Answer 7

B cells secrete immunogloublins- which have heavy chains and light chains

Light chains can be kappa or lambda

In B cell lymphoma, ratio between these two is abnormal. This indicates monoclonal gammopathy

Question 8

Most common leukaemias by age?
Newborn - 14 yo
40 - 60
> 60

Answer 8

Newborn - 14: ALL (overall ALL is the most common leukaemia anyway)

40-60: AML or CML

> 60: CLL

Question 9

ALL peripheral smear

Answer 9

LymphoBLASTS
medium sized, agranular, scanty cytoplasms

Blasts > 10%

Question 10

AML peripheral smear

Answer 10

MyeloBLASTS
Larger, more cytoplasm, granules (Auer rods)

Blasts > 10%

Question 11

CML peripheral smear

Answer 11

MyeloCYTES & neutrophils, basophils

Blasts <10%

Question 12

CLL peripheral smear

Answer 12

LymphoCYTES +/- smudge cells

Blasts < 10%

Question 13

Hodgkin’s lymphoma

Answer 13

“local” contagious spread

Reed sternberg cell “B cell”

Question 14

Non Hodgkin’s lymphoma

Answer 14

More common than Hodgkins’ lymphoma

Nodal and extranodal constitutional symptoms hepatosplenomegaly

Can be B cell or T cell

Question 15

B cell NHLs

Answer 15

AGGRESSIVE:

• DLBCL
• Burkitt (the most agg)
• Mantle

INDOLENT:

• Follicular lmyphoma
• Marginal zone/maltoma
• Hairy cell leukaemia/lymphoma
• CLL/SLL