Lymphoreticular pathology

Question 1

What makes up the primary immune system?

Answer 1

bone marrow, thymus

Question 2

What makes up the secondary immune system?

Answer 2

lymph nodes, spleen, MALT

Question 3

What cells are inside the bone marrow?

Answer 3

Haemopoietic stem cells

Question 4

What can haemopoietic stem cells become?

Answer 4

MYLOID PROGENITOR CELLS - platelets, eosinophils, basophils, neutrophils, monocytes, erythrocytes
LYMPHOID PROGENITOR CELLS - T cells, B cells

Question 5

What makes up a lymph node?

Answer 5

Afferent lymph vessel
Primary lymphoid follicle ( B cell area)
Secondary lymphoid follicle
Germinal centre
Medullary cords (macrophages and plasma cell area)
Efferent vessel

Question 6

How do we classify lymphoreticular disorders? (cancers)

Answer 6

Benign - reactive lymph node

Malignant - lymphocytic leukaemia, lymphomas, myeloma

Question 7

What predisposes (causes) someone to lymphoreticular disorders?

Answer 7

Infective - acute (bacterial, viral), chronic (TB)
Autoimmune
Immunocompromised
Unknown

Question 8

What is leukaemia?

Answer 8

Malignant clonal proliferation of one of the bone marrow cell lines - white blood cells
Acute (ALL, AML) or chronic (CLL,CML)

Question 9

What causes leukaemia?

Answer 9

Multifactorial
Host factors
Random
Damage to DNA during cell division

Question 10

Describe ALL?

Answer 10

Acute lymphoblastic leukaemia
Overproduction and accumulation of cancerous, immature white blood cells (lymphoblasts)
Most common childhood
Cure 60- 90%
Age 2 - 10 yrs

Question 11

Describe AML?

Answer 11

Acute myloid leukaemia
Possible involvement of all cell lines
Overproduction of immature white blood cells, called myeloblasts or leukaemic blasts. These cells crowd the bone marrow, preventing it from making normal blood cells.

Question 12

What are some oral signs of leukaemia?

Answer 12

lymphadenopathy
nerve palsy
infection
hyperplasia
bleeding
hairy leukoplakia
ANUG

Question 13

What problems may occur secondary to treatment?

Answer 13

Bone marrow failure due to irradiation
Salivary gland damage
Swelling 
Dry mouth
Osteonecrosis
Mucositis

Question 14

Describe CML?

Answer 14

Chronic myloid leukaemia
Production of pleuripotent stem cells together with philadelphia chromosome (9 and 22 translocation)
Non specific symptoms - malaise, weight loss
Mainly adults

Question 15

Describe CLL?

Answer 15

Chronic lymphocytic leukaemia
Clonal proliferation of mature B cells
Painless, lymphadenopathy, recurrent infections, anaemia
Elderly

Question 16

What is a lymphoma?

Answer 16

Malignant proliferation in lymph nodes

Two forms : Hodgkins and Non - Hodgkins

Question 17

What is the difference between leukaemia and lymphoma?

Answer 17

LEUKAEMIA - proliferation of WBC - circulating cells

LYMPHOMA - proliferation of cells originally in one place - static tumour

Question 18

What is Hodgkins lymphoma?

Answer 18

Malignant proliferation of atypical lymphocytes with a reactive inflammatory background within a lymph node
M>F 20-30 yrs and then 50-60 yrs
Many types : nodular sclerosing, mixed cellularity, lymphocyte depletion, lymphocyte rich
Linked to EBV and HIV
Present with reed - sternberg cells which are multinucleatd enlarged leukocytes
Symptoms - lymphadenopathy, splenomegaly, sweats, fever, weight loss

Question 19

What is Non - Hodgkins lymphoma?

Answer 19

Slow growing, incurable and non aggressive or fast growing, aggressive, cureable, sudden
Most common in B cell
Destruction of normal nodal architecture, capsular invasion, and extension to soft tissues
Can arise outside the lymph node
Symptoms - lymphadenopathy, lesions intra-orally,
Lined to Sjogrens syndrome

Question 20

How does lymphadenopathy present?

Answer 20

Local or generalised

Question 21

What is the cause of local lymphadenopathy?

Answer 21

Infection, inflammation

Question 22

What is the cause of generalised lymphadenopathy?

Answer 22

Lymphoma, RA, HIV

Question 23

What is the prognosis for leukaemia?

Answer 23

Depends on the grade, type and stage
Stage 1 - involves single lymph node or localised organ
Stage 2 - 2+ lymph nodes on same side of diaphragm
Stage 3 - lymph nodes on both sides of diaphragm
Stage 4 - organs with or without lymph nodes, distal involvement

Question 24

What is the treatment for leukaemia?

Answer 24

Radiotherapy

Chemotherpay

Question 25

What is a multiple myeloma?

Answer 25

Proliferation of lymphoid cells where the malignant cells show differentiation towards plasma cells.
Common in the elderly
Plasma cells produce Ig’s
Presents as jaw lesions, soft tissue mass, bone pain, tenderness, anaemia, impaired renal function

Question 26

How do we treat multiple myeloma?

Answer 26

Chemo