Malignancy Flashcards
Proliferation of abnormal progenitors
with block in differentiation/maturation
Acute leukaemia
Proliferation of abnormal progenitors,
but NO differentiation/maturation block
Chronic myeloproliferative disorders/neoplasm (MPN)
e.g. chronic myeloid leukaemia
Normal vs malignant haemopeoisis.
Polyclonal or monoclonal?
Normal = polyclonal
Malignant = monoclonal
Lymphoblastic vs lymphocytic
Lymphoblastic = more primitive cells
Lymphocytic = more mature cells
All malignancies of haemopoietic and lymphoid systems
Acute lymphoblastic leukaemia: blood/marrow involving primitive, lymphoid malignancy
Acute myeloid leukaemia: blood/marrow involving, primitive, myeloid malignancy
Chronic lymphocytic leukaemia*: blood/marrow involving, less primitive, lymphoid malignancy
High grade B/T cell (non Hodgkin) lymphoma: nodal, lymphoid malignancy, less primitive, clinically aggressive
Low grade B cell (non Hodgkin) lymphoma: nodal, lymphoid malignancy, less primitive, clinically less aggressive
Hodgkin lymphoma: nodal, lymphoid malignancy, less primitive, less aggressive
Myeloma – plasma cell malignancy usually, not exclusively, in the bone marrow
Chronic myeloproliferative neoplasms disorders: primitive, myeloid compartment, maturation preserved (e.g. chronic myeloid leukaemia)
Introduction to leukaemias:
https://mbchb.dundee.ac.uk/mod/systemweek/activity.php?cmid=5303&aid=1559
Blood cancer in lymph node =
LYMPHOMA
Non-tender, hard, irregular, mobile lymph node
Lymphoma or metastatic carcinoma?
Metastatic carcinoma
Non-tender, rubbery/soft, smooth, immobile lymph node
Lymphoma or metastatic carcinoma?
Lymphoma
Lymphoma investigation
Large biopsy/core biopsy
(ideally whole node, need a big sample to assess architecture of the lesion)
Methods of assessing lymph node pathology
- Histology-microscopic appearances.
- Immunohistochemistry of solid node.
- Immunophenotyping of blood/marrow.
- Genetic analysis.
- Molecular analysis.
B cell lymphoma
CD20
Hodgkin’s lymphoma
CD30 (Reed-Sternberg)
When is immunophenotyping used?
V useful in leukaemias, and in lymphomas involving marrow e.g., Burkitt’s Lymphoma.
Causes of a leucoerythroblastic film
- Reactive (sepsis)
- Marrow infiltration
- Myelofibrosis
Ann-Arbor staging (be roughly aware of it)
Stage I involves one lymph node area or extra-lymph node area
II involves 2 or more, on one side of the diaphragm
III involves 2 or more on both sides of the diaphragm
IV disseminated or multiple extra nodal area (including bone marrow)
Which leukaemias infiltrate lymph nodes?
CLL, commonly
ALL, less commonly,
AML, rarely
JAK2 mutation =
Myeloproliferative disorders - … ___ finish
What test distinguishes between lymphocytic and myeloid leukaemia?
Immunophenotyping
Antigen which shows myeloid cells
Myeloperoxidase
Antigens which show lymphoid cells
CD19 (B)
CD20 (B)
CD3 (T)
Primitive antigens
CD34 - stem cells
TDT - enzyme in primitive lymphoid cells
Pancytopaenic, easy bruising, prolonged PT
Vitamin K deficiency blood results:
Which organism is most likely to cause death within hours in acute leukaemia?
Gram-negative bacillus
- causes endotoxic/septic shock
Lymph node enlarged + blood count + no lymph biopsy =
Probably CLL
In exam, lymph node biopsy needed for lymphoma diagnosis
How to confirm CLL diagnosis?
Immunophenotyping
How to treat asymptomatic CLL
‘Watch and wait’
Age of presentation for Fanconi’s anaemia
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