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Y3 HAEMATOLOGY > Malignancy > Flashcards

Malignancy Flashcards

1
Q

Outline the kinetics/processes that occur in normal haemopoiesis

A 
Self-renewal
Proliferation
Differentiation (lineage commitment)
Maturation
Apoptosis
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2
Q

What happens in malignant haemopoiesis?

A 
Increased numbers of dysfunctional cells, due to one or more of
 increased proliferation
 lack of differentiation
 lack of maturation
 lack of apoptosis
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3
Q

How does acute leukaemia affect normal haemopoeitic processes? What do the cells look like?

A

Proliferation of abnormal progenitors with block in differentiation/ maturation, therefore abnormal looking cells

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4
Q

How do chronic myeloproliferative disorders affect normal haemopoeitic processes? What do the cells look like?

A

Proliferation of abnormal progenitors with NO block in differentiation/ maturation, therefore normal looking cells

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5
Q

What causes haematological malignancies?

A

Genetic, epigenetic and environmental interactions causing the expression of driver mutations (chromosome change) which pass onto daughter cells

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6
Q

Driver mutations select clones. Normal haemopoeisis is monoclonal/ polyclonal.

A

Polyclonal - involves input from different populations of cells

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7
Q

Driver mutations select clones. Malignant transformation is monoclonal/ polyclonal.

A

Monoclonal - involves input from a single clone

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8
Q

How are types of haematological malignancies classified?

A

Lineage (myeloid/lymphoid)
Developmental stage (precursor/lymphocyte/plasma)
Anatomical site involved (blood, lymph node))

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9
Q

Leukaemias involve the blood, whereas lymphomas involve the lymph node. What is the exception to this?

A

Chronic lymphocytic leukaemia involves the blood and the lymph nodes

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10
Q

What type of leukaemias and lymphomas are histologically and clinically more aggressive?

A

Acute leukaemias

High grade lymphomas

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11
Q

List histological features of aggression

A

Large cells
High nuclear-cytoplasmic ratio
Prominent nucleoli
Rapid proliferation

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12
Q

State the main feature of clinical aggression

A

Rapid progression of symptoms

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13
Q

What is the main difference between acute and chronic leukaemia?

A

Acute leukaemia shows failure of normal bone marrow function

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14
Q

List the main haematological malignancies

A 
Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
Lymphoma (Hodgkins or Non-Hodgkins)
Myeloma
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15
Q

What is acute leukaemia?

A

Rapidly progressive clonal malignancy of marrow/blood with cell maturation defects

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16
Q

State the histological findings of acute leukaemia on blood film or bone marrow aspirate

A

Excess of blasts (>20%) in peripheral blood or marrow

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17
Q

What may the blood results show in an acute leukaemia?

A

Reduced or loss of normal haemopoietic reserve

Anaemia, thrombocytopaenia, neutropaenia

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18
Q

State the two types of acute leukaemia

A

Acute myeloid leukaemia (plasma cells in marrow)

Acute lymphoblastic leukaemia (lymphoid precursors)

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19
Q

Which haematological malignancy is more common in the elderly?

A

Acute myeloid leukaemia (over 60s)

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20
Q

Which haematological malignancy is the most common childhood cancer?

A

Acute lymphoblastic leukaemia, a malignant disease of lymphocytes

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21
Q

Give two distinct clinical features of AML subgroups

A

DIC

Gum infiltration

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22
Q

List some clinical features of acute lymphoblastic leukaemia

A 
Anaemia
Infection
Bleeding
CNS involvement
Bone pain
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23
Q

List investigations for acute leukaemia

A 
Blood count
Blood film (abnormal blasts)
Coagulation screen
Bone marrow aspirate
Immunophenotyping
24
Q

What is the diagnostic feature of AML seen on blood film?

A

Auer rods (elongated needles seen in the cytoplasm of myeloid leukemic blasts)

25
Q

What investigation for acute leukaemia is diagnostic of the particular subtype?

A

Immunophenotyping

26
Q

How is acute leukaemia treated?

A

Curative chemotherapy (AML more intensive)
Stem cell transplantation
Targeted treatments

27
Q

What are the problematic consequences of bone marrow suppression treatment for leukaemia?

A

Anaemia
Neutropenia (infections)
Thrombocytopenia (bleeding)

28
Q

What type of infection is most common in bone marrow suppression treatment for leukaemia? How is it treated?

A

Gram negative bacterium related sepsis

Broad spectrum antibiotics as soon as fever

29
Q

If an infection is resistant to antibiotics, what type of infection in leukaemia should be suspected?

A

Fungal infection

30
Q

What is the prognosis like in acute leukaemia?

A

Man go into remission but later relapse

31
Q

List early side effects of chemotherapy

A 
Nausea, vomiting
Hair loss
Liver, renal dysfunction
Tumour lysis syndrome
Infection
32
Q

List late side effects of chemotherapy

A

Infertility

Cardiomyopathy with anthracyclines

33
Q

List some causes of lymphadenopathy and give examples

A

Lymphoma (Hodgkin’s disease)
Infection (viral e.g. glandular fever, bacterial e.g. TB)
Metastatic cancer (breast, lung, ovarian)
Connective tissue disease (sarcoidosis, SLE)

34
Q

What is the classic presentation of Hodgkin’s lymphoma?

A

Drinking alcohol causes painful lymph nodes, especially in chest

35
Q

List symptoms to ask about if a patient complains of lymphadenopathy

A 
Night sweats
Weight loss
Itch without rash
Alcohol-induced pain
Fatigue
36
Q

What are the two main types of lymphadenopathy it is important to differentiate between?

A

Regional lymphadenopathy

Generalised lymphadenopathy

37
Q

Describe the nature of viral lymphadenopathy, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

A 
Tenderness: yes
Consistency: hard
Surface: smooth
Skin inflammation: no
Tethering: no
38
Q

Describe the nature of bacterial lymphadenopathy, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

A 
Tenderness: yes
Consistency: hard
Surface: smooth
Skin inflammation: yes
Tethering: maybe
39
Q

Describe the nature of lymphoma, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

A 
Tenderness: no
Consistency: soft
Surface: smooth
Skin inflammation: no
Tethering: no
40
Q

Describe the nature of metastatic lymph nodes, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

A 
Tenderness: no
Consistency: hard
Surface: irregular
Skin inflammation: no
Tethering: yes
41
Q

What sampling/biopsy methods are used for lymph nodes?

A

Core biopsy

FNA aspirate is usually not enough

42
Q

Lymphoma can be diagnosed by CT. True/ False?

A

False

Looks very similar to metastatic malignancy

43
Q

List the methods used to assess lymph node pathology

A 
Histology (architecture)
Immunohistochemistry of solid node
Immunophenotyping of blood or marrow
Cytogenic analysis (G banding, FISH)
Molecular analysis
44
Q

What histological pattern is characteristic of Hodgkin’s lymphoma?

A

Nodular sclerosing

45
Q

What is the difference between immunohistochemistry and immunophenotyping?

A

Immunohistochemistry looks at pattern of proteins on surface of lymphoma cells from a solid sample whereas immunophenotyping uses a liquid phase

46
Q

What is the purpose of cytogenic analysis?

A

Looks for specific patterns of chromosome abnormality in certain lymphomas

47
Q

What is the purpose of molecular analysis?

A

Looks at patterns of gene expression, and which are switched on or off

48
Q

Describe the immunohistochemistry of Hodgkin’s lymphoma

A

CD30 Reed Sternberg cells
Look like boobs
Few tumour cells

49
Q

Describe the immunohistochemistry of non-Hodgkin’s lymphoma

A

CD20 cells

Many tumour cells

50
Q

List types of lymphoma

A

Hodgkin’s lymphoma
T cell Non-Hodgkin’s lymphoma
B cell Non-Hodgkin’s lymphoma
Burkitt’s lymphoma (B cell cancer, very aggressive)
Mantle cell lymphoma (abnormal B cells)
Marginal zone NHL (B cells in wrong place)

51
Q

Chronic lymphocytic leukaemia typically presents asymptomatically. True/False?
What are the signs/symptoms to look out for?

A

True

Lymphadenopathy, splenomegaly (in 50% of cases), and shortness of breath and fatigue

52
Q

What is the characteristic histopathological sign of CLL?

A

Smudge or smear cells

53
Q

List causes of lymphocytosis

A

Viral infection
Pertussis
Childhood response to infection
Chronic lymphocytic leukaemia

54
Q

What is a diagnostic test to differentiate between NHL and HL ?

A

Node biopsy

55
Q

How is lymphoma staged?

A

Using CT and PET scan:

1: one lymph node group
2: two lymph node groups on same side of diaphragm
3: two or more above or below the diaphragm
4: infiltration of other organs

Y3 HAEMATOLOGY (16 decks)

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