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CP > Myeloma and Lymphoma > Flashcards

Myeloma and Lymphoma Flashcards

1
Q

What is B cell differentiation?

A

B cells converting from immature to mature B cells

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2
Q

Where does the first stage of B cell differentiation occur and what happens?

A

Bone marrow
pro B cells to naive B cells
gain immoglobulins

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3
Q

Where does the second stage of B cell differentiation occur and what happens?

A

secondary lymphoid organs
Antigen dependent stage
B cells get antigens presented to them to develop surface immunoglobulins
plasma cells are made

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4
Q

What marker is unique to plasma cells?

A

CD38 - useful for diagnosing myeloma

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5
Q

What is the Plasma Cell Differentiation Pathway?

A

final stage in producing plasma cells

details not important - there just to show that if there are errors in any stage = increased proliferation = myeloma

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6
Q

What are the light chains in immunoglobulins?

A

kappa

lambda

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7
Q

What is protein electrophoresis?

A

laboratory technique whereby serum is placed in a gel and exposed to an electric current
used to diagnose myeloma

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8
Q

What in protein electrophoresis is important to diagnosing myeloma?

A

gamma globulin

m spike seen - neoplastic cells only producing one type of immunoglobulin

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9
Q

What is immunofixation?

A

next step after electrophoresis
(Anti-immunoglobulin antisera) gel added with antibodies to those globulins to identify what is there
positive result = complex precipitates

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10
Q

What is myeloma a malignancy of?

A

plasma cells

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11
Q

What is the common age and ethnic origin that suffer with myeloma?

A

70 years

Afro-Caribbean

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12
Q

What can present in patients before they myeloma or can help to predict the rate of the disease?

A

asymptomatic monoclonal gammopathy of undetermined significance (MGUS) - can be normal or high risk
amyloidosis
POEMS syndrome - combination of a plasma-cell proliferative disorder
Solitary plasmacytoma (with minimal bone marrow involvement) - discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue
myeloma with adverse cellular features

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13
Q

Apart from seeing more than 10% of neoplastics plasma cells and/or extramedullary plasmacytomas, what else should the patient present with in order to diagnose a patient with myeloma?

A

CRAB features

MDEs - Myeloma defining events

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14
Q

What are the CRAB features?

A

calcium elevation
renal insufficiency
anaemia
bone lesions

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15
Q

What are myeloma defining events?

A

> 60% neoplatic plasma cells on biopsy
Serum Free Light Chains ratio >100mg/L- kappa to lambda chain ratio abnormal
bone focal lesion on MRI measuring >5mm

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16
Q

If a patient has myeloma defining events but no symptoms, what is this known as?

A

“asymptomatic / smouldering” myeloma cases

17
Q

How do kidney problems arise in myeloma?

A

light chains clog up the glomerulus

18
Q

What is the management of acute kidney injury with suspected myeloma?

A

MEDICAL EMERGANCY

STEROIDS

19
Q

What other diseases patients with MGUS progress to have?

A

Waldenstrom’s macroglobulinaemia
Primary Amyloaid light chain amyloidosis
Lymphoproliferative disorders

20
Q

What is used to determine the risk of a patient with MGUS progressing to myeloma?

A

low para-protein
IgG rather than IgM/IgA
abnormal SFLC ratio
all mean low chance of progression to myeloma

21
Q

What is amyloid light chain amyloidosis?

A

Light chain fragments misfold and self-aggregate to form beta-pleated fibrils
Nephrotic-range proteinuria containing mainly albumin and small monoclonal light chain component
Cardiac and liver involvement
End stage renal failure
peripheral neuropathy

22
Q

What is follicular lymphoma?

A

Neoplastic disorder of lymphoid tissue

Type of non-Hodgkin lymphoma - characterised by slowly enlarging lymph nodes

23
Q

Who is follicular lymphoma more common in?

A

Incidence rises with age

M=F

24
Q

What is used to determine the prognosticate of follicular lymphoma?

A

Follicular International Prognostic Index (FLIPI)

25
Q

What is night sweats a classic symptom of?

A

lymphadenopathy

26
Q

What is seen histologically on a biopsy for a Hodgkin’s lymphoma?

A

Reed–Sternberg cell = speckled looking cell
usually surrounded by inflammatory cells i.e. eosinophils
lots of T cells

CP (50 decks)

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