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MD2 Surgery and Anaesthesia > Pathology of Plasma Cell Lesions and Amyloid > Flashcards

Pathology of Plasma Cell Lesions and Amyloid Flashcards

1
Q

What are the red flags for back pain?

A 
Pain at night
Pain at rest
Trauma
Constitutional symptoms
Incontinence
Radicular pain
IVDU
Other neurological symptoms
Localised tenderness
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2
Q

What do rouleaux on the blood film indicated?

A

Happen when plasma protein level high

Presence of disease

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3
Q

For what diseases is beta 2 microglobulin measured?

A

Multiple myeloma

Lymphoma

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4
Q

What is Congo Red stain used for?

A

Amyloid

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5
Q

What are plasma cell neoplasms?

A

Proliferation of clone of plasma cells
Often produce
- Monoclonal Ig = paraprotein/M protein
- Free light chains

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6
Q

Which plasma cell neoplasm often affects the axial skeleton?

A

Multiple myeloma

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7
Q

What happens in monoclonal gammopathy of undetermined significance (MGUS)?

A

Bone marrow based clonal proliferation of plasma cells
Make up <10% of total cells
Low levels of M protein

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8
Q

What happens in solitary plasmacytoma of bone, or extraosseus plasmacytoma?

A

Single clonal proliferation of plasma cells within bone/soft tissue
May produce M protein

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9
Q

What happens in multiple myeloma?

A

Multifocal, bone marrow based, monoclonal proliferation of plasma cells
More than 10% of plasma cells
High levels of M protein

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10
Q

What happens in symptomatic multiple myeloma?

A

Organ/tissue impairment = CRAB

  • C = hyper-calcaemia
  • R = renal insufficiency
  • A = anaemia
  • B = bone lesions
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11
Q

Is MGUS considered neoplastic?

A

No

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12
Q

What can MGUS evolve into?

A

Plasma cell myeloma
Other lymphoproliferative disorders
Amyloidosis

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13
Q

What is the cell of origin in multiple myeloma?

A

Post-germinal centre B cell

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14
Q

What is the median age of diagnosis of multiple myeloma?

A

70 yrs

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15
Q

Other than CRAB, what other things can occur in symptomatic multiple myeloma?

A

Increased susceptibility to infection
Hyper-viscosity
Amyloidosis

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16
Q

How does hyper-calcaemia present?

A 
Neurological manifestations
Polyuria
Constipation
Nephrocalcinosis
Renal calculi
17
Q

How do bone lesions occur in multiple myeloma?

A

Neoplastic cells produce factors > activate osteoclasts and inhibit osteoblasts > bone erosion

18
Q

How do bone lesions present?

A

Pain
Pathological fractures
Hyper-calcaemia

19
Q

Why do patients with multiple myeloma get anaemia?

A

Neoplastic proliferation in bone marrow > pancytopaenia

20
Q

How do bisphosphonates work?

A

Bind to Ca > ingested by osteoclasts > cause apoptosis > overall decrease in bone resorption

21
Q

Why are bisphosphonates used in the symptom management of multiple myeloma?

A

Decrease hyper-calcaemia and bone resorption

22
Q

What are the circulating monoclonal immunoglobulins in multiple myeloma?

A

IgG in 50%
IgA in 20%
Light chains in 20%

23
Q

What causes hyper-viscosity syndrome in symptomatic multiple myeloma?

A

Increased blood viscosity

  • ESR
  • Rouleaux
24
Q

What causes increased susceptibility to infection in symptomatic multiple myeloma?

A

Abnormal Ig > impaired humoral immunity

25
Q

What causes renal insufficiency in symptomatic multiple myeloma?

A 
Hyper-calcaemia
Hyper-viscosity syndrome
Increased susceptibility to infection
Light chains filtered by kidney
Light chains deposit in tissues, including kidney, as amyloid
26
Q

What are light chains when detected in the urine in plasma cell lesions called?

A

Bence-Jones proteins

27
Q

What is amyloid?

A

Pathological extracellular protein
Fibrillary ultrastructural appearance
Due to mis-folding of normal/abnormal proteins
Can’t be removed

28
Q

What is primary amyloidosis?

A

Associated with plasma cell/lymphoplasmacytic lesion
Usually light chains - usually lambda
Usually deposits in multiple organs

29
Q

What sort of light chains can be excreted, and what cannot?

A

Lambda can’t be excreted

Kappa excreted in urine = Bence-Jones proteins

30
Q

What is secondary amyloidosis?

A

Associated with systemic chronic inflammatory conditions/tumours
Derived from serum amyloid associated protein (SAA) = acute phase reactant
Usually deposits in multiple organs

31
Q

What are some systemic chronic inflammatory conditions and tumours with which secondary amyloidosis is associated?

A 
IBD
TB
Rheumatoid arthritis
Hodgkin's lymphoma
Renal cell carcinoma
32
Q

What is the amyloid in Alzheimer’s disease?

A

Amyloid beta protein (ABP)
Derived from amyloid precursor protein (APP)
Forms senile plaques

33
Q

In which conditions does CNS amyloid deposit in vessel walls?

A

Alzheimer’s disease

cerebral amyloid angiopathy

34
Q

What are the complications of amyloidosis?

A 
Organ failure - function deteriorates with progressive amyloid deposition
Vessels become
- Brittle
- Prone to rupture
Cardiac amyloid
- Restrictive cardiomyopathy
- Cardiac failure
- Arrhythmias
Renal amyloid
- Proteinuria
- Nephrotic syndrome
- Chronic renal failure

MD2 Surgery and Anaesthesia (31 decks)

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