WBC pathology Flashcards
Leukaemoid reaction definition and types
Reactive excess leucocytosis in peripheral blood that resembles leukemia in a pt without leukemia.
Types:
Myeloid and lymphoid
ALL lab findings
①blood examination: anemia, thrombocytopenia, leukopenia to normal TLC to leucocytosis, high NIC ratio,>20% blast cells with round to convoluted nucleus, abscence of cytoplasmic granules, smear cells in peripheral blood-degenerated leucocytes.
②bone marrow examination: 20-95% malignant undifferentiated cells of pre B cell pre T cell origin
③ cytochemistry: cytochemical stains for charecterisation of leukemic blasts in all
PAS: positive for immature lymphoid cells in all
Acid phosphatase: + in leukemic blasts
Myeloperoxidase: -ve in all immature cells,
Sudan black -ve in all immature cells.
Non specific esterase -ve
④ immunophenotyping:TdT(terminal deoxy nucleotidyl transferase) expressed by both pre b and t cell nuclei.
B-ALL- positive for CD 19,CD 10
T-ALL- positive for CD1,2,3,5,7
⑤ cytogenic analysis:B-ALL- t ( 9,22)- unfavorable prognosis-bcr -abl fusion gene or Philadelphia positive all
t(12,21) favorable prognosis
T-ALL:14q11,myc gene
Hodgkins lymphoma definition
Arises within lymph nodes primarily and secondarily spreads to other extranodal sites. Biphasic age group 15-30yrs and fifth decade of life.
Classification of h.l.
WHO:
1. nodular-lymphocyte predominant hl.
2. Classical hl - rye classification
① nodules sclerosis.(RS cells-CD 15,cd 30 + ve)
② lymphocyte depleted ( cd 15,30 + ve)
③ lymphocyte predominant(CD15;30- ve, CD20+ve)
④mixed cellularity(CD15;30 +ve)
Staging of hodgkins
A-absence of symptoms. B- presence of symptoms (night sweats, weight loss,.fever) s-splenogegaly e-extranodal involvement.
Stage I (a or B)- I- involve 1 lymph node
I E- involve an extralymphatic organ
Stage ll (a or B)- ll- involve 2 or more lymph node regions on same side of diaphragm. IIE- (or) with localised contagious involvement of an extranodal site or organ
Stage III (a or B) - III - involve lymph nodes on both sides of diaphragm.
IIIE-with localised contagious involvement of an extranodal site or organ IIIS-or with spleen involvement
IIIES- both E andS
Stage IV (Aor B)- IV- multiple or disseminated involvement of extralymphatic organs with or without lymphatic involvement.
Myeloid neoplasms classification
① myeloproliferative neoplasms(myelofibrosis, essential thrombocytosis, CML, polycythemia Vera)
② myeloid ol lymphoid neoplasms with eosinophilia
③ myelodysplastic or myeloproliferative neoplasms
④ .myelodysplastic syndromes
⑤ Acute myeloid leukemia’s and related neoplasms
Acute myeloid leukemia definition
AML is a heterogenous disease where there is infiltration of malignant myeloid blast cells into blood, bone marrow and other tissues.
Mainly affects older adults.
Defect caused by mutations causes lack of maturation in myeloid stem cells.
AML classification
① FAB classification : >30% of blast cells in b.m
② who classification: differ from FAB in 1. Based on clinical, cytogenic, molecular abnormalities mainly ( unlike FAB which includes blast morphology & cytochemistry) 2. >20% of blast cells in BM
FAB CLASSIFICATION: M 0 : minimally differentiated AML M 1 : AML without maturation M 2: AML with maturation M 3: Acute promyelocytic leukaemia M 4: Acute myelomonocytic leukaemia M 5: Acute monocytic leukaemia M 6 : Acute erythro leukaemia M 7: Acute megakaryocytic leukaemia
REED-STERNBERG cell morphologic variants
① classic Rs cell: Large cell bilobed nucleus, prominent eosinophilic inclusion like nucleoleus with clear halo around it, giving owl eye appearance (mixed cellularity)
② lacunar type: it is smaller inside a peri cellular space or lacunae due to shrinkage of cell cytoplasm. In nodular sclerosis
③ polypoid: large cell with multilobulated nuclei resembling popcorn, in lymphocyte predominant
⑦ pleomorphic: pleomorphic. , atypical nuclei in lymphocyte depleted.
