mlab 1415- hematology keri brophy-martinez lymphoid malignancies
DESCRIPTION
Pathogenesis Acquired genetic factors Proto-oncogenes Tumor suppressor genes Inherited genetic factors Wiskott Aldrich Ataxia telangiectasia Environmental factors EBV infection Helicobacter pyloriTRANSCRIPT
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MLAB 1415- Hematology
Keri Brophy-MartinezLymphoid Malignancies
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Introduction
Two broad categories Leukemia
A malignant disease of hematopoietic tissue characterized by replacement of normal bone marrow elements with abnormal (neoplastic) blood cells.
Abnormal cells are also seen in peripheral blood Lymphoma
Abnormal proliferation of lymphoid cells within the lymphatic tissue or lymph nodes, results in a solid tumor
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Pathogenesis
Acquired genetic factors Proto-oncogenes Tumor suppressor genes
Inherited genetic factors Wiskott Aldrich Ataxia telangiectasia
Environmental factors EBV infection Helicobacter pylori
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Classification
Factors to consider Morphological appearance of cells
Clonality Flow cytometry Chromosome analysis
Translocations present? Molecular analysis Clinical information & history
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MATURE B CELL NEOPLASMS
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Chronic Lymphocytic Leukemia(CLL) General requirements for diagnosis
Peripheral blood and bone marrow lymphocytosis (>5 x 109/L)
Lymphocytes are small with mature appearance Nucleus is round, with block-type chromatin Cytoplasm scarce
Smudge cells common Occur due to the cell’s fragility in making a smear
Prolymphocyte < 10%
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CLL Blood Picture
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Chronic Lymphocytic Leukemia Clinical features
Occurs in persons >50 years old Chronic fatigue, infection
Result of bone marrow replacement of normal cells with lymphocytes.
Skin and organ infiltration and enlargement Median survival is 10 years
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Chronic Lymphocytic Leukemia Treatment
Usually treatment is not required until lymphocytosis causes other cells to be crowded out resulting in infections.
Treatment depends on the stage at which the disease is diagnosed and is usually for the symptoms, not the disease. Chemotherapy
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Prolymphocytic Leukemia
Aggressive Non-responsive to treatment
Poor prognosis Low incidence rate Origin can be B or T cell
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Prolymphocytic Blood Picture
Punched out nucleolus
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Hairy cell leukemia (HCL)
Presents in middle age
Affects males7:1 over females Spleenomegaly
Pancytopenia common Increases opportunity for infections
Bone marrow aspirate can result in a “dry tap” due to marrow fibrosis.
Hairy cell leukemia can be treated with a one-time chemotherapy regimen with a good prognosis of long-term survival.
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Hairy cell
TRAP stain
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Mature T cell Neoplasms
Less common than B cell Lymphoma ~10% of all lymphomas
Occur in extranodal sites
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Sezary’s syndrome
Leukemic phase of the most common cutaneous T-cell lymphoma, mycosis fungoides.
Lymphadenopathy Red skin due to disesemination
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Sezary Cell
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Hodgkin’s Lymphoma
Cause is unknown, but has been linked to Epstein-Barr virus.
Bimodal distribution Diagnosed between 15 and 35 years of age Over 50 population
Males have higher incidence rates Lymph node are involved
Regional, contiguous sites
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Hodgkin’s Lymphoma
Characteristic cell is the Reed-Sternberg Found in tissue biopsy Giant size (up to 45µm in diameter) Abundant acidophilic cytoplasm Multinucleated or polylobated nucleus Gigantic nucleoli
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Hodgkin’s lymphoma
Treatment and prognosis Radiation of localized involvement Chemotherapy Combination of above With early diagnosis, long-term disease-free
survival is seen in about 80-90% of cases.
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Nodular Lymphocyte Predominant Hodgkin’s Lymphoma Cause is unknown at this time. Predisposing
factors seem to be chemicals, ionizing radiation and certain viruses.
Reed-Sternberg cells are NOT present. B cell origin Widely disseminated, extranodal
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Burkitt Lymphoma Three variants
Endemic Common in Africa Children aged 4-7 Jawbone mass
Sporadic Children & adults Abdominal mass
Immunodeficiency-associated
Rapid growth and tumor cell death results in “starry sky” appearance of the biopsy caused by macrophages cleaning up the dead cells.
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Plasma Cell Disorders
• Disorders that do not involve lymph nodes
• Secrete monoclonal immunoglobulin into the serum and /or urine
• Disorders• Plasma Cell Myeloma• Plasmacytoma• Monoclonal gammopathy of undetermined
significance (MGUS)
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Plasma Cell Myeloma
Overproduction of abnormal plasma cells which are the final stage in the development of B lymphocytes.
These cells secrete immunoglobulin, resulting in lytic bone lesions
Risk increases with age- rare under 40 Median age 70 years old
Suspected cause is chronic stimulation of the immune system from environmental sources. Ionizing radiation Viruses
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Etiology
50% greater risk for men than women Risk increases with age; rare under 40
Median age 65 years old
Suspected cause is chronic stimulation of the immune system from environmental sources. Ionizing radiation Viruses
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Features Increased production of immunoglobulin heavy and light chains
(monoclonal gammopathy) Heavy chains: IgG, IgA, IgD, IgE, IgM Light chains: kappa, lambda Most common type of plasma cell myeloma is increased production
of IgG. Bence-Jones protein
Light chains spill into the urine and can be detected by lab test Causes kidney damage
Hyperviscosity syndrome Excess immunoglobulin causes viscous blood which sludges and
causes fluid congestion.
Normal Immunoglobulin production decreased Results in infections
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Lab Findings
CBC and peripheral smear Red cells form characteristic rouleaux formation (resemble stacked
coins) Plasma cells may be seen in peripheral blood
Bone marrow Increased number of plasma cells which form “sheets”
ESR Increased - serum protein causes red cells to stick together and fall faster
Chemistry studies Increased BUN and creatinine (kidney tests) Increased calcium Increased LDH
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Plasma Cell Myeloma
C: hyperCalcemiaR: Renal insufficiencyA: AnemiaB: lytic Bone lesions
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Plasma Cell Myeloma
Treatment Chemotherapy Radiation for localized areas Bone marrow/stem cell transplant for
younger patients Poor prognosis for individuals that are
symptomatic
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References
http://www.itriagehealth.com/wl/disease/burkitt-lymphoma-%28lymph-node-tumor%29#wrapperTop
http://www.med-ed.virginia.edu/courses/path/innes/wcd/lympleuk.cfm
McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc.