Introduction to leukaemia and lymphoma diagnosis

Question 1

What series of tests are conducted in haemato-oncology to find the diagnosis?

Answer 1

Morphology
Immunophenotype
Cytogenetics
Molecular genetics

Question 2

What are the components of morphology?

Answer 2

Architecture of tumour
Cytology
Cytochemistry

Question 3

What are the components of immunophenotype?

Answer 3

Flow cytometry

Immunohistochemistry

Question 4

What are the components of cytogenetics?

Answer 4

Conventional karyotyping

Fluorescent in-sotu hybridisation - interphase FISH, metaphase FISH

Question 5

What are the components of molecular genetics?

Answer 5

Mutation detection - direct sequencing, pyrosequencing
PCR analysis
Gene expression profiling
Whole genome sequencing

Question 6

Why are there so many haematological cancers/why is it so complex?

Answer 6

Normal lympho-haemopoietic system is complex
Multiple lineages: myeloid, erythroid, T cells B cells
Multiple stages of differentiation e.g. myeloblasts–> neutrophils or B lymphoblasts to Plasma cells

Question 7

What types of mutation cause leukaemia and lymphoma?

Answer 7

Cellular proliferation (type 1)
Impair/block cellular differentiation (type 2)
Prolong cell survival (anti-apoptosis)

Question 8

In clinic the histopathologist’s precise classification is used to?

Answer 8

Predict the likely clinical course

Choose appropriate treatment

Question 9

What do the clinical problems of leukaemia and lymophomas generally relate to?

Answer 9

Lympho-haemopoietic failure
Excess of malignant cells
Impair organ function
Other problems

Question 10

How does lympho-haemopoietic failure cause clinical problems?

Answer 10

Bone marrow: anaemia, infection (neutrophils), bleeding (platelets)
Immune system: recurrent infection

Question 11

How does excess of malignant cells cause clinical problems?

Answer 11

Erythrocytes (polycythemia): impair blood flow –> stroke/TIA
Massively enlarged lymph nodes (lymphoma) –> comperss structures, bowel, vena cava, ureters, bronchus