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Clinical Pathology > Myeloma and lymphoma > Flashcards

Myeloma and lymphoma Flashcards

1
Q

Where does B cell maturation take place?

A

Bone marrow

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2
Q

What does B cell maturation comprise?

A

Gain surface immunoglobins

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3
Q

What happened during B cell differentiation?

A

Mature B cells are exposed to antigens and become either…

  • apoptose
  • differentiate into plasma cell
  • enter germinal centre
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4
Q

What produced immunoglobins?

A

Plasma cells in response to immunogen

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5
Q

Wha t is the structure of an immaunogen? How are they classified?

A

4 polypeptide chains - 2 light, 2 heavy held together by disulphide bonds

Heavy chain - IgG, IgM, IgE, IgD, IgA

Light chain kappa or lama

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6
Q

What are the techniques by which myeloma is identified?

A

Protein electrophoresis - serum placed in gel and exposed to electric current

Immunofixation

Bone marrow biopsy

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7
Q

What is the group of interest when investigating myeloma using electrophoreses?

A

Gamma globulins

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8
Q

What is produced with myeloma? How is this different to normal plasma cells?

A

Produce just one type of immunoglobin

Usually plasma cells produce a variety

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9
Q

What is myeloma? What is myeloma’s aetiology?

A

incurable malignant condition of clonal plasma cells

No know aetiology

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10
Q

What condition is myeloma always preceeded by?

A

Monoclonal gammopathy of undetermined Significance (MGUS)

No features of myeloma

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11
Q

What is diagnostic of myeloma?

A

> 10% plasma cells are neoplastic AND any one/more of…

  • CRAB features
  • Myeloma defining events
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12
Q

What are the CRAB features?

A

C - hyperCalcaemia - due to promoted osteoclastic activity)
R - Renal insufficiency - free light chains damage kidney (BENCE JONES protein - proteinuria)
A - Anaemia
B - bone lesions

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13
Q

What are the myeloma defining events?

A

> 60% clonal plasma cells in BM biopsy

  • Focal lesions on MRI scan
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14
Q

What other factors, other than myeloma, could box out the kidney?

A
  • Hyperviscocity
  • Renal vein thrombosis
  • CT contrast
  • Dehydration
  • NSAIDs/ACEi
  • Hypercalcaemia
  • Biaphosphonates
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15
Q

What should you treat individuals with suspected myeloma in first instance?

A

Steroids (delays damage to kidney)

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16
Q

What does intensive therapy for myeloma involve?

A

VCD (chemo) - extract stem cells - chemo (melphalan) - replace stem cells (allows bone marrow to recover)

17
Q

What is the aim for intensive chemotherapy

A

Myeloma = incurable, put into remission for as long as possible

Also allow bone marrow to recover and reduce symptoms

18
Q

What are the first line treatments for myeloma?

A

thalidomide/ lenalidomide in

combination with dexamethasone.

19
Q

What are the diagnostic criteria for MGUS?

A

-Paraproteins (M proteins/light chains)

20
Q

What is amyloidosis caused by?

A

Light chain fragments released from monoclonal plasma cells misfiled and aggregate, form Beta pleated fibrils

  • deposit into organs
  • Cause liver/cardiac enlargement, proteinuria, peripheral neuropathy
21
Q

What is follicular lymphoma? What is it characterised by/

A

Neoplastic disorder of the lymph tissue (non-hopkin’s)

Slowly enlarging lymph node

22
Q

What is the genetic component occurring in the majority of cases in follicular lymphoma?

A

Translocation between chromosome 14 to 18

23
Q

What is Hogkin lymphoma characterised by?

A

Presence of Hodgkin Reed Sternberg cells - giant cells (usually originate from B germinal cells) which lack antibodies, do not undergo apoptosis and are surrounded by non-malignant infiltrates (i.e. T cells, plasma cells, B cells)

24
Q

What is Hodgkins disease caused by? i.e. pathogenesis

A

Resistance to apoptosis

Genetic mutation/transciption error to Ig genes - no longer express Ig antibodies

Environmental - EBV virus

25
Q

What are the clinical features of Hodkin lymphoma

A

Enlarged lymph nodes
B cell symptoms - night sweats, cachexia, fever
Hepatosplenomegaly
Lung involvement - breathlessness

26
Q

How is Hodkins lymphoma managed?

A

Chemotherapy and radiotherapy

27
Q

What is non Hodkins lymphoma?

A

Malignant tumours of lymphoid tissues WITHOUT Reed Sternberg cells

28
Q

What is the clinical presentation of non-hoskins Lymphoma?

A
  • Superficial lymph enlargement
  • B cell symptoms - night sweats, fever, cachexia
  • pancytopenia - anaemia of RBCs, WBCs, and platelets

Clinical Pathology (50 decks)

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