Malignancy

Question 1

Outline the kinetics/processes that occur in normal haemopoiesis

Answer 1

Self-renewal
Proliferation
Differentiation (lineage commitment)
Maturation
Apoptosis

Question 2

What happens in malignant haemopoiesis?

Answer 2

Increased numbers of dysfunctional cells, due to one or more of
 increased proliferation
 lack of differentiation
 lack of maturation
 lack of apoptosis

Question 3

How are types of haematological malignancies classified?

Answer 3

Onset (acute/chronic)
Site (medullary/extramedullary/blood/lymph)
Lineage (myeloid/lymphoid)

Question 4

List the main haematological malignancies

Answer 4

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
Lymphoma
Myeloma

Question 5

What is acute leukaemia?

Answer 5

Rapidly progressive clonal malignancy of marrow/blood with cell maturation defects

Question 6

Which haematological malignancy is the most common childhood cancer?

Answer 6

Acute lymphoblastic leukaemia, a malignant disease of lymphocytes

Question 7

List some clinical features of acute lymphoblastic leukaemia

Answer 7

Anaemia
Infection
Bleeding
CNS involvement
Bone pain

Question 8

Which haematological malignancy is more common in the elderly?

Answer 8

Acute myeloid leukaemia

Question 9

List investigations for acute leukaemia

Answer 9

Blood count
Blood film
Coagulation screen
Bone marrow aspirate
Immunophenotyping

Question 10

How is acute leukaemia treated?

Answer 10

Curative chemotherapy

Stem cell transplantation

Question 11

What are the problematic consequences of bone marrow suppression treatment for leukaemia?

Answer 11

Anaemia
Neutropenia (infections)
Thrombocytopenia

Question 12

List some causes of lymphadenopathy

Answer 12

Lymphoma
Infection
Metastatic cancer
Connective tissue disease

Question 13

What is the classic presentation of Hodgkin’s lymphoma?

Answer 13

Drinking alcohol causes painful lymph nodes, especially in chest

Question 14

Describe the nature of viral lymphadenopathy, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

Answer 14

Tenderness: yes
Consistency: hard
Surface: smooth
Skin inflammation: no
Tethering: no

Question 15

Describe the nature of bacterial lymphadenopathy, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

Answer 15

Tenderness: yes
Consistency: hard
Surface: smooth
Skin inflammation: yes
Tethering: maybe

Question 16

Describe the nature of lymphoma, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

Answer 16

Tenderness: no
Consistency: soft
Surface: smooth
Skin inflammation: no
Tethering: no

Question 17

Describe the nature of metastatic lymph nodes, commenting on tenderness, consistency, surface appearance, skin inflammation and tethering

Answer 17

Tenderness: no
Consistency: hard
Surface: irregular
Skin inflammation: no
Tethering: yes

Question 18

What sampling/biopsy methods are used for lymph nodes?

Answer 18

Fine needle aspirate

Core biopsy

Question 19

Describe the immunohistochemistry of Hodgkin’s lymphoma

Answer 19

CD30 Reed Sternberg cells

Question 20

Describe the immunohistochemistry of non-Hodgkin’s lymphoma

Answer 20

CD20 cells