BM neoplastic disorders

Question 1

Some general BM characteristics found in myeloproliferative neoplasms (MPN)

Answer 1

• Hypercell. & hyper vascular
• MK hyperplasia & dysMKpoeisis
• Haematopoeitic maturation
• Reticulin fibrosis

Question 2

What would you classify this? (MPN)
- WBC-cytosis (Hi eosin & baso)
- 10% blast
- RBC & plt -paenia
- BM myeloid lineage hyperplasia
- JAK2 mutation neg
- BCR-ABL1 neg
- PCM1-JAK2 pos

Answer 2

• BCR-ABL1 neg = not CML
• PCM1-JAK2 pos => Activates JAK2 kinase => MPN

=> MPN, unclassifiable

Question 3

Some general BM characteristics found in myelodysplastic syndrome (MDS)

Answer 3

• Variable cellularity
• M:E often dec
• L-shift
• <20% blast
• Dysplastic change in 1/+ cell line (RBC, WBC)

Question 4

what is ringed sideroblast

Answer 4

Fe on periphery of cell (still in mitochondria & not used up= improper haematopoeisis)

Question 5

What’s the effects of hypocupremia (Lo Cu)

Answer 5

• Lo Cu bc Hi Zn (bc work competitively)
• Lo Cu = impaired Fe absorption & Fe accumulation (sideroblast & dysplastic changes)
  => reversible pancytopenia w/ dysplastic changes (i.e. not neoplastic MDS)

Question 6

Effect of RARS-T to RBC/WBC/plt

Answer 6

• RBC: sideroblast, macrocytosis
• plt: -cytosis

Question 7

Some general BM characteristics found in Acute myeloid leukaemia (AML)

Answer 7

• > 20% blast
• mixed w/ haematopoeitc cells, lympho & plasma cells
• differentiated haematopoeitic cells may exhibit dysplastic features
• hypercellularity
• Granulomas
• Fibrosis
• Reactive plasmocytosis

Question 8

What are lymphoglandular bodies & what does it mean when found in BM smears

Answer 8

LB: cytoplasmic fragments of cell’s cytoplasm - pale, lightly basophilic & lack granulation (occasional blebs)
- Often associated w/ lymphoid malignancies

Question 9

Some general BM characteristics found in Acute Lymphoblastic Leukaemia (precursor lymphoid neoplasm)

Answer 9

• > 20% blast
• mixed w/ haematopoeitc cells, lympho & plasma cells
• differentiated haematopoeitic cells w/ NO dysplastic features

Question 10

What’s the difference b/w B-ALL w/ hyPERdiploidy & B-ALL w/ hyPOdiploidy

Answer 10

• hyPER: multiple chromosomes have extra copies = better prognosis
• hyPO: multiple chrom. have one less copy = poor prognosis

Question 11

What is Dual & Sequential Haematopoetic Neoplasia (DSHN) & what causes it

Answer 11

• 2 haematopoetic neoplasms (HN) reported in same patient
• in 2% of pts Therapy for one HN may lead to 2nd HN = Therapy-related HN
- usually when using drugs that can affect DNA & processes (e.g. alkylators, inhibitors, ionising radiation)

Question 12

Describe changes that may occur in the composition of bone marrow and peripheral blood that occur with (combined) non-haematological
and haematological neoplasm (CNHHN)

Answer 12

• severe thombocytopenia
• anaemia
• mild leukocytosis
• BM: 2 population of cells due to 2 different neoplasm (haematopoetic & metastatic neoplasm)