Cancers Flashcards
(141 cards)
1
Q
b cell maturation occurs in the
A
bone marrow
2
Q
t cell maturation occurs in the
A
thymus
3
Q
primary lymphoid tissues
A
bone marrow
thymus
4
Q
secondary lymphoid tissue
A
Lymph nodes Spleen Tonsils (Waldeyer’s ring) Epithelio-lymphoid tissues Bone marrow
5
Q
what is ascites of lipid rich lymph called?
A
chylous ascites
6
Q
describe the pathway of lymph through the peripheral sinus
A
Afferent channels drain lymph through the capsule in to the peripheral sinus
Lymph filters through the node
An efferent vessel leaves from the hilum
7
Q
where can lymph drain to
A
cisterna chyli / thoracic duct
L jugular, subclavian or bronchomediastinal trunks
R jugular, subclavian or bronchomediastinal trunks
8
Q
Arterial and venous vessels serving the node enter/exit at the
A
hilum
9
Q
Lymph is filtered within the ….. before return to the blood stream
A
node parenchyma
10
Q
main cells contained in lymph node
A
b t nk macrophages apcs dendritic endothelial
11
Q
what are the two types of t cells?
A
helper and cytotoxic
12
Q
what is a marker of a b cell?
A
cd20
13
Q
what is a marker of a t cell?
A
cd3
14
Q
systemic inflammatory lymphadenopathy usually caused by
A
viruses (can be widespread malignancy)
15
Q
what are the main malignancies involving the lymph node
A
lymphoma
leukaemia
16
Q
sarcoidosis may mask …. in a lymph node
A
malignancy
17
Q
Superficial lymphadenopathy may be the first sign of
A
malignancy
18
Q
a predominant b cell response is usually
A
autoimmune onditions or infection
19
Q
a predominant phagocytic response is usually
A
draining a tumour site
20
Q
a predominant t cell response is usually
A
viral or drugs such as phenytoin
21
Q
what is the normal weight and size of the spleen?
A
150-200g and 12x7x3cm
22
Q
arterial and venous supply of spleen
A
splenic artery and vein
23
Q
what are the main structures of the spleen?
A
white pulp red pulp and capsule
24
Q
red pulp contains
A
sinusoids and cords
25
what are sinusoids
fenestrated
lined by endothelial cells
supported by hoops of reticulin
26
whats the main function of the spleen?
Detect, retain and eliminate unwanted, foreign or damaged material
Facilitate immune responses to blood borne antigens
27
describe the structure and function of the white pulp
White pulp comprises the peri-arteriolar lymphoid sheath (PALS).
CD4+ lymphoid cells
This is expanded by lymphoid follicles
May show reactive changes as in lymph node
Antigen reaches white pulp via the blood.
APCs in the white pulp present antigen to immune reactive cells
When stimulated by antigen, T and B cell responses may occur
28
what symptoms can patients experience fi they have an enlarged splee?
Dragging sensation in LUQ
Discomfort with eating
Pain if infarction
29
what is the triad seen in hypersplenism?
1. splenomegaly
2. fall in one or more cellular components of blood
3. correction of cytopenias by splenectomy
30
what is the main cause of the features occurring in splenomegaly?
Features mainly from reduced red pulp function
Howell-Jolly bodies
Other red cell abnormalities
31
what is a Howell jolly body?
nuclear remnants in an erythrocyte
32
define clone
daughter cells derived from the same precursor cell
33
polyclonal
multiple clones exist under normal conditions
34
monoclonal
in malignant haemopoeisis there is domination by a single clone
35
what is Philadelphia chromosome?
abn in chromosome 22 seen in leukaemia (mainly cml)- it is an abnormal clonal marker
36
what is aplastic anaemia?
lymphocyte activation and an autoimmune reaction against haemopoietic stem/progenitor cells/ bone marrow failure affecting production of red cells, neutrophils and platelets
37
pancytopenia
deficiency in rbcs wbcs and platelets
38
Likely cell of origin for CML
stem cells
39
Likely cell of origin for AML
multipotent progenitors
40
Likely cell of origin for acute leukaemias
MEP or GMP (precursors of erythrocytes platelets granulocytes and macrophages)
41
Likely cell of origin for acute lymphoblastic leukaemias
precursors for wbcs - t/b/nk/ dendritic
42
Likely cell of origin for lymphoma
lymph node
43
Likely cell of origin for myeloma
plasma cell
44
In B12/folate deficiency, there are fewer rounds of cellular division in the more mature erythroblast compartments as ….. is affected
nuclear maturation
45
normal cytoplasmic maturation and haemoglobin accumulation despite B12/folate deficiency t/f
t
46
why is there anaemia in b12 and folate deficiency
Although the amount of Hb per cell is adequate (since cytoplasmic maturation is unaffected), there are fewer cells in total as cell division in the earlier compartments had been affected; hence the anaemia.
47
NK cells are
antiviral or tumour fighters
48
do platelets have a nucleus
no
49
meaning of blasts
nucleated precursor cell
50
polypoid
megakaryocyte
51
what is maturation?
descendents acquire functional properties and may stop proliferating
52
Embryonically, haemopoietic stem cells originate in the
mesoderm
53
Circulating committed progenitors detectable as early as week
5
54
Yolk sac, the first site of erythroid activity, stops by week
10
55
Liver starts haematopoesis by week
6
56
bone marrow starts haematopoesis by week
16
57
what are the non haemopoietic cells of the bone marrow
eg adipocytes (fat cells), ‘fibroblasts’ osteoclasts, osteoblasts
58
Formed blood cells can pass through …. in endothelial cells to enter circulation
fenestrations
59
associated with sinusoidal dilatation and increased blood flow
release of red cells
60
red marrow
active
61
yellow marrow
inactive and fatty
62
Neutrophil precursor maturation is regulated by
GCSF
63
…… regulates growth and development of megakaryocytyes from their precursors
thrombopoeiten
64
cd34
haemopoeitic stem cell
65
cd3
t lymphocyte
66
cell cycle specific agents are
tumour specific
| duration more important than dose
67
classes of cell cycle specific agents
Antimetabolites
impair nucleotide synthesis / incorporation
Mitotic spindle inhibitors
68
what are the three types of antimetabolites
methotrexate
6-Mercaptopurine / Cytosine arabinoside / Fludarabine
hydrocyurea
69
which enzyme associatied with folate metabolism is used as a target for chemo
dihydrofolate reductase
70
which enzyme associatied with nucleotide synthesis is used as a target for chemo
ribonucleotide reductase/
| adenosine deaminase
71
eg of mitotic spindle inhibitors
Vinca alkaloids
vincristine / vinblastine
Taxotere (Taxol)
72
non cell cycle specific agents are
non tumour specific
damage normal stem cells
dose more important than duration
73
non cell cycle specific agents
```
alkylating agents (chlorambucil)
platinum derivatives (cisplatin)
cytotoxic antibiotics (anthracyclines)
```
74
what are the general side effects of cytotoxic drugs
Bone marrow suppression
Gut mucosal damage
Hair loss (alopecia)
75
Vinca alkaloids side effects
neuropathy
76
anthracyclines side effects
cardiotoxicity
77
cis platinum side effects
nephrotoxicity
78
alkylating side effects
infertility
| secondary malignancy
79
how do you biopsy lymph node
take the full thing out
80
nodular sclerosing
hodgkins
81
how do you confirm if a patient has lymphoma/leukaemia
immunohistochemistry
82
CD20 +ve cells in
follicular NHL
83
CD30 +ve Reed Sternberg Cells in
hodgkins disease
84
T(14:18)
follicular nhl
85
T(11:14) in
mantle cell NHL
86
b cell lymphoma recats well to
ibrutinib
87
what are the two classifications of nhl
t and b
88
what are the two types of b cell nhl
low and high grade
89
inherited marrow failure syndromes occur due to defects in
dna repair/ ribosomes
90
what is the main inherited marrow failure syndrome
fanconis anaemia
91
acquired primary bone marrow failure causes
aplastic anaemia
myelodysplastic syndromes
acute leukaemia
92
aplastic anaemia involves b or t cells?
t cells
93
myelodysplasia syndromes have the tendency to develop into
AML
94
what is seen in myelodysplastic syndromes?
dysplasia
hypercellular marrow
increased apoptosis
95
how do we identify normal, more mature non lymphoid cells?
morphology
cell surface antigens
enzyme expression
96
glycophorin A
red cell
97
myeloperoxidase
neutrophils
98
how do we recognise cell surface antigens?
immunophenotyping
99
Malignant haemopoiesis is usually characterised by
increased numbers of abnormal & dysfunctional cells
| loss of normal activity
100
what is aml?
Proliferation of abnormal progenitors
| with block in differentiation/maturation
101
what is cml?
Proliferation of abnormal progenitors,
but NO differentiation/maturation block
(e.g. Chronic Myeloid Leukaemia)
102
normal haemopoesis is monoclonal/polyclonal
polyclonal
103
malignant haemopoesis is monoclonal/polyclonal
monoclonal
104
Guthrie cards used in
all
105
types of haematological malignancies are based on
Based on lineage
Based on developmental stage (precursor) within lineage
Based on anatomical site involved
106
lineage split into
myeloid or lymphoid
107
myeloid
platelets or erythrocytes (CMP)
108
lymphoid
NK T B dendritic cells (CLP)
109
lymphoid and affecting the Pro lymphoid cells
ALL
110
lymphoid and affecting the B NK T cells
CLL
111
lymphoid and affecting the plasma cell
myeloma
112
what produces plasma cells
b cells
113
blood involvement
leukaemia
114
Lymph node involvement with lymphoid malignancy
lymphoma
115
what are features of histological aggression ?
large cells with high nuclear-cytoplasmic ratio, prominent nucleoli, rapid proliferation
116
what are features of clinical aggression?
rapid progression of symptoms
117
Acute leukaemias (in contrast to chronic leukaemias) present with
failure of normal bone marrow function
118
acute leukaemia
Rapidly progressive clonal malignancy of the marrow/blood with maturation defect(s)
Defined as an excess of ‘blasts’ (≥20%) in either the peripheral blood or bone marrow
Decrease/loss of normal haemopoietic reserve
119
what are the types of acute leukaemia?
aml
| all
120
ALL is a malignant disease of
primitive lymphoid cells (lymphoblasts)
121
what is the most common childhood cancer
all
122
all presentation
due to marrow failure (anaemia, infections, bleeding)
leukaemic effects: high count with obstruction of circulation, involvement of areas outside the marrow and blood (extra-medullary) e.g. CNS, testis
Bone pain
123
more common in the elderly
aml
124
DIC/ gum infiltration
AML
125
blood film in acute leukaemia
reduction in normal
| presence of abnormal cells with high n:c ratio
126
auer rod
aml
127
what makes the definitive diagnosis between aml and all
immunophenotyping
128
what is trephine
(piece of bone)-enables better assessment of cellularity and helpful when aspirate sub-optimal
129
what is a hickman line?
central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis
130
chemo is a marrow suppressant: what are the problems with this?
anaemia
neutropenia (infection)
thrombocytopenia (bleeding)
131
if neutropenic fever (chemo and infection) think
gram negative
132
anthracyclines cause
cardiomyopathy
133
Philadelphia chromosome seen in ….. allows for …… as targeted therapy
all
| kinase inhibitors
134
An AML sub-type (acute promyelocytic leukaemia) has a specific chromosomal translocation t(…..) and is associated with a …..
15;17
| coagulopathy
135
myelo
bone marrow lineage(s)
| granulocytes, red cells & platelets
136
proliferative
to grow or multiply by rapidly producing new tissue, parts, cells, or offspring
137
what are myeloproliferative disorders
Clonal haemopoietic stem cell disorders with an increased production of one or more types of haemopoietic cells
138
In contrast to acute leukaemia, in chronic myeloproliferative disorders ..... is relatively preserved
maturation
139
BCRABL1 positive
chronic myeloid leukaemia (overproduction of granulocytes)
140
BCRABL1 negative
idiopathic myelofibrosis
PRV
essential thrombocythaemia
141
```
High Granulocyte count
High Red cell count / haemoglobin
High Platelet count
Eosinophilia/basophilia
```
Splenomegaly
Thrombosis in an unusual place
myeloproliferative disorder
