Concepts of Malignancy

Question 1

How can we identify normal, more mature non-lymphoid cells?

Answer 1

morphology

Question 2

How can we identify normal progenitors/stem cells? (3)

Answer 2

Cell surface antigens (immunophenotyping)​= eg CD34​

​Cell culture assays​

​Animal models (not very practical)​

​

Question 3

Malignant haemopoiesis characterised by= (4)

Answer 3

increased numbers of abnormal & dysfunctional cells​

loss of normal activity​

• haemopoiesis (e.g. acute leukaemias/marrow-based malignancies)​
• immune function (e.g. certain lymphomas)​

Question 4

Malignant haemopoiesis due to (3)

Answer 4

Increased proliferation (in the absence of a stimulus)

Lack of differentiation/maturation​

Lack of apoptosis

Question 5

Acute leukaemia (2)

Answer 5

Proliferation of abnormal progenitors​ with block in differentiation/maturation​

(e.g. Acute Myeloid Leukaemia)​

Question 6

Chronic myeloproliferative disorders/neoplasm (MPN)​ (2)

Answer 6

Proliferation of abnormal progenitors, ​but NO differentiation/maturation block​

(e.g. Chronic Myeloid Leukaemia)

Question 7

What causes haematological malignancies?​ (4)

Answer 7

genetic, epigenetic, environmental interaction

ACQUIRED somatic mutations in regulatory genes
[driver mutations vs passenger mutations]

more than single catastrophic event

deletions, chromosomal translocations etc

Question 8

‘Clone’ ?

Answer 8

population of cells derived from a single parent cell​

Question 9

Driver mutations can select ‘clones’ (2)

Answer 9

This parent cell has a genetic marker (driver mutation or chromosomal change) that is shared by the daughter cells​

Clones can diversify but contain a similar genetic ‘backbone’​

Question 10

Normal haemopoiesis

Answer 10

polyclonal

Question 11

Malignant haemopoiesis

Answer 11

monoclonal

Question 12

Driver mutations

Answer 12

confer growth advantage on the cells and are selected during the evolution of the cancer

Question 13

Passenger mutations

Answer 13

do not confer growth advantage, but happened to be present in an ancestor of the cancer cell when it acquired one of its drivers​

Question 14

Lymphoid- cells (4)

Answer 14

Dendritic cells, B cells, T cells, NK cells

Question 15

Myeloid- cells (5)

Answer 15

Dendritic cells, Erythrocytes, Platelets, Granulocytes, Macrophages

Question 16

Haemopoietic stem cell= Lymphoid progenitor (lymphoma)

Answer 16

= T + B lymphocyte= Plasma cell

Question 17

Haemopoietic stem cell= Myeloid progenitor (leukAemia)

Answer 17

= Red cells, Neutrophils, Platelets

Question 18

Classifying cancers of the haemopoietic and lymphoid systems (4)

Answer 18

Site​

Lineage​

​Stage of development/histology

Preservation of differentiation/maturation​

Question 19

acute leukaemias & high-grade lymphomas

Answer 19

histologically and clinically more aggressive than chronic leukaemias & low-grade lymphomas​

Question 20

Features of histological aggression: (3)
​

Answer 20

large cells with high nuclear-cytoplasmic ratio

prominent nucleoli

rapid proliferation​

Question 21

Features of clinical aggression:

Answer 21

rapid progression of symptoms

Question 22

Acute leukaemias present =

Answer 22

(more commonly than chronic leukaemias)

with failure of normal blood cell production​

Question 23

Acute lymphoblastic leukaemia:

Answer 23

​blood/marrow involving primitive, lymphoid malignancy

Question 24

Acute myeloid leukaemia​:

Answer 24

blood/marrow involving, primitive, myeloid malignancy​

Question 25

Chronic lymphocytic leukaemia:

Answer 25

blood/marrow involving less primitive, lymphoid malignancy

Question 26

Chronic lymphocytic leukaemia​

Answer 26

blood/marrow involving, less primitive, lymphoid malignancy​

Question 27

High grade B/T cell (non Hodgkin) lymphoma​

Answer 27

nodal, lymphoid malignancy, less primitive, clinically aggressive​

Question 28

Low grade B cell (non Hodgkin) lymphoma​

Answer 28

nodal, lymphoid malignancy, less primitive, clinically less aggressive​

Question 29

(Hodgkin) lymphoma ​

Answer 29

nodal, lymphoid malignancy, less primitive, less aggressive​

Question 30

Chronic myeloproliferative neoplasms/disorders ​

Answer 30

primitive, myeloid compartment, maturation preserved (e.g. chronic myeloid leukaemia)​

Question 31

Myeloma​

Answer 31

plasma cell malignancy usually, not exclusively, in the bone marrow​