Haematology: Haem malignancies, proliferative and dysplastic blood disorders (From Module 2 exam)

Question 1

What disease does this blood film suggest?

Answer 1

• ALL
• Could also possibly be AML M0-1

Question 2

What disease does the following immunophenotype suggest? Sig+, CD5+, Cyclin D1+, CD20+, CD10-, CD23-, BCL6-, MUM1-

Answer 2

• Mantle cell lymphoma
• (abnormal CD5 and Cyclin D1 expression)

Question 3

What disease does this blood film suggest?

Answer 3

CLL

• Lymphocytosis
• Smear cells

Question 4

What is the treatment for APML (Acute promyelocytic leukemia)?

Answer 4

-ATRA and arsenic

/////////////////////////////////////////////

-ATRA is All trans retinoic acid

Question 5

What is the main genetic cause of Burkitt lymphoma?

Answer 5

-Lost regulation of c-myc

Question 6

Outline clinical presentation of MDS (Myelodysplastic syndrome)

Answer 6

• Signs of bone marrow failure
• fatigue, infections, easy bruising
• Bone marrow hypercellular
• Cytopenia (a dysplastic change of a particular lineage causes the cytopenia of that lineage, i.e anaemia in erythroid dysplasia)

Question 7

What disease does the following immunophenotype suggest? CD45+, CD13+, CD33+, CD117+, CD34+, HLA-DR+, CD19-, Tdt-

Answer 7

• AML M0/M1/M2
• CD34+, HLA-DR+, (Both markers of immaturity)

Question 8

-What viruses can cause infectious mononucleosis?

Answer 8

EBV and CMV

Question 9

What disease does this blood film show?

Answer 9

CML, in chronic phase

Myelocytes and basophils can be present

Question 10

Outline the pathophysiology of CML

Answer 10

• Translocation occurs between chromosome 9 and 22, forming BCR-ABL1 fusion gene
• BCR-ABL1 molecule is a constitutively active tyrosine kinase
• Causes downstream activation of oncogenes, such as JAK, PI3K and RAS
• Leading to increased proliferation, survival and clonal expansion of cells with the initial t(9;22) mutation.

Question 11

Outline the clinical presentation of Adult T-cell laeukaemia/lymphoma (ATL)

Answer 11

• Human T-cell lymphotrophic virus 1 (HTLV-1)
• Hypercalcaemia (Stones, bones, groans etc.)
• Skin rash
• Other things pertaining to ALL or NHL

Question 12

How does Multiple myeloma lead to bone weakness?

Answer 12

• Multilpe myeloma (MM) cells overproduce RANK ligand
• Leads to activation of osteoclasts
• Imbalance of osteoblast/osteoclast activity leads to osteolytic lesions and bone weakness

Extra info://///////////////////////////////////////////////////////

• Osteoprotegerin (OPG, regulator of normal bone formation) is downregulated (MM endocytosis)
• MM cels produce Dkk-1 which inhibit osteoblasts
• produces sclerostin, which inhibits osteoblasts

Question 13

Case: A 51 year old woman was admitted to hospital showing: Asthenia(weakness), anorexia, weight loss. No significant findings on physical examination. Haemoglobin 83, WBC 6.5, platelets: 245. ESR 138 (high). IgA 14.1(high). Creatine 290 (high). See serum protein electrophoresis. CD38+, CD56+. What is the most likely diagnosis?

Answer 13

Multiple myeloma

Question 14

Outline the causes of Marginal zone lymphoma

Answer 14

• Hep C
• H pylori
• Autoimmune causes

Question 15

What disease does the following immunophenotype suggest? CD30+, CD15+, CD79a-, SmIg-, CD45-, CD34-, Tdt-

Answer 15

Hodgkin lymphoma

(CD30+, CD15+)

///////////////////

You see CD30+ and CD15+, you know its hodgkins lymphome

Question 16

What disease oes this immunophenotype suggest?CD45-, no SCC, CD19-, CD33+, CD7-, CD13+

Answer 16

-AML M0-M1

Question 17

What disease does this blood film suggest?

Answer 17

Multiple myeloma

-Characteristic, pushed off to one side, extended cytoplasm

Question 18

What are the viruses that can contribute to lymphoma?

Answer 18

EBV (Burkitt, Hodgkin)

HIV (Hodgkin, High grade B-cell lymphoma)

HTLV-1 (ATLL)

Hep C (Marginal zone lymphoma)

Human Herpes Virus (HHV8)

Hep B

Question 19

What are the most common cytogenetic abnormalities associated with ALL?

Answer 19

• High hyperdiploidy (good prognosis)
• t(12;21)/ETV6-RUNX1 (Childhood, Good prognosis)
• t(9;22)/BCR-ABL1/Ph (older adults, bad prognosis)
• T-ALL: t(10;14)

/////////////////////////////////////////////////

• 11q23 rearrangements/KMT2A (infants, bad prognosis)
• t(1;19)/TCF-PBX1

Question 20

What is the mechanism of action of Imatinib?

Answer 20

• Imatinib is a tyrosine kinase inhibitor
• It binds to the ATP binding site of BCR-ABL1, preventing ATP from binding and donating it’s phosphate.
• Therefore no activation of oncogenic proteins

Question 21

What disease does this blood film suggest?

Answer 21

Mantle cell lymphoma

-Characteristic morphology?

Question 22

Outline the main subtypes of myelodysplastic syndrome

Answer 22

• So it’s classified into these 5 subtypes though a condition can belong to more than one I suppose
• Single lineage dysplasia
• Erythroid dysplasia
• Granulocytic dysplasia
• Megakaryocytic dysplasia
• Multiple lineage dysplasia
• Adult
• Childhood
• Ring Sideroblasts (Single lineage erythroid dysplasia)
• 5q deletion
• Excess blasts
• Excess blasts type 1 (5-9% blasts)
• Excess blasts type 2 (10-19% blasts)

Question 23

What genes are involved in multiple myeloma?

Answer 23

• IGH gene can be fused with:
• Cyclin D1
• MMSET gene
• Maf
• All leading to overproduction of Ig

Question 24

Describe the myeloid maturation sequence

Answer 24

Myeloblast,

Promyelocyte,

Myelocyte,

Metamyelocyte,

Band,

granulocyte (e.g Neutrophil)

Question 25

What blood parameters are associated with CML?

Answer 25

- High white cell count - Anaemia (Sometimes) - platelets can be either high or low (Mostly high) - Basophiliia

Question 26

What disease does this immunophenotype suggest? CD8-, CD4+, CD7-, CD3+, CD25+, CD5+, CD19-, CD34-, Tdt-

Answer 26

- Adult T-cell leukaemia/lymphoma (ATLL) - **CD25+** ////////////////////////////////////////////////// CD25+: ATLL

Question 27

Describe the typical blood film of multiple myeloma

Answer 27

- **Plasma cells** (lymphocytes with extended cytoplasm, usually shifted in one direction. - Granulation with pale are of ‘golgi zone’ - **Roleaux formation**

Question 28

Case: See blood film. Immunophenotype: CD19+, CD5+, CD79b+/-, CD20+, CD2+/-, CD22+. What is the most likely diagnosis?

Answer 28

- CLL - Smear cells, lymphocytosis - CD5+, CD79b+,

Question 29

What are the nucleated cells here?

Answer 29

Nucleated red cells/erythroblasts

Question 30

What is the main clinical presentation of CML?

Answer 30

- Weight loss, - Low grade fever - Abdominal enlargement

Question 31

What is the characteristic feature of multiple myeloma in a bone marrow aspirate?

Answer 31

\>10% plasma cells

Question 32

outline the pathophysiology of AML M2

Answer 32

- RUNX1-RUNX1T fusion causes the ineffectiveness of CBFalpha - This leads to decreased differentation and maturation

Question 33

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20-, CD22-, CD10-, CD19-, CD7+, CD3+, CD2+, CD13-, CD33-, cytoplasmic m-.

Answer 33

T-ALL (T acute lymphoblastic leukaemia) | (CD7 is a t cell thing)

Question 34

What disease does the following immunophenotype suggest? CD19+, CD20+, CD22+, CD79a+, CD79b+, BCL6+, CD10+(/-), Tdt-, Sig+, CD5-, CD23-, MUM1-, Monoclonal mature IgM (based on kappa:Lambda)

Answer 34

- Burkitt lymphoma. - Monoclonal mature IgM (kappa 75% of cases/lambda 25% of cases) - BCL6+ (maintains cells at germinal centre stage of development)

Question 35

What disease does this lymph node histology suggest?

Answer 35

- ATLL - Large T lymphocytes - Reactive cell population (most likely eosinophils)

Question 36

What are the most common cytogenetic abnormalities associated with MDS

Answer 36

- Del(11q) or –Y (Very good prognosis) - Normal karyotype or del(5q) (Good prognosis) - Del(7q) or double independent clones (intermediate) - Inv(3) or double including -7 or 1del(7q) (Poor prognosis) - Complex: \>3 abnormalities (Very poor prognosis) ///////////////////////////////////////////////// This is really fringe knowledge you probably dont need to know for path. Just understand that particular cytogenetic abnormalities are associated with/ cause MDS

Question 37

Case: 66 year old woman, 2 week history of fatigue and pallor. Full blood count showing pancytopenia: Hb 98, WBC 4, platelets 16. No family history. No hepatomegaly or lymphadenopathy. Abdominal CT, mild splenomegaly. Blood film, immature granulocytes, occasional circulating blasts, with granules. Flow cytometry: High FSC, low SCC, cCD79, MPO-, HLA-DR+, CD34+, CD19+, CD20(mostly -), CD10+, CD38-, CD19+, CD45+/-, Tdt+, CD33-, CD13 (mostly-). What is the most likely diagnosis?

Answer 37

- CLL, B-lineage. - granules rule out MDS

Question 38

Case: See blood film: Immunophenotype: high FCC, moderate SCC. CD19+, CD5-, CD79b+, CD20+, CD2+/-, CD22+, CD23-, CD10+, monoclonal Ig (Lambda:kappa). t(14;18). What is the most likely diagnosis?

Answer 38

Follicular lymphoma | (Coffee bean/ butt cells)

Question 39

Herpes zoster can increase incidence of:

Answer 39

-CLL or Hodgkin lymphoma //////////////////////////////////////////// Don't ask me how, something to do with constantly stimulating the immune cells to proliferate

Question 40

The white cell shown is:

Answer 40

A normal large granular lymphocyte.

Question 41

What is the normal range of haemoglobin?

Answer 41

- Male: 130-180 g/L - Female: 115-165 g/L ///////////////////////////////// Major Key Alert

Question 42

What disease does the following lymph node histology suggest?

Answer 42

- Hodgkin lymphoma - Sclerosis - Reed-sternberg cells

Question 43

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10(+/-), CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m+.

Answer 43

B-ALL, specifically PreB-ALL ////////////////////////////////////////////// One of these markers make it a 'PreB-ALL' rather than a regular B-ALL but this is beyond path.

Question 44

What disease does this blood film suggest?

Answer 44

- ATLL - Pleomorphism. Flower cell morphology

Question 45

How does multiple myeloma cause kidney failure?

Answer 45

Excess Ig (normally IgG) leads to precipitation of light chains in the renal tubules of the kidney

Question 46

What haematologial malignancy is Coxiella Burnetti linked to?

Answer 46

Diffuse large B-cell lymphoma (Non-Hodgkin) ////////////////////////////////// no idea how or why really other than the whole 'infection causes chronic stimulation and proliferation of immune cells leading to malignancy of those cells' principle.

Question 47

What disease does this blood film suggest

Answer 47

- Large cell lymphoma - large and pleomorphic cell

Question 48

What disease does this immunophenotype suggest? Large FCC, large SCC, CD117-, CD3-, CD34-, HLA-DR-, CD13+, CD33+, CD45+, CD14-

Answer 48

CML ////////////////////////// Myeloid cells are CD13+, CD33+

Question 49

What disease does this blood film suggest?

Answer 49

- Burkitt lymphoma - mature blasts, with no granules (lymphoid cells) - **Characteristic prominent vacuolation** /////////////////////////////////// This vacuolation is pathognomonic of Burkitt's Lymphoma

Question 50

Outline presentation of MALT lymphoma

Answer 50

- **Extranodal sites** (Bascially a GI cancer) - Caused by infection (**H. Pylori**) or autoimmune causes (**Coeliacs**) - Immunophenotype: SIg+, CD20+, CD5-, CD10-, CD23+/-, BCL6-, MUM1+/- - Cytogenetics: t(11;18). Activation of NFkB pathway.

Question 51

Hypogranular neutrophil, blast cell, stomatocytes. Most likely diagnosis?

Answer 51

MDS ///////////////////////////////// If no evidence of proliferation

Question 52

This white cell shows what?

Answer 52

Toxic granulation and vacuolisation.

Question 53

What disease does the following immunophenotype suggest? CD7-, CD13-, CD19-, CD33+, HLA-DR-, CD117+, CD15-, CD34+

Answer 53

- AML M3 (APML) - Could also be AML M0, M1, M2

Question 54

What is the typical presentation of multiple myeloma?

Answer 54

- Back pain - Fatigue, pallor (anaemia) - Infections (eg pneumonia) - Signs of acute renal failure (polydipsia)

Question 55

What disease does the following immunophenotype suggest? CD11c+, CD103+

Answer 55

Hairy cell leukaemia (A type of CLL) ////////////////////////////////////// Very fringe, probably not needed for path

Question 56

The white cell shown is:

Answer 56

An eosinophil

Question 57

What are the clinical signs and symptoms of CLL?

Answer 57

- Lymphadenopathy - features of anaemia (fatigue, pallor) (From Bone marrow failure) - Bruising/purpura from thrombocytopenia (Also from Bone marrow failure) - rarely hepatosplenomegaly - Features of immune suppression (Infection)

Question 58

What is the normal range of red cell count?

Answer 58

- Male: 4.5-6.5 10¹²/L - Female: 3.8-4.8 10¹²/L

Question 59

What haematological malignancy can coeliacs lead to?

Answer 59

-(non-hodgkin), of M.A.L.T lymphoma,

Question 60

What are the most common cytogenetic abnormalities associated with CLL?

Answer 60

- Del(6q) - Trisomy 12 - Del(13q)/miR-15a **-Del(13q)/retinoblastoma gene** - Del(17p)/TP53 loss - Del(11q)/ATM ////////////////////////////////////////////////////// This may be a bit too nische for path. Maybe just remember the retinoblastoma one cause it sounds important.

Question 61

What disease does this blood film show?

Answer 61

CML (Left shift, a shift to immature cells) Myelocyte \> promyelocyte \> metamyelocyte \> Band forms

Question 62

What kind of white cell is this?

Answer 62

Atypical lymphocyte - Minimal chromatin condensation, lots of cytoplasm - Large cell with no granulation

Question 63

Describe the typical laboratory findings of Hodgkin lymphoma

Answer 63

- Normochromic, normocytic anaemia (without later bone marrow involvement) - neutrophilia (1/3 of patients) - ESR raised, CRP raised. - Raised serum LDH - Also characteristic histology

Question 64

What disease is associated with a bone marrow trephine biopsy showing a marked increase in marrow lymphocytes, a nodular pattern of **lymphoid accumulation** and interstitial infiltration?

Answer 64

CLL

Question 65

What disease does this blood film suggest?

Answer 65

- MDS - White cells showing psudeo-pelger cells, agranular myelocytes an neutrophils ////////////////////////////////////////// In MDS: - Red cells are usually macrocytic but can be hypochromic. - Granulocytes reduced in number and show lack of granulation - Pelger abnormality (single or bilobed nucleus) - Platelets unusual (usually reduced)

Question 66

Case: A 38 year old woman of Caribbean origin. Rash of several years duration. Family history of ‘leukaemia’. Shortly before she had developed marked cervical lymphadenopathy and hypercalcaemia. Her skin showed plaque-like infiltrates. Flow cytometry: High SCC, CD2+, CD5+, CD7-, CD4+, CD8+, CD25+, CD71. She had also recently broken her clavicle

Answer 66

ATLL ///////////////////////////////////////////////// I think of this as 'Contagious leukaemia'

Question 67

What is the most prominent cytogenetic abnormality associated with Burkitt lymphoma?

Answer 67

- t(8;14) C-MYC and IgH locus (90%) - Other translocations of chromosome 8

Question 68

What disease does this blood film suggest?

Answer 68

- MDS - Mononuclear megakaryocyte /////////////////////////////////////////////// - Red cells are usually macrocytic but can be hypochromic. - Granulocytes reduced in number and show lack of granulation - Pelger abnormality (single or bilobed nucleus) - Platelets unusual (usually reduced)

Question 69

What disease does this blood film suggest?

Answer 69

- One of the myelodysplastic syndromes - Hypogranular neutrophil - blast cell - stomatocytes

Question 70

Outline the clinical presentation of Burkitt lymphoma

Answer 70

- Painless lymphadenopathy, normally on jaw or abdomen - History of Epstein Barr virus - Can affect abdominal organs (Sporadic Burkitt lymphoma) - Signs of pancytopenia in advanced disease

Question 71

What disease does this blood film suggest?

Answer 71

- Follicular lymphoma - Cleft/coffee bean/butt cells pathognomonic

Question 72

What are the main cytogenetic abnormalities associated with multiple myeloma?

Answer 72

- Del(13q) - mutations of telomere end of chromosome 14q32 (location of heavy chains, IgH) - eg. t(4;14) IGH-MMSET1

Question 73

Describe the typical blood count of a patient with CLL

Answer 73

- Lymphocytosis - Anaemia - Thrombocytopenia ///////////////// Lots of white cells but bone marrow failure

Question 74

What disease is the following karyotype associated with? 46, XX, inv(16)(p13q22)

Answer 74

AML M4

Question 75

What are the main sub-types of CLL?

Answer 75

- CLL, regular - Prolymphocytic leukaemia (PLL) - Hairy cell leukaemia (HCL) - Plasma cell leukaemia - T cell: - Large granular lymphocytic leukaemia - T-PLL - ATLL (Can be classed as a type of CLL or lymphoma)

Question 76

What is the normal range of white cell count?

Answer 76

3.6-11.0 10⁹/L //////////////////////////////// Major Key Alert

Question 77

What is the clinical presentation of CML (symptoms and signs)?

Answer 77

- Fatigue - Night sweats - Malaise and weight loss - Left upper quadrant pain - Splenomegaly - Less common (in advanced diseas) - Bone pain - Lymphadenopathy - Skin infiltration - Extra medullary mass

Question 78

What is the major complication of CLL?

Answer 78

- Autoimmune haemolytic anaemia: shown by spherocytes and polychromasia - Direct antiglobulin test would be positive in this case //////////////////////////////////// Good niche bit of knowledge that I reckon could get you a good extra mark somewhere in the exam

Question 79

What bacteria can contribute to the development of lymphoma?

Answer 79

**Helicobacter pylori (MALT lymphoma)** **Campylobacter jejuni** Mycobacterium tuberculosis Borrelia burdorferi Chlamydophila psittaci

Question 80

Outline the treatment for ATLL

Answer 80

**Interferon** and **zidovudine**. It’s as good as chemotherapy //////////////////////// I think this is because of viral cause

Question 81

What is the normal range of platelet count?

Answer 81

140-400 10⁹/L /////////////////////////////////////////////////// Major Key Alert

Question 82

Outline the clinical presentation of Hodkin lymphoma

Answer 82

- Painless lymphadenopathy, more often localised to a single nodal site - Splenomegaly - History of Epstein Barr virus or HIV-1 - Consitutional symptoms in widespread disease: weight loss, night sweats, weight loss, etc.

Question 83

What disease does the following lymph node histology suggest?

Answer 83

-Hodgkin lymphoma /////////////////////////////////// - Sclerosis - Reed-sternberg cells

Question 84

Which is the most common haematological malignancy in children?

Answer 84

ALL /////////////////////////////////////// It is what it is

Question 85

What are the genes most commonly involved in CLL?

Answer 85

- **P53** (bad prognosis) - **Retinoblastoma gene** (bad prognosis) - MiR15a - ATM gene - Loss of P53/del(17p) (bad prognosis) //////////////////////////////////////////////// Arbitrarily picked the top two to remember since this is a bit to detailed

Question 86

A child with mediastinal mass, weight loss, anaemia. Most likely diagnosis?

Answer 86

-T-ALL | (thymus enlargement)

Question 87

What disease does this blood film suggest?

Answer 87

-MDS //////////////////////////////////////// - Monocytoid cells and an agranular neutrophil - Red cells are usually macrocytic but can be hypochromic. - Granulocytes reduced in number and show lack of granulation - Pelger abnormality (single or bilobed nucleus) - Platelets unusual (usually reduced)

Question 88

What is the main cytogenetic abnormality associated with follicular lymphoma?

Answer 88

t(14;18) involving BCL-2 gene (Causing abberrant expression) ////////////////////////////////////////////////////////// Quite fringe for path

Question 89

What disease does this lymph node histology suggest?

Answer 89

-Mantle cell lymphoma /////////////////////////////////////////////////////////// - Characteristic deformed pattern of small lymphocytes with angular nuclei - Expression of cyclin D1 can also show up - Located in mantle zone //Niche but could be useful

Question 90

What disease does the following immunophenotype suggest? CD45+, CD34-, CD2-, CD13+, CD33+, CD117+, CD235a/Glycophorin+, CD19-

Answer 90

- AML M6 acute **erythroid l**eukaemia - **CD235a/Glycophorin** (erythroid marker)

Question 91

In what disease may CAR-T cell therapy be effective?

Answer 91

-B-ALL (Specific for CD19) /////////////////////////////////////////////////// But I think this therapy could be adapted to target any malignancy that has a distinguishing CD cell marker

Question 92

Describe the typical blood count of a non-Hodgkin lymphoma

Answer 92

-In advanced disease there may be anaemia, neutropenia or thrombocytopenia

Question 93

Describe the pathophysiology of APML

Answer 93

- PML-RARA fusion protein binds NCoR-HD complex - This leads to inhibition of transcription and in turn a block in cell differentiation - **Retinoic acid** (**Vitamin A**) is unable to exert it’s effect of continuing transcription

Question 94

Describe how t(12;21) leads to ALL

Answer 94

- RUNX1 encodes CBFalpha, which binds to HAT (Activating transcription) - In ETV6-RUNX1 fusion, the protein cannot bind to HAT. - Therefore transcription is not activated (Causing a loss of differentiation?)

Question 95

What disease does this immunophenotype suggest? CD45-, no SCC, CD10 (mostly+), CD19+, CD34(mostly+), CD5-, HLA-DR(+/-)

Answer 95

B-ALL ///////////////////////////////////////////////// CD19+ means B cell

Question 96

What disease does this blood film suggest?

Answer 96

AML -M2. 1 Aur rod present ////////////////////////// Aur rods means AML 1 Aur rods means AML M2 many aur rods means AML M3

Question 97

Outline the symptoms of acute lymphoblastic/Myeloid leukaemia.

Answer 97

- Fever, sweats, weight loss (Systemic malignant symptoms) - Caused by Bone marrow failure: - tiredness, bruising and bleeding, infections/sepsis - Caused by tissue infiltration - Pulmonary infiltrates -\> Shortness of breath, hepatomegaly, splenomegaly, gum hypertrophy

Question 98

What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD7-, CD2- CD34-, CD41+, CD42+, CD61+.

Answer 98

-AML M7. Acute myeloid megakaryoblastic leukaemia ////////////////////////////////////////////////////////// -CD41+, CD42+, CD61+ are platelet antigens.

Question 99

Describe the typical node biopsy of Hodgkin lymphoma

Answer 99

- Sclerosis - Reed-Sternberg cells/Owl cells

Question 100

What disease does this lymph node histology (with BCL-6 staining) suggest?

Answer 100

- Follicular lymphoma - Germinal centre cell origin - BCL-6 stain +ve - Also BCL-2 stain +ve in follicles - Also diffusely CD10 +ve

Question 101

What disease does the following immunophenotype suggest? CD19-, CD20- CD34-, Tdt- CD38+, CD138+, SIg-, CD7-, CD3-

Answer 101

-Multiple myeloma //////////////////////////////////////////////////// - CD38, CD138 classic plasma cell markers - MM cells don’t have SIg

Question 102

What is the difference between MGUS, smouldering myeloma and multiple myeloma?

Answer 102

- MGUS: - Monoclonal serum protein: \<30g/L - BM plasma cells: \<10% of BM cells - **Multiple Myeloma** **-Monoclonal serum protein: \>/=30g/L** - BM plasma cells: \>10% of BM cells - Smouldering myeloma: - Is just asymptomatic multiple myeloma

Question 103

What disease does this blood film suggest?

Answer 103

- CLL - Lymphocytosis, smear cells, thrombocytopenia

Question 104

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10+, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-

Answer 104

B-ALL //////////////////////////////////////////////// Not sure why other than CD19+ and CD20+ means B cells

Question 105

What are the lab findings associated with multiple myeloma?

Answer 105

- **C**alcium raised - **R**enal impairment (raised creatinine) - **A**naemia (reduced Hb) - **B**one lesions (osteolytic) on x-ray Also: ///////////////////////////// - monoclonal protein \>/=30mg/L - Abnormal immunoglobulins on electrophoresis (Monoclonal gammopathy). Excessive amounts of gammaglobulin - increased serum immunoglobulin-free light chains - Increased ESR

Question 106

What disease does this blood film suggest?

Answer 106

ALL -Could also possibly be AML M0-1

Question 107

What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD15+, CD11c+, CD14+, CD64+, CD34-, CD19-, CD22-, Tdt-

Answer 107

-AML M5 acute myeloid monocytic leukaemia /////////////////////////////////////// - CD13, CD33+ are myeloid markers - **CD15, CD11c, CD14, CD64 are monocyte markers**

Question 108

What is the main cytogenetic abnormality associated with Mantle Cell lymphoma?

Answer 108

-t(11;14), Cyclin D1 overexpression (also TP53 mutation) //////////////////////////////////////// Probably too detailed for path

Question 109

What is the typical immunophenotype of AML?

Answer 109

CD13+, CD33+, CD117+, -CD 34+ (if immature cells)

Question 110

What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10-, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-

Answer 110

B-ALL, specifically ProB-ALL ////////////////////////////////////////////

Question 111

What disease does this lymph node histology (with cyclin D1 stain) suggest?

Answer 111

- Mantle cell lymphoma - expression of cyclin D1 - Located in mantle zone - Characteristic deformed pattern of small lymphocytes with angular nuclei

Question 112

Outline the treatment of Multiple myeloma

Answer 112

**-Steroids** **-Alkylating agents (melphalan)** ///-Adds alkyl group to guanine residues, blocks replication, causes lymphopenia.//// **-Proteosome inhibitors** ///-proteosome required for protein degredation into oligopeptides/amino acids. - Blocking proteasome leads to decreased amino acids in cell, leading to decreased protein synthesis - Effective in MM as there is lots of protein production//// **-Monoclonal Abs (daratumumab: anti CD38 antibody)** -**Immunomodulatory drugs** (IMIDS)

Question 113

What disease does the following immunophenotype suggest? CD34-, Tdt-, CD19+, CD20+,CD23+, CD5+, CD13-, CD33-, CD7-, CD10-, CD79b-, light chain restriction (large disparity between Lambda:kappa)

Answer 113

CLL ///////////////////////////////// -Not to be confused with mantle cell lymphoma (CD23-, Cyclin D1+)

Question 114

What complications can arise from TKI therapy?

Answer 114

- Renal impairment - Nausea and vomiting - Pancytopenia - Pleural effusion (From dasatinib)

Question 115

What is the main translocation associated with CML?

Answer 115

t(9;22)/BCR-ABL1/Philadelphia chromosome

Question 116

What diseases are caused by Epstein-Barr Virus?

Answer 116

- Burkitt’s lymphoma - Hodgkin lymphoma

Question 117

Presentation of tonsillar enlargement and cervical lymphadenopathy. Atypical lymphocytes and atypical mononuclear cells on blood film. Most likely diagnosis?

Answer 117

infectious mononucleosis.

Question 118

What disease does this blood film suggest?

Answer 118

Multiple myeloma - Plasma cell. Paler area is golgi zone. - Roleux formation

Question 119

Describe the typical blood count of a patient with ALL

Answer 119

- Anaemia - Thrombocytopenia - Neutropenia

Question 120

What disease does this immunophenotype suggest? SIg+, CD20+, CD5-, CD10+, CD23+/-, BCL6+, MUM1-

Answer 120

- Follicular lymphoma (NHL) - CD10+ main give away

Question 121

What disease does this lymph node histology suggest?

Answer 121

- Burkitt lymphoma - Germinal centre cell - ‘starry sky appearance’

Question 122

What disease does this immunophenotype suggest? CD45+, some SCC, Tdt-, MPO+, CD13+, CD33+, CD117+, CD34-, HLA-DR-, CD2(+/-)

Answer 122

- APML - Suggested by abberant T-cell marker expression ///////////////////////// CD2 is a T cekll marker, so that with Myeloid markers (CD13 and CD33) suggest APML.