Lec 14 - Lymphoid Malignancies

Question 1

3 major underlying principles of lymphoid malignancies

Answer 1

• share many characteristics with normal lymphocytes as they arise from normal cells
• depedning on what stageof developmetn the malig cell is deribed from, they resemble cells at that stage
• behave differently due to there being so many of them, but also unusual features

Question 2

4 types of malig cells in terms of developmetal stage

Answer 2

1. from initial lymphocyte production stage
2. from cells responding to antigen
3. from cells that have met antigen
4. from memory cells

Question 3

1. where

Answer 3

in bone marrow, highly proliferative

Question 4

1. appearance of cell

Answer 4

• big nucleus and nucleous = unravelled
• blue cytoplasm = packed with ribosomes

Question 5

1. name of cells at this stage

Answer 5

acute lymphoblastic leukemia

Question 6

1. where does it grow initially

Answer 6

• at first = edge of bone marrow, resembling normal cells

Question 7

1. later behaviour of these cells

Answer 7

• grow rapidly, dont mature
• fill bone marrow, eliminates all fat spaces
  = supress grwoth of normal cells
• after filling marrow entirely, will spill over to other areas e.g. the blood

Question 8

1. what causes the symptoms

Answer 8

• suppression of normal cell production
• growth in bone marrow = bone pain

Question 9

1. common symptoms

Answer 9

• bleeding (lack of platelets)
• infection (lack of WBCs)
• anemia of diff types
• bone pain

Question 10

1. how does its effects change depending on age

Answer 10

• children = behaves like adult disease, but mutations mean more sensitive to treatment
• elderly = many diff mutations, poor response to treatmenr

Question 11

1. which mutation, that is often seen in myeloid leukemias, can be seen is ALL

Answer 11

BCR/ABL mutation
used to be hard to treat but new treatment means its now curable

Question 12

2. where

Answer 12

lymph nodes
this is after meeting an antigen, they go here to proliferate

Question 13

2. why variable in visibility

Answer 13

• initially cells vry proliferative = more like bone marrow cells
• later look like effector cells, less proliferative (still in lymph glands)

Question 14

2. appearnace of lymph node

Answer 14

• filled with malignant cells
• enlarged
• less variability of cells

Question 15

2. name of cells that develop from this stage

Answer 15

lymphoma

Question 16

2. how can it be traced

Answer 16

PET scan
can be seen in lymph nodes
and small amount in kidnet bladder as its excreted

Question 17

2. why is Burkitt lymphoma special

Answer 17

MYC gene is mutated
(usually controls cell division progression)
= makes cells continually proliferate
= one of fastest growing malignancies

Question 18

3. what stage do these cells arise from

Answer 18

effector cells
that leave the lymph glands, and travel through blood to get to bone marrow (where they grow)
(mainly plasma cells ie antibody producing cells)

Question 19

3. appearance of these cells

Answer 19

• dense chromatin, most is inactive and wrapped around histone (only antibody protein is made)
• large pale area where the golgi body is = nucleus pushed to one side
• blue cytoplasm = lots of ribosomes

Question 20

3. name

Answer 20

myeloma

Question 21

3. avg normal amount of antibodies

Answer 21

~30g/L

Question 22

3. amount of antibodies in myeloma

Answer 22

up to 100g

Question 23

3. how plasma cell myeloma cause disease

Answer 23

1. excess antibody = sticky = block kidneys, plasma hyperviscosity
2. abnormal plasma cells displace normal plasma cells = infection
3. plasma cells make cytokines = holes in bones, fractures, high Ca in bone

Question 24

3. symptoms

Answer 24

• bone pain and fractures
• kidney failure
• effects of slow circulation
• high rate of infection, reactivation of diseases e.g. shingles

Question 25

4. arise from what type of cell

Answer 25

memory cellls

Question 26

4. where

Answer 26

migrates widely between nodes, blood and tissue in lots of diff tissues

Question 27

4. name

Answer 27

chronic lymphocytic leukemia

Question 28

4. appearance

Answer 28

- nucleus is dense, no nucleolus - pale blue, few ribosomes

Question 29

4. problem wiht these cells

Answer 29

- slow progressive proliferation - survive in excess number - migrate widely

Question 30

4. common way of being diagnosed

Answer 30

routine blood test = raised numbe rof abnormal lymphocytes in blood

Question 31

4. other symptoms of this

Answer 31

- widespread enlargement of lymph glands (slow, painless, usually symmetrical) - bone marrow failure - immune deficiency (but because cells are moslty inert, symptoms are minimal)

Question 32

4. most common cause of death

Answer 32

- immunosuppression = chonic ill health

Question 33

4. autoimmune effects

Answer 33

autoimmune destruction of red cells vry common - severe anaemia

Question 34

4. treatment used

Answer 34

combination of cancer drugs = FCR chemotherapy

Question 35

4. what mutation causes hairy cell leukemia

Answer 35

mutation of BRAF gene - also a malignancy of memory cells