Myeloma and lymphoma Flashcards Preview

Clinical Pathology > Myeloma and lymphoma > Flashcards

Flashcards in Myeloma and lymphoma Deck (28):
1

Where does B cell maturation take place?

Bone marrow

2

What does B cell maturation comprise?

Gain surface immunoglobins

3

What happened during B cell differentiation?

Mature B cells are exposed to antigens and become either...
- apoptose
- differentiate into plasma cell
-enter germinal centre

4

What produced immunoglobins?

Plasma cells in response to immunogen

5

Wha t is the structure of an immaunogen? How are they classified?

4 polypeptide chains - 2 light, 2 heavy held together by disulphide bonds

Heavy chain - IgG, IgM, IgE, IgD, IgA

Light chain kappa or lama

6

What are the techniques by which myeloma is identified?

Protein electrophoresis - serum placed in gel and exposed to electric current

Immunofixation

Bone marrow biopsy

7

What is the group of interest when investigating myeloma using electrophoreses?

Gamma globulins

8

What is produced with myeloma? How is this different to normal plasma cells?

Produce just one type of immunoglobin

Usually plasma cells produce a variety

9

What is myeloma? What is myeloma's aetiology?

incurable malignant condition of clonal plasma cells

No know aetiology

10

What condition is myeloma always preceeded by?

Monoclonal gammopathy of undetermined Significance (MGUS)

No features of myeloma

11

What is diagnostic of myeloma?

>10% plasma cells are neoplastic AND any one/more of...

- CRAB features

- Myeloma defining events

12

What are the CRAB features?

C - hyperCalcaemia - due to promoted osteoclastic activity)
R - Renal insufficiency - free light chains damage kidney (BENCE JONES protein - proteinuria)
A - Anaemia
B - bone lesions

13

What are the myeloma defining events?

>60% clonal plasma cells in BM biopsy

- Focal lesions on MRI scan

14

What other factors, other than myeloma, could box out the kidney?

-Hyperviscocity
-Renal vein thrombosis
- CT contrast
- Dehydration
- NSAIDs/ACEi
- Hypercalcaemia
-Biaphosphonates

15

What should you treat individuals with suspected myeloma in first instance?

Steroids (delays damage to kidney)

16

What does intensive therapy for myeloma involve?

VCD (chemo) - extract stem cells - chemo (melphalan) - replace stem cells (allows bone marrow to recover)

17

What is the aim for intensive chemotherapy

Myeloma = incurable, put into remission for as long as possible

Also allow bone marrow to recover and reduce symptoms

18

What are the first line treatments for myeloma?

thalidomide/ lenalidomide in
combination with dexamethasone.

19

What are the diagnostic criteria for MGUS?

-Paraproteins (M proteins/light chains)

20

What is amyloidosis caused by?

Light chain fragments released from monoclonal plasma cells misfiled and aggregate, form Beta pleated fibrils

- deposit into organs

- Cause liver/cardiac enlargement, proteinuria, peripheral neuropathy

21

What is follicular lymphoma? What is it characterised by/

Neoplastic disorder of the lymph tissue (non-hopkin's)

Slowly enlarging lymph node

22

What is the genetic component occurring in the majority of cases in follicular lymphoma?

Translocation between chromosome 14 to 18

23

What is Hogkin lymphoma characterised by?

Presence of Hodgkin Reed Sternberg cells - giant cells (usually originate from B germinal cells) which lack antibodies, do not undergo apoptosis and are surrounded by non-malignant infiltrates (i.e. T cells, plasma cells, B cells)

24

What is Hodgkins disease caused by? i.e. pathogenesis

Resistance to apoptosis

Genetic mutation/transciption error to Ig genes - no longer express Ig antibodies

Environmental - EBV virus

25

What are the clinical features of Hodkin lymphoma

Enlarged lymph nodes
B cell symptoms - night sweats, cachexia, fever
Hepatosplenomegaly
Lung involvement - breathlessness

26

How is Hodkins lymphoma managed?

Chemotherapy and radiotherapy

27

What is non Hodkins lymphoma?

Malignant tumours of lymphoid tissues WITHOUT Reed Sternberg cells

28

What is the clinical presentation of non-hoskins Lymphoma?

- Superficial lymph enlargement
- B cell symptoms - night sweats, fever, cachexia
- pancytopenia - anaemia of RBCs, WBCs, and platelets

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