Pathology of Plasma Cell Lesions and Amyloid Flashcards Preview

MD2 Surgery and Anaesthesia > Pathology of Plasma Cell Lesions and Amyloid > Flashcards

Flashcards in Pathology of Plasma Cell Lesions and Amyloid Deck (34):
1

What are the red flags for back pain?

Pain at night
Pain at rest
Trauma
Constitutional symptoms
Incontinence
Radicular pain
IVDU
Other neurological symptoms
Localised tenderness

2

What do rouleaux on the blood film indicated?

Happen when plasma protein level high
Presence of disease

3

For what diseases is beta 2 microglobulin measured?

Multiple myeloma
Lymphoma

4

What is Congo Red stain used for?

Amyloid

5

What are plasma cell neoplasms?

Proliferation of clone of plasma cells
Often produce
- Monoclonal Ig = paraprotein/M protein
- Free light chains

6

Which plasma cell neoplasm often affects the axial skeleton?

Multiple myeloma

7

What happens in monoclonal gammopathy of undetermined significance (MGUS)?

Bone marrow based clonal proliferation of plasma cells
Make up <10% of total cells
Low levels of M protein

8

What happens in solitary plasmacytoma of bone, or extraosseus plasmacytoma?

Single clonal proliferation of plasma cells within bone/soft tissue
May produce M protein

9

What happens in multiple myeloma?

Multifocal, bone marrow based, monoclonal proliferation of plasma cells
More than 10% of plasma cells
High levels of M protein

10

What happens in symptomatic multiple myeloma?

Organ/tissue impairment = CRAB
- C = hyper-calcaemia
- R = renal insufficiency
- A = anaemia
- B = bone lesions

11

Is MGUS considered neoplastic?

No

12

What can MGUS evolve into?

Plasma cell myeloma
Other lymphoproliferative disorders
Amyloidosis

13

What is the cell of origin in multiple myeloma?

Post-germinal centre B cell

14

What is the median age of diagnosis of multiple myeloma?

70 yrs

15

Other than CRAB, what other things can occur in symptomatic multiple myeloma?

Increased susceptibility to infection
Hyper-viscosity
Amyloidosis

16

How does hyper-calcaemia present?

Neurological manifestations
Polyuria
Constipation
Nephrocalcinosis
Renal calculi

17

How do bone lesions occur in multiple myeloma?

Neoplastic cells produce factors > activate osteoclasts and inhibit osteoblasts > bone erosion

18

How do bone lesions present?

Pain
Pathological fractures
Hyper-calcaemia

19

Why do patients with multiple myeloma get anaemia?

Neoplastic proliferation in bone marrow > pancytopaenia

20

How do bisphosphonates work?

Bind to Ca > ingested by osteoclasts > cause apoptosis > overall decrease in bone resorption

21

Why are bisphosphonates used in the symptom management of multiple myeloma?

Decrease hyper-calcaemia and bone resorption

22

What are the circulating monoclonal immunoglobulins in multiple myeloma?

IgG in 50%
IgA in 20%
Light chains in 20%

23

What causes hyper-viscosity syndrome in symptomatic multiple myeloma?

Increased blood viscosity
- ESR
- Rouleaux

24

What causes increased susceptibility to infection in symptomatic multiple myeloma?

Abnormal Ig > impaired humoral immunity

25

What causes renal insufficiency in symptomatic multiple myeloma?

Hyper-calcaemia
Hyper-viscosity syndrome
Increased susceptibility to infection
Light chains filtered by kidney
Light chains deposit in tissues, including kidney, as amyloid

26

What are light chains when detected in the urine in plasma cell lesions called?

Bence-Jones proteins

27

What is amyloid?

Pathological extracellular protein
Fibrillary ultrastructural appearance
Due to mis-folding of normal/abnormal proteins
Can't be removed

28

What is primary amyloidosis?

Associated with plasma cell/lymphoplasmacytic lesion
Usually light chains - usually lambda
Usually deposits in multiple organs

29

What sort of light chains can be excreted, and what cannot?

Lambda can't be excreted
Kappa excreted in urine = Bence-Jones proteins

30

What is secondary amyloidosis?

Associated with systemic chronic inflammatory conditions/tumours
Derived from serum amyloid associated protein (SAA) = acute phase reactant
Usually deposits in multiple organs

31

What are some systemic chronic inflammatory conditions and tumours with which secondary amyloidosis is associated?

IBD
TB
Rheumatoid arthritis
Hodgkin's lymphoma
Renal cell carcinoma

32

What is the amyloid in Alzheimer's disease?

Amyloid beta protein (ABP)
Derived from amyloid precursor protein (APP)
Forms senile plaques

33

In which conditions does CNS amyloid deposit in vessel walls?

Alzheimer's disease
cerebral amyloid angiopathy

34

What are the complications of amyloidosis?

Organ failure - function deteriorates with progressive amyloid deposition
Vessels become
- Brittle
- Prone to rupture
Cardiac amyloid
- Restrictive cardiomyopathy
- Cardiac failure
- Arrhythmias
Renal amyloid
- Proteinuria
- Nephrotic syndrome
- Chronic renal failure