Plasma Cell Disorders Flashcards by Richhpal Singh

Multiple myeloma arises from

Post germinal cells

How well did you know this?

Not at all

Perfectly

Multiple myeloma is type of

Plasma cancer

How well did you know this?

Not at all

Perfectly

Mutations in plasma cell in case of Multiple myeloma

Chr. 13q deletion (MC)
t(11;14) - Cyclin D1 overexpression
Increased Myc
Chr 17p deletion

How well did you know this?

Not at all

Perfectly

Formation of abnormal antibodies is seen in which plasma cancer

Multiple myeloma

How well did you know this?

Not at all

Perfectly

Increased no. Of plasma cells can

1) Replace normal BM cells (decreased RBC,WBC And platelets)
2) can lead to Cytokines secretion

How well did you know this?

Not at all

Perfectly

Cytokines secreted by plasma cells

IL-6, TNF-alpha, MIP, DKK-4

How well did you know this?

Not at all

Perfectly

Cytokines secreted by plasma cells

IL-6, TNF-alpha, MIP, DKK-4

How well did you know this?

Not at all

Perfectly

Cytokines secretion from plasma cells can lead to

Increased activity of Osteoclast whereas osteoblasts normal - Results in Bone destruction - Lytic lesions

How well did you know this?

Not at all

Perfectly

Most commonly affected bones in multiple myeloma

Vertebral bones > Ribs > Sternum > Pelvis > skull

How well did you know this?

Not at all

Perfectly

Most commonly affected bones in multiple myeloma

Vertebral bones > Ribs > Sternum > Pelvis > skull

How well did you know this?

Not at all

Perfectly

Serum calcium levels in Multiple myeloma

Increased - Hypercalcemia

How well did you know this?

Not at all

Perfectly

Serum alkaline phosphatase levels in Multiple myeloma

Normal - bcz it depends on osteoblasts activity

How well did you know this?

Not at all

Perfectly

Hypercalcemia in Multiple myeloma can leads to

Polyuria
Renal failure

How well did you know this?

Not at all

Perfectly

2nd most common cause of death in multiple myeloma

Renal failure

How well did you know this?

Not at all

Perfectly

Clinical features in multiple myeloma

Bony pain

How well did you know this?

Not at all

Perfectly

Common antibody affected in multiple myeloma

IgG

How well did you know this?

Not at all

Perfectly

Abnormal M proteins can stick to

RBCs - leads to aggregation of RBC - ROULEAU FORMATION

How well did you know this?

Not at all

Perfectly

Increased viscosity of blood in Multiple myeloma can lead to involvement of

Brain - Confusion, dizziness

How well did you know this?

Not at all

Perfectly

Increased viscosity of blood in Multiple myeloma can lead to involvement of

Brain - Confusion, dizziness

How well did you know this?

Not at all

Perfectly

Due to presence of light chains in urine we can see

Bence jones Proteins

How well did you know this?

Not at all

Perfectly

Most common cause of death in multiple myeloma

Severe infection

How well did you know this?

Not at all

Perfectly

IMWG updated criteria for multiple myeloma

Clonal BM plasma cells >10% / Biopsy proven Bony extra medullary plasmacytoma
AND
Any 1 of myeloma defining event(MDE)

How well did you know this?

Not at all

Perfectly

Myeloma defining events includes

Related organ/ Tissue involvement (ROTI)
Biomarkers of malignancy

How well did you know this?

Not at all

Perfectly

Related organ/ tissue impairment includes

Ca2+ levels high - >11mg/dl
Renal dysfunction - s. Creatinine >2mg/dl
Anemia - Hb <10g/dl
Bony lesions - >1 osteolytic lesions

How well did you know this?

Not at all

Perfectly

Biomarkers of malignancy includes

BM clonal plasma cells >60% Light chain - Ratio of involved LC is to Uninvolved LC >100 On MRI - >1lesion (>5mm in size)

Morphological finding in BM Biopsy in MM

MOTT cell Flame cell (Orangish red color) Russell Body Dutcher body

Flow cytometry results in Multiple myeloma

CD19, CD38, CD45, CD138

In Multiple myeloma there is higher expression of which gene

Cyclin D1

Blood examination results in Multiple myeloma

Anemia, Neutropenia, Thrombocytopenia Increased ESR Hypercalcemia Normal serum alkaline phosphatase Increased levels of Serum beta2 microglobulin and Serum IL-6 levels

Spike seen on Serum protein Electrophoresis

'M' Spike

Result of urine examination in multiple myeloma

Presence of Bence Jones proteins

At room temperature urine in presence of Bence Jones proteins

Urine will be clear

At room temperature urine in presence of Bence Jones proteins

Urine will be clear

After heating urine at 40-60°C Urine will be

Turbid urine - because Bence Jones proteins becomes insoluble and coagulates

Urine on heating more than >60°C

Urine again becomes clear

Radiological examination in multiple myeloma

PET Scan X ray

"Punched out" lesions on skull is seen in

Multiple myeloma

Treatment of Multiple myeloma

Dexamethasone + Lenalidomide + Bortezomib

Diagnostic criteria for Plasma cell Leukemia

Peripheral blood - >20% no. Of plasma cells Absolute count of plasma cells >2000/microlitre

Good prognosis of multiple myeloma in case of

t(11;14)

Bad prognosis indicators in multiple myeloma

Chr. 17p deletion Myc overexpression CRAB +ve Serum beta2 microglobulin levels high

Best bad prognosis indicator of Multiple myeloma

Serum beta2 microglobulin elevated levels

Differential diagnosis of Multiple myeloma with Monoclonal gammopathy of unknown significance

>50yr(1%), >70yr(5%) Clonal plasma cells <10% No myeloma defining events

Differential diagnosis of multiple myeloma with. Smoldering myeloma

Asymptomatic myeloma BM plasma cells 10-59% No myeloid defining events/ No amyloid deposition

Biopsy proven single lesion plasma tumor

Solitary plasmacytoma

Solitary plasmacytoma involves which organs

Bones - same as MM Soft tissues - Lungs/ paranasal sinuses/oropharynx

Solitary plasmacytoma involves which organs

Bones - same as MM Soft tissues - Lungs/ paranasal sinuses/oropharynx

Bone marrow in Solitary plasmacytoma

Normal (No tumor cell)

Skeletal screening in Solitary plasmacytoma

Normal ( only 1 lesion)

Solitary plasmacytoma can progress to

Multiple myeloma in 10-20 years

Treatment of Solitary plasmacytoma

Radiotherapy Surgical resection

Lymphoplasmacytic Lymphoma means

Excessive proliferation of Lymphocytes/plasma cells or increased mast cells

Mutations seen in lymphoplasmacytic Lymphoma

MYD88 gene

Which antibody involved in Lymphoplasmacytic Lymphoma

IgM antibody - Macroglobulinemia - Waldenstroms

Lymphoid tissue involved in Lymphoplasmacytic Lymphoma

Lymph node, spleen, liver

Treatment of Lymphoplasmacytic Lymphoma

Plasmapheresis - abnormal antibodies are removed Rituximab - against CD20

Abundant chain in heavy chain disease

Heavy chains

Disease due to excessive alpha heavy chains

Seligmann disease

Most common heavy Chain disease

Seligmann disease

Seligmann disease affects which organs

GIT Respiratory tract

Clinical features of Seligmann disease

Malabsorption syndrome Weight loss Diarrhea

Excessive mu heavy chains is associated with

CLL

Light chains may appear in which heavy chain disease

Mu-HCD - Bence Jones proteins++

Light chains may appear in which heavy chain disease

Mu-HCD - Bence Jones proteins++

Disease caused by excessive gamma heavy chains

Franklin's disease

Clinical features in Franklins disease

Fever Lymphadenopathy Hepato and splenomegaly

Franklin's disease is associated with which disease

Rheumatoid arthritis