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    Quiz Week 4 Group II

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    Christopher Taki

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    Quiz Week 4 Group II

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    Christopher Taki
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    Quiz Week 4 Group II (1)

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    4 views22 pages

    Quiz Week 4 Group II

    Uploaded by

    Christopher Taki

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    © All Rights Reserved
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    QUIZ WEEK 4

    Dr Niki Vyrides MD PhD


    Haematology Course
    Lead Consultant MD6
    Haematologist SEPTEMBER 2021
    Vyrides Clinic
    2

    SAQs and SBAs


    Week 4 - 2019
    Group B
    SBA 1

    3
    ►1. In a normal lymph node, the paracortex includes
    pronominally:
    • A. T cells
    • B. B cells
    • C. Macrophage
    • D. Plasma cells
    Normal lymph node
    ► CORTEX
     Primary follicles are aggregates of small naïve B lymphocytes
    memory
    that express pan-B cell markers: CD19, CD20
     Secondary follicles contains:
    germinal centers here occurs the activation of the naïve B T
    lymphocyte in the presence of dendritic cells
    mantle zone in the periphery, populated from P

    Naïve B lymphocytes remaining inactivated Naïve B


     Marginal zone is the outer zone, populated from centrocytes
    with surface immunoglobulins with high affinity for a particular
    antigen that will differentiate into memory cells
    ►PARAFOLICULAR or PARACORTEX :separates the follicles  T zone
    ►MEDULARY CORD zone for plasma cells that express CD138, CD38
    ►SINUSE
    6
    ► If the patient is a young adult and presents:
    • cervical lymphadenopathy and
    • alteration of the d ifferenti al count on leucogram
    (N: 28%, L:60% M :12%) and
    • reactive lymphocytes , what disease comes to
    your m ind?

    • A. Toxoplasma
    • B. Infectious Mononucleosis
    • C. Chronic Lymphocytic Leukaemia
    • D. Ac ute lymphobla stic Leukaemia
    ► In most cases the diagnosis of lymphoma relies on all of
    follow ing EXCEPT:
    • A. Microscopic examination of affected lymph nodes
    • B. lmmunophenotyping using immunohistochemistry or flow
    cytometry
    • C. Molecular or cytogenetic analysis
    • D. Peripheral blood examination and a full blood count (FBC)
    ▪ Rarely the peripheral blood is affected
    ▪ The bone marrow is infiltrated in only very progressed lymphomas
    ▪ Most of the cases even infiltrated the bone marrow there is no
    leukaemic picture in the peripheral blood
    SBA4

    7
    ►The t (8;14) is the defining feature of:
    • A. Follicular Lymphoma
    • B. Hodgkin's Lymphoma
    • C. Burkitt’s Lymphoma
    • D. Mantle Cell Lymphoma
    Chromosomal translocations & Lymphomas
    BCL2 Cycline D1 C- myc 11
    Chromosome 18 Chromosome 11 Chromosome 8

    Heavy chain of immunoglobulins


    chromosome 14

    t(14;18) t(11;14) t(8;14)


    Block apoptosis Neoplastic Neoplastic
    proliferation proliferation

    Follicular Mantle cell Burkitt


    lymphoma Lymphoma Lymphoma
    SBA5
    ► Which is the correct order of the followi ng
    lymphoma from the BEST to WORST prognosis
    • A. DLBCL Burkitt  Hodgkin's T-NHL Follicula r
    • B. Follicula r Hodgkin's  Burkitt  DLBCL T-NHL
    • C. Hodgkin's Follicular Burkitt DLBCL T- NHL
    • D. T-NHL  DLBCL Burkitt Follicula r  Hodgkin's

     Hodgkin 's has the better prognosis >75% of the patients cure

     Follicular is a low grade lymphoma  "wait and see"


    the treatment starts when appear
    symptoms or if progress to DLBCL
     DLBCL and Burkitt are high grade lymphomas need urgently
    treatment

     T- NHL has the worse prognosis  if responds to treatment 


    ► A patient with rela psing Hodgkin's disease presents with:
     weight gain,
     foot ulcers,
     vision problems, What is the most likely etiology of the
     elevated blood suga r, patient's psychiatric symptoms?
     ora l candidiasis and
     new onset of wildly swinging mood changes.
    ► Gold standard treatment  ABVD-
    Pneumonitis , A : Adriamycin
    A. Adverse effects of bleomycin pulmona ry fibrosis B :Bleomycin
    V:Vincristine
    B. Adverse effects of prednisone D:Decarbazide

    C. Adverse effects of vinc ristine neuropathy ► Stanford V regimen .


    Prednisone
    ► Escalated BEACOPP
    D. Normal psychiatric response to having cancer
    E. Progression of disea se
    Glucocorticoid effects 17

    Hypothalamic-Pituitary-Adrenal Axis
    SAQ8

    12
    ►What do you know about “popcorn cells”

    ►Morphology: multilobated or extremely folded (like popcorn) nucleus with


    vesicular chromatin, a thin nuclear membrane, and scant cytoplasm.

    ►Immunophenotyping (clusters of differentiation):


    • CD15 and CD30 negative
    • CD20 +

    Characteristic related disease: Lymphocyte predominant Non classical


    Hodgkin's diseased
    Reed Stemberg Cell and its variants
    CD20 +,
    CD15+ and CD30+ CD15 -,
    CD30 -

    “Classic RS cell” “Lacunar cell” “Popcorn cell”


    mixed cellularity Lymphocyte predominance
    nodular sclerosis
    Lymphocyte rich
    Lymphocyte depleted
    SAQ9

    14
    ►What is Diffuse Large B cell Lymphoma

    ►Definition

    ►Classification

    ►Translocation
    2. DLBCL Diffuse large B cell Lymphoma

    15
    ►DLBCL can be:
    • Primary  de novo
    • Secondary after progression of a
    follicular lymphoma
    ►it is a high grade malignancy
    ►Treatment: chemotherapy
    with anti- CD20 = Rituximab in
    • Follicular lymphoma only in
    ◦ symptomatic patients
    ◦ patients with bulky disease
    • Primary or secondary DLBCL
    SAQ9

    16
    ► What are the 7 poor prognostic factors in IPS-7 (International prognostic
    system-7) for Hodgkin’s lymphoma?
    1. Age> 45 years
    2. Stage IV
    3. Haemoglobin< 10.5g/dl
    4. Lymphocyte count < # 6090
    or < 8%
    5. Male
    6. Albumin <4g/dl
    7. White blood cell count >
    15000/ml
    SBA 10

    17
    What are the most important 4 differences between
    the benign and malignant lymph node?
    Differential Diagnosis

    18
    Benign lymph node Malignant lymph node

    ►Usually painful ►Painless


    ►Tender ►nontender,
    ►Mobile, non-fixt with underling tissue ►fixed lymphadenopathy
    ►The lymph node architecture is ► lymph node architecture is lost or
    preserved distorted due to the increased
    cellular proliferation
    ►Hyperplasia
    ►Not recognizable the light and dark
    ►multiple large germinal centers with zones
    ►recognizable light and dark zones ►Necrosis
    SBA11

    19
    ►Define hypersplenism
    Hypersplenism
    RBC, WBC, Platelets in the circulation:

    20
     Normally only
    • the 5% of the Red blood Cells Influx, efflux, and redistribution
    • the 30% of the Platelets and
    • The 50% of the marginating White blood cells Platelet count
    are located in the spleen RBC
     In splenomegaly
    • Up to 40% of the RBC CIRCULATING
    • 90% of the Platelets may DESTRUCTION
    PRODUCTION -PLATELETS
    be trapped in the spleen or REMOVAL
    -RBC
     Hypersplenism
    70%
    • Is a clinical syndrome characterized by :
    • Splenomegaly +
    • reduction of at least one of the blood cell
    SPLEEN
    line
    • In case of normal bone marrow 50% marginating WBC
    30% PLT
    5% RBC
    Dr. Roberto Stasi
    21
    Do you have any questions?

    22
    [email protected]

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