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Download PG Medical 2nd Year Pathology Leukemia Handwritten Notes

Download PG Medical ( Post Graduate Medical degree) 2nd Year Pathology Leukemia Handwritten Notes

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Medical PG Handwritten Notes 1st Year, 2nd Year, 3rd Year and 4th Year (Study Material)


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Leukemia - PB, B. T.

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Lymphoma-Lymphnodes, Organs

When tumor load ↑ changeable.

WHO Classification

HL

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Nodal (LN).

Step-wise.

Rare.

m/c involved Lymphnode Cervical.

Hodgkin's Lymphoma:

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EBV mostly a/w HL (not always)

EBV → B cells

Reed-Sternberg/cells-

NHL

extranodal(organs)

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Random.

Very Common

mirrors like nuclei

pink/eosinophilic/nucleoli

alone It's not characteristic of Hodgkin's lymphoma

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1) → also present in Infectious mononucleosis

Rowney cells-activated CD8 T cells

2) NHL → Diffuse Large B cell lymphoma

Immunoblastic 1° CNSly. 1° effusion lymphoma

m/c-a/w

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For Histological diagnosis:

Reed Stein Berg cells +/- mixed inflammatory background

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Neoplastic + non-neoplastic Background

Hodgkins

Classical

RS cells Lymphocyte predominant

CD 15+ 30+

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with different Immuno phenotyping

CD30 > CD15.

(90-100%) (70%)

1) Nodular Sclerosis

Collagen Band

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Lacunar RS

2) mixed Cellularity

mc-India

mononuclear RS

EBV m/c associated/HIV

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3) Lymphocyte poor

mummified RS, Hodgkin type cells

4) Lymphocyte Rich

mononuclear RS

CD 15-30-

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germinal centre of lymphnodes

CD-20+

CD-45+

BCL-6+

Popcorn cells

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Lymphocyte, Histiocyte Rich

RS.

atypical

Histiocytes.

multilobulated

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polypoid nuclei.

EBV/not associated

Nodular Sclerosis lymphocyt predominant HL

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i) NHL

ii) Kaposi Sarcoma

HIV → AIDS

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decreasing order

iii) Cervical invasive Carcinoma

NHL: DLBCL: m/c - Immunoblastic then Hodgkins lymphoma

1° CNS lymphoma (20%)

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m/c brain tumor in HIV - PCNS lymphoma

Acute Leukemia

- PS/ BMT aspirate/bx/cytogenetics

Blast-cells->20% WHO.

Lymphoblast

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agranular cytoplasm

No nucleoli

Myeloblast

granular cytoplasm

prominent nucleoli

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PAS +ve

MPO +ve

Both PAS +ve.

Lymphoblast Erythadblast

Block positive.

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Diffuse PAS positivity.

Sudan Black B +ve

Monocytes (MPO, SBB.)

NSE (+ve)

MT3, MT4, MT5

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Erythadblast-PAS +ve

→ Based on pattern of staining

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Auer Rods → abnormal granules

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ALL- m/c Cancer of childhood

- all is Common in ALL compared to AML

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CNS

mediastinum

Testis

Bad Prognosis

B cell (80%) T-cell (15-20%)

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Adolescents

2-5 years

→ BMT involvement

mediastinal mass.

anaemia.

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NOTCH positive!

FPT PAX-5

CD-10+

CALLA +ve

CD1-8

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CD28

Good prognosis

CD-19+-24+ +ve

Even when Blast count is <20% is

of Translocation, t(8:21) t(15,17) inv 16.

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Irrespective of Blast - AML

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2-10 years

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-white

-female

Cytogenetics

Hyperdiploidy

(ch>50)

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Trisomy, -4,7,10

+(9,12)

+(12,21)

CALLA +ve.

B-ALL

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(early pre-B-ALL)

ANTL:

Bad

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- Black

-male

CNS, mediastinal, Testicular

Hypodiploidy [ch<50]

t(9,22) BCR-ABL.

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+(8,14)

+(1,19)

T-ALL.

Precursor B-ALL.

mature B-ALL.

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Recurrent genetic abnormalities

a) t (8,21) -MT2 good

b) t (15,17) -MT3 good

ANTL

irrespective of Blast count.

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c) t (16,16) inv 16. -M4 Hypereosinophilia.

d) t (U:11) Variable -11-. Bad prognosis

(any chromosome no).

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associated with

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bad prognosis.

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cytogenetics-

Monosomy - 5

Monosomy - 7 - Pediatrics/m/c)

Deletion - 5 - Adult (m/c) Overall

Deletion - 7

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3) AML Treatment Related - Worse Prognosis

4) Not otherwise specified

MPO+

NT0 undifferentiated

Auer Rods NT1 - AML without maturation

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most

definite

myeloid

AML with maturation

NT2

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NT3 - Acute Promyelocytic leukemia [Auer Rods-max]

NT4 - Acute myelomonocytic MPO+ NSE+

NT5 - Acute monocytic - NSE+ MPO-ve

Auer-ve

NT6 - Acute erythroblastic - CD 71/glycophorin A

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NT7 - Acute megakaryocytic - &uparrow; Synthesis

of fibrogenic cytokines

BM fibrosis

plt/RBC/WBC- ↓

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NTS & NT4 (monocyte infiltration)

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Chloroma - MT2

Myeloblastoma; m/c site-Orbital Tissue, skin infiltration.

[Granulocytic Sarcoma]

→Pabasiovalls (atypical monocytes)

PB/Blast → skin/ & Blast cells

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BMT Tissue

→predictor for future myeloid Ca

Myelodysplastic Syndrome-

Myeloid stem-cells, maturation defect.

erythroblasts

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Myeloid lineage

Megakaryocytes

Largest cell

Nuclei injured &

Syncytium like

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Fe protoporphyrin. Neutrophils

Heme.

Fe deposits

around nucleus

in mitochondria

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Ringed Sideroblasts

MDS,

Lead poisoning

Sideroblastic anaemia.

Pseudo-Pelger Huet anomaly

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Dohle bodies

Pavon Ball megakaryocytes

Pelger Huet

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Chronic Leukemia

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Bone marrow biopsy → only prognosis

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never diagnostic.

CLL

SLL

boyes

massive splenomegaly

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LN enlargement

peripheral / small lymph node organ.

P's/PB: &uparrow; Lymphocyte count

Absolute lymphocyte count >5000/mm3

IOC → Flowcytometry

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B cell > T cell

Immunophenotyping CD5+ CD23+ / Diagnostic

Mantle cell lymphoma- CD5+; CD 23-ve

B cell type mantle zone- marker-CD5+

Bad Prognosis- i) Expression of ZAP-70

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ii) No Somatic Hypermutation.

m/c Cytogenetic change.

iii) Trisomy 12.

iv) Richter's Transformation

@CLL-del 13q-good

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multiple myeloma pug

(one lymphoma to other)

SLL → DLBL) Worst prog

Bad Prognosis

Western world-Follicular ii) m/c NHL in

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lymphoma India would

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acute calls Barbet coller

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Chronic Myeloproliferative Disorder.

1) CML Philadelphia

2) PV

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End Result Rumanymyelos

3) Essential Thrombocytosis all myeloid stem cell proliferation

4) Progressive myelofibrosis Risto abnormal tyrosine.

JAK-2 kinase activation

due to IT IT

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Essential thrombocytosis-mild/no splenomegaly.

Chronic Myeloid Leukemia:

Age- bed, adult, elderly

Peak age 50-70 yus

representation - massive splenomegaly

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Nalymphnode enlargement

K/c/o CML with sudden & painful LN enlargement!!

Blast Crisis.

PS: Neutrophil &uparrow; immature >mature.

Platelet &uparrow;

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Basophilia. Presumption.

eosinophils. &uparrow;.

Confirm - Cytogenetics

BCR < FISH

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ISH- BCR-ABL

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+(9:22)

Philadelphia chromosome

longtalong aim Translocation

Philadelphia chromosome 22 long aim

Ph-chromosome - megakaryocyte - dx of cml

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→ any myeloid lineage

3 years

6mo.

i) Chronic phase ii] Accelerated iii] Blast Crisis

phase →Blast> 20%

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B. MT Biopsy <10%

Blast 10-19%

extramedullary

cytogenetics

Basophil >20%

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Chloroma

Blast cells

Thrombocytosis

confirm

Thrombocytopenia

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Large group of

Blast cells in

Not Responding to PR.

BM Bx

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1) Mantle

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→ B cell >60 years

→m/c-Cervical LN enlargement

CD5+ CD-23-ve.

cytogenetics

t(11:14)

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cyclin D1 (BCL)

3) Burkitt lymphoma:

2) Follicular

→B cell type

20-30 years

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LN Biopsy

1) Centrocytes (Smaller)

- Buttock cells.

2) Centroblasts.

cytogenetics t(14:18)

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cyclin D2 (BCL 2)

Takkue B cell lymphoma.

CD34-ve; Ig ⊕

→ Highest proliferative Index among all Human cancers

i) poor prognosis (Brain Tissue involvement)

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ii) m/c association with tumor lysis Syndrome

Bcl 2 -ve. Germinal Centre BCL-6+ve.

LN Biopsy- Small Round Blue cell tumor

i) wilms

ii) Neuroblastoma

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iii) Ewings

iv) Lymphoma

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tholic

to high Fami

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Dead-tumor-cells

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Small Round cells

Macrophage engulf with

(foamy macrophages)

Starry Sky appearance

t (3:14) m/c type of Cytogenetics

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t (8,22)

t (2,8)

Hairy Cell Leukemia

→B cell lymphoma

→60/m.

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-massive splenomegaly

Cytoplasmic Hair like projections (in phase contrast):

TRAP+ve

(Halo contrast around cells)

A. BMT aspirate-Dry Tap.

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BMT Biopsy-

Tumor cell pattern

Honey Comb pattern:

Fried egg appearance

(perinuclear Halo)

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Text Specific Best inv:

CD-11C

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CD-25

CD 103

Annexin A1+

&uparrow; Risk - Atypical mycobacterial infection

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790/-BRAF mutation

Multiple myeloma

plasma cell disorder

&uparrow;IL-6

abnormal plasmablast

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(no perinuclear Hoff)

Reinuclear Hall

Hoff

due to golgi body

Light chain Ig.

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monoclonal protein-M protein.

Ig G (m/c)

A

NT

D (Rare)

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E (very Rare)

Bence Jones protein

50° clot

100c° Liquid

Myeloma kidney - Primary type of Amyloidosis

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AL type

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infection → Renallay

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m/c Cause of Renal failure in MNT-Light chain deposition.

&uparrow; Abnormal Ig synthesis

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Russell Bodies

Cytoplasm

Cells Mott's cells

Bluish cluster of grape like Ig

Dutcher Bodies

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Nucleus

Flame Cells

Fiery Red cytoplasm due to Ig

Diagnosis: 1) BMT Biopsy - Plasma cell >10%

2) NT-protein &uparrow;-Both Serum & Urine

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3] Incidence of end organ damage

c-calcemia

R -Renal damage

A- Anemia

B-Bone lytic lesion

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Prognosis B2-microglobulin &uparrow; Tumor load - Best

&uparrow; Sa LDH

Bad prog

&uparrow; C-R.P.

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Pin-Di

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Langerhan's Cell Histiocytosis:

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→2-10 years.

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m/c chavethisthe -involving all bones of body,

simultaneously

→Seborrheic dermatitis like lesion - Scalp.

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Gonadal Involvement-Absent / Rare.

1) Letterer-Siwe -multisystem,

multifocal, multicentric

2) Eosinophilic granuloma-Scalp defects-multifocal

3) Hand-Schuller christian

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unisystem

Calvarial defect.

Diabetes insipidus

Exophthalmos

Cytogenetics - Immunophenotyping - CD1a (Best),

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S-100, VHLA-DR,

CD-207 (langerin protein)

m/E: Langerhans cells + eosinophilia

elongated cells with coffee bean nucleus

Cytoplasmic granules (EM) → Birbeck granules.

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Tennis racket

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