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Lecture 18 – Lymphoproliferative Disease

Lecture 18 – Lymphoproliferative Disease -...

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Lecture 17 – Lymphoproliferative Disease **main idea: Myeloid vs Lymphoid (today = lymphoid) B-Cell Malignancies Bone Marrow Lymph/Blood Stem cell Immature B- Cell Mature B Cell Plasma Cell B-cell Leukemia B-Cell Lymphoma Waldenstrom’s Multiple Myeloma T-cell Malignancies Bone Marrow Lymph/Blood Stem cell Immature T- Cell Mature T Cell Activated T Cell T-Cell Acute Lymphoblastic Leukemia (T- ALL) Peripheral T-Cell Lymphomas (P TCL) **AGGRESSIVE LYMPHOMAS** Cutaneous T-Cell Lyphoma (CTCL) **AGGRESSIVE LYMPHOMAS** Acute T-Cell Leukemia/Lymphoma (ATLL) **AGGRESSIVE LYMPHOMAS** T-Cell Chronic Lymphocyte Leukemia (TCLL) Infectious Mononucleosis (one nucleus in things) - Mimics lymphoproliferative disease with one nucleus in blood smear (reactive lymphocytes, typically active t-cell lymphocytes) - Swollen lymph nodes - The great lymphoma mimic - Inhalation or saliva exchange - Splenomegaly o Young adults!! (bigger reaction) o Young children (no splenomegaly) - Blood smear o Mononucleosis – mono-nuclear cell (any WBC – typically activated t-cells) - Cause by Epstein Barr Virus - Diagnosis o Monospot – test for heterohile antibodies o EBV serology: IgM (IgM means it is acute, IgG means you already have it) Coombs test would not detect it all the time, direct test only test for IgG and complements Use super coombs test - Treatment: o Supportive – avoid causing harm o No steroids or antibiotics or taking spleen out - Other Etiologic agents o Cytomegalovirus (CMV) o Toxoplasma gondii o Other Lymphoma : - Not one cancer, rather is a group of related cancers that arise from lymphocytes that have undergone neoplastic transformation - On a spectrum of disease with lymphoid leukemias - Lymphoma cells commonly have defects in growth or apoptosis , causing the cells to accumulate into tumors that most involve the network of lymph nodes - Lymphoma can present anywhere normal lymphocytes are found - When a lymphocyte becomes malignant, its stage of development is reflected by its biologic behavior - CAUSES o Majority - ? Cellular misadventures aberrations of normal cell processes spontaneous mutations resulting in oncogene formation inadequacies of DNA repair mechanisms o Minority – Infections Viruses: HIV Epstein-Barr (EBV) Human Herpes virus 8 (HHV8=KSHV)
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Hepatitis C Human T-cell lymphocytotropic virus (HTLV) Bacteria: Helicobactor pylori (gastric MALT) (you can cure the cancer by treating the H. Pylori) STAGES : - Measure of cancer burden in a patient - Distinct from tumor grade o differentiation status o aggressiveness of tumor - Different staging used for hematologic versus non-hematologic malignancies o Lymphoma staging Ann Arbor Stage 1 Stage II Stage III Stage IV Single lymph node region (I) 2/more lymph node regions or lymphatic structures *same side as diaphragm Lymph structures alone ( II ) Involvement of lymph ode regions on both sides of the diaphragm ( III ) The gut, the lungs, the tissues, the
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