Hematopoietic Neoplasms 2007

60 %
40 %
Information about Hematopoietic Neoplasms 2007
Science-Technology

Published on January 12, 2009

Author: aSGuest10201

Source: authorstream.com

Hematopoietic Neoplasms : Hematopoietic Neoplasms Glenna E. Mauldin, DVM, MS Dipl. ACVIM (Oncology) and ACVN Cancer Treatment Unit LSU School of Veterinary Medicine Overview : Overview Definitions Review of cell origins Types of hematopoietic neoplasms lymphoproliferative disorders myeloproliferative disorders Definitions : Definitions Hematopoiesis formation and development of blood cells in bone marrow extramedullary hematopoiesis (EMH) spleen, liver, lymph node Neoplasm proliferation of abnormal cells that generally reproduce faster than normal Hematopoietic neoplasm abnormal, uncontrolled proliferation of blood cells or blood precursor cells Definitions : Definitions Lymphoma proliferative disease of lymphocytes arising as solid tissue masses in lymphoid tissue other than bone marrow lymph nodes spleen other sites Leukemia neoplastic proliferation of hematopoietic cells originating in bone marrow Where do blood cells come from? : Where do blood cells come from? Pluripotential stem cell (bone marrow) Multipotential myeloid stem cell (CFU-GEMM) Multipotential lymphoid stem cell (CFU-L) T-lymphocytes B-lymphocytes Neutrophils Eosinophils RBCs NK cells Basophils/Mast cells Megakaryocytes Monocytes Where do blood cells come from?Lymphoid Lineage : Where do blood cells come from?Lymphoid Lineage T-lymphocytes immature T-cells exported from bone marrow development and maturation in thymus mature T-cells travel to peripheral lymphoid tissue lymph nodes, spleen, MALT circulate around body through lymphatics “activated” by presentation of an antigen Natural killer (NK) cells mode of development not clear probably similar to T-cell development Where do blood cells come from?Lymphoid Lineage : Where do blood cells come from?Lymphoid Lineage B-lymphocyte development and maturation in bone marrow mature B-cells exported from bone marrow travel to lymph nodes, spleen, MALT “activated” by antigen presentation memory B-cells long-lived ready for action next time invader appears plasma cells short-lived makes many copies of antibody against invader Where do blood cells come from?Myeloid Lineage : Where do blood cells come from?Myeloid Lineage Neutrophils, eosinophils, basophils, RBCs development and maturation in bone marrow released into circulation Monocytes development and maturation in bone marrow released into circulation exit circulation (into tissues) and become macrophages Where do blood cells come from?Myeloid Lineage : Where do blood cells come from?Myeloid Lineage Megakaryocytes development and maturation in bone marrow cytoplasmic fragmentation produces platelets platelets released into circulation Mast cells immature mast cells exported from bone marrow development and maturation in connective tissue throughout body Hematopoietic Neoplasms : Hematopoietic Neoplasms Causes of neoplastic transformation spontaneous genetic mutation oncogenes tumor suppressor genes oncogenic viruses FeLV FIV radiation damage to DNA leukemias Hematopoietic Neoplasms : Hematopoietic Neoplasms Causes of neoplastic transformation chemical carcinogens chemotherapy phenylbutazone chloramphenicol genetic predisposition boxers golden retrievers Hematopoietic NeoplasmsLymphoproliferative Disorders : Hematopoietic NeoplasmsLymphoproliferative Disorders Lymphoma (LSA) aka - lymphosarcoma aka - malignant lymphoma Acute lymphoblastic leukemia (ALL) Chronic lymphocytic leukemia (CLL) Multiple myeloma aka - plasma cell myeloma Primary macroglobulinemia aka - Waldenstrom’s macroglobulinemia Lymphoproliferative DisordersCanine Lymphoma : Lymphoproliferative DisordersCanine Lymphoma Common disease in dogs 7-24% of all tumors 83% of hematopoietic neoplasms Various anatomic forms multicentric (80%) alimentary (5-7%) mediastinal (5%) cutaneous (uncommon) primary extranodal (uncommon) ocular, CNS, nasal, etc. Lymphoproliferative DisordersCanine Lymphoma : Clinical staging system Stage I: single node or lymphoid tissue in single organ Stage II: multiple lymph nodes on one side of diaphragm Stage III: generalized lymph node involvement (both sides of diaphragm) Stage IV: liver and/or spleen involvement (+/- stage III) Stage V: bone marrow and/or other organ system involvement (+/- stages I-IV) Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Clinical staging system substage (a) no signs of systemic illness (b) signs of systemic illness Phenotyping ? 80% B-cell ? 20% T-cell Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Staging tests CBC, chemistry panel urinalysis (+/- urine culture) thoracic rads (2 views) abdominal rads (+/- ultrasound) FNA of lymph node lymph node biopsy bone marrow aspirate immunophenotyping B-cell vs. T-cell +/- coagulation profile Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : CBC abnormalities anemia chronic disease bone marrow involvement chemotherapy IMHA blood loss thrombocytopenia bone marrow involvement chemotherapy DIC Get coagulation panel! Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : CBC abnormalities neutropenia bone marrow involvement chemotherapy circulating lymphoblasts bone marrow involvement large volume visceral involvement liver, spleen Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Chemistry abnormalities hypercalcemia total Ca++ > 12 mg/dL normal range varies with lab tumor produces PTHrP increased Ca++ resorption from bone, gut and renal tubules causes PU/PD blocks ADH receptors in kidney mitochondrial and tubular basement membrane calcification ? renal failure present in 20% of cases frequently associated with mediastinal or bone marrow forms of lymphoma Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Chemistry abnormalities elevated liver enzymes AST, ALT, ALP hepatic involvement concurrent disease corticosteroid therapy azotemia prerenal systemic illness renal renal involvement renal calcification from hypercalcemia concurrent disease Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Chemistry abnormalities hyperglobulinemia polyclonal gammopathy chronic inflammatory disease (concurrent) immune-mediated disease monoclonal gammopathy gamma globulins (antibodies) produced by plasma cells from a single clone B-cell lymphoma Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : UA abnormalities abnormal specific gravity hyposthenuria with hypercalcemia Ca++ blocks ADH receptors tubular water resorption inhibited kidneys can’t concentrate but can still dilute urine Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : isosthenuria may be normal hypercalcemia ? renal calcification ? renal failure kidneys cannot concentrate or dilute urine concurrent disease pyelonephritis, chronic renal disease proteinuria glomerulonephritis Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Thoracic radiographs lymphadenopathy perihilar sternal cranial mediastinal mass pleural effusion Abdominal radiographs hepatomegaly splenomegaly lymphadenopathy sublumbar Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : FNA of lymph node lymphoblasts ? suspicious for LSA lymph node germinal centers contain lymphoblasts biopsy of node for definitive diagnosis cytology sometimes acceptable for definitive diagnosis pleural or abdominal effusion bone marrow kidney liver Lymph node biopsy whole node Tru-cut punch Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Bone marrow aspirate lymphoblasts ? definitive diagnosis of LSA decreased granulocytic precursors myelophthesis chronic chemotherapy decreased erythrocytic precursors myelophthesis chronic chemotherapy anemia of chronic disease decreased megakaryocytes myelophthesis chronic chemotherapy Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersCanine Lymphoma : Immunophenotyping B-cell vs. T-cell cell surface proteins specific to cell type wash cells with antibody against specific surface protein color change signals presence of surface protein B-cell: CD79a T-cell: CD3 T-cell phenotype associated with worse prognosis Lymphoproliferative DisordersCanine Lymphoma Lymphoproliferative DisordersFeline Lymphoma : Very common disease in cats 33% of all tumors 60-90% of hematopoietic neoplasms Various anatomic forms alimentary (75%) multicentric (10%) mediastinal (10%) renal (uncommon) CNS (uncommon) nasal (uncommon) Lymphoproliferative DisordersFeline Lymphoma Lymphoproliferative DisordersFeline Lymphoma : Staging tests same as for dog FeLV/FIV test always repeat, even if done recently or previously vaccinated thyroid hormone levels (T4) hyperthyroid cats have similar signs Lymphoproliferative DisordersFeline Lymphoma Lymphoproliferative DisordersFeline Lymphoma : Clinical pathology abnormalities some differences from canine patients hypercalcemia uncommon azotemia with isosthenuria renal lymphoma concurrent disease pyelonephritis, chronic renal disease Lymphoproliferative DisordersFeline Lymphoma Lymphoproliferative DisordersFeline Lymphoma : Clinical pathology abnormalities FeLV test is for viral antigen (p27) snap test on whole blood IFA on bone marrow sample positive test indicates worse prognosis older studies most cats young, FeLV (+), mediastinal disease recent studies most cats older, FeLV (-), alimentary disease Lymphoproliferative DisordersFeline Lymphoma Lymphoproliferative DisordersFeline Lymphoma : Clinical pathology abnormalities FIV test is for antibodies against virus snap test on whole blood can confirm equivocal results with Western Blot analysis positive test not shown to affect prognosis T4 concurrent disease Lymphoproliferative DisordersFeline Lymphoma Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) : Signalment generally young dogs and cats often < 4 years old (dogs) median age 5.5 years (dogs) German Shepherds? FeLV (+) cats Presentation usually sick lethargy and anorexia vomiting and diarrhea shifting leg lameness Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) : Physical examination findings splenomegaly/hepatomegaly pallor moderate lymphadenopathy fever Difficult to distinguish from Stage V lymphoma Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) : Differences between ALL and lymphoma acute onset of clinical signs lymphadenopathy in <50% of cases poor response to chemotherapy short survival times Difficult to distinguish from AML in cats immunophenotyping, special stains necessary Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) : Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) Clinical pathology abnormalities malignant lymphoblasts in bone marrow nonregenerative anemia (90%) moderate to severe thrombocytopenia (50%) dogs: normal to greatly elevated WBC may be decreased cats: usually normal to decreased WBC Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) : Lymphoproliferative DisordersAcute Lymphoblastic Leukemia (ALL) circulating lymphoblasts number of lymphoblasts variable less than 5,000/?L to over 100,000/?L elevated liver enzymes (40%) increased BUN (30%) Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) : Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) Signalment generally older dogs females overrepresented rare in cats FeLV (-) cats Presentation usually not sick from disease often incidental finding Can be difficult to distinguish from Ehrlichia canis infection Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) : Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) Clinical pathology abnormalities malignant infiltration of mature lymphocytes in bone marrow mild nonregenerative anemia mild thrombocytopenia WBC counts usually elevated (can be neutropenic) Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) : Lymphoproliferative DisordersChronic Lymphocytic Leukemia (CLL) mature lymphocytosis number of lymphocytes variable: usually greater than 30,000/?L monoclonal gammopathy may occur Lymphoproliferative DisordersMultiple Myeloma (MM) : Systemic proliferation of malignant plasma cells 8% of canine hematopoietic tumors Diagnostic criteria (2 out of 4) monoclonal gammopathy IgG or IgA infiltration of neoplastic plasma cells in marrow > 10% of nucleated cells Bence Jones proteinuria light chains (? subunit) of immunoglobulins Lymphoproliferative DisordersMultiple Myeloma (MM) Lymphoproliferative DisordersMultiple Myeloma (MM) : Diagnostic criteria radiographic evidence of osteolytic bone lesions “punched out” lytic lesions Lymphoproliferative DisordersMultiple Myeloma (MM) Lymphoproliferative DisordersMultiple Myeloma (MM) : Lymphoproliferative DisordersMultiple Myeloma (MM) Complications of MM hyperviscosity syndrome (HVS) marked increase in serum viscosity 20% of cases with monoclonal gammopathy “sludging” of blood due to aggregation of large numbers of immunoglobulins coagulopathies neurologic dysfunction ocular abnormalities congestive heart failure hypercalcemia usually local osteolysis Lymphoproliferative DisordersMultiple Myeloma (MM) : Lymphoproliferative DisordersMultiple Myeloma (MM) Complications of MM renal failure calcification from hypercalcemia nephrotoxicity from Bence-Jones proteins concurrent amyloidosis/glomerulonephritis renal hypoxia from HVS anemia IMHA myelophthesis coagulation disorders leading to blood loss pathologic fracture severe osteolysis Lymphoproliferative DisordersMultiple Myeloma (MM) : Lymphoproliferative DisordersMultiple Myeloma (MM) Complications of MM immunosuppression/infection defects in cellular and humoral immunity normal immunoglobulin levels usually severely depressed proliferating B cells release inhibitory factor that blocks proliferation of normal B cells infection - major cause death in human patients with monoclonal gammopathies Lymphoproliferative DisordersMultiple Myeloma (MM) : Lymphoproliferative DisordersMultiple Myeloma (MM) Negative prognostic factors poor response to therapy hypercalcemia Bence Jones proteinuria extensive skeletal lesions renal insufficiency Lymphoproliferative DisordersPrimary Macroglobulinemia : Primary macroglobulinemia aka – Waldenstrom’s macroglobulinemia neoplastic proliferation of B-lymphocytes with a monoclonal expansion of IgM more prone to HVS than multiple myeloma patients due to large size of IgM Lymphoproliferative DisordersPrimary Macroglobulinemia Hematopoietic NeoplasmsMyeloproliferative Disorders : Hematopoietic NeoplasmsMyeloproliferative Disorders Major categories myelodysplastic syndrome (MDS) (preleukemia) chronic myeloid leukemia (CML) acute myeloid leukemia (AML) acute undifferentiated leukemia (AUL) Hematopoietic NeoplasmsMyeloproliferative Disorders : Hematopoietic NeoplasmsMyeloproliferative Disorders Characteristics of diseases myelodysplastic syndrome anemia or multiple cytopenias normal to hypercellular bone marrow ineffective hematopoiesis blast cells comprise < 30% of nucleated cells in bone marrow chronic myeloid leukemia blast cells comprise < 30% of nucleated cells in bone marrow elevated cell counts of one or more cell lines in peripheral blood with mature forms predominating Hematopoietic NeoplasmsMyeloproliferative Disorders : Hematopoietic NeoplasmsMyeloproliferative Disorders Characteristics of diseases acute myeloid leukemia blast cells comprise ? 30% of nucleated cells in bone marrow +/- circulating blast cells may need immunophenotyping to differentiate between cell lines acute undifferentiated leukemia term used when light microscopy cannot differentiate between acute lymphoblastic leukemia and acute myeloid leukemia Immunophenotyping or special stains necessary Hematopoietic NeoplasmsMyeloproliferative Disorders : Hematopoietic NeoplasmsMyeloproliferative Disorders Chronic myeloid leukemia chronic myelogenous leukemia eosinophilic leukemia basophilic leukemia chronic myelomonocytic leukemia polycythemia vera aka – polycythemia rubra vera essential (primary) thrombocytosis Acute myeloid leukemia Acute myelogenous leukemia Basophilic differentiation acute myelomonocytic leukemia acute monocytic leukemia erythroleukemia erythroid predominance aka - erythremic myelosis acute megakaryoblastic leukemia Myeloproliferative DisordersMast Cell Leukemia : Mast cell leukemia technical definition neoplastic proliferation of mast cells with large numbers of tissue mast cells in peripheral blood without skin lesions mast cells comprise ? 20% of nucleated cells in bone marrow used to describe metastatic manifestation of cutaneous mast cell tumor (esp. dogs) bone marrow buffy coat very poor prognosis in dogs cats? Myeloproliferative DisordersMast Cell Leukemia Remember… It could be worse. : Remember… It could be worse.

Add a comment

Related presentations

Related pages

Classification of the hematopoietic neoplasms

Classification of the hematopoietic neoplasms. Authors Arnold S Freedman, MD. Arnold S Freedman, MD. ... Blood 2007; 110:695. Armitage JO, Weisenburger DD.
Read more

SEER Hematopoietic and Lymphoid Neoplasm Database

C96.7 Other specified malignant neoplasms of lymphoid, hematopoietic. Corresponding ICD-10-CM Codes (effective October 1, 2015 U.S. only) C96.4 ...
Read more

Expression of the RNA-binding protein VICKZ in normal ...

Expression of the RNA-binding protein VICKZ in normal hematopoietic tissues and neoplasms. Yasodha Natkunam, ... Haematologica Feb 2007, 92 (2) 176-183 ...
Read more

Hematopoietic and Lymphoid Neoplasm Project

7/13/2010 1 Hematopoietic and Lymphoid Neoplasm Project Hematopoietic and Lymphoid Lineages Steven Peace, CTR FCDS Annual Meeting July 22, 2010
Read more

PPT - Hematopoietic and Lymphoid Neoplasm Project ...

Hematopoietic and Lymphoid Neoplasm Project. Introduction to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues 4 th edition.
Read more

Association between atl and non-hematopoietic neoplasms ...

Association between atl and non-hematopoietic neoplasms. Dr Nobutaka Imamura 1,*, Tominari Inada 1, ... 2 MAR 2007; Manuscript Accepted: 15 JUL 1993;
Read more

2007 ICD-9-CM Diagnosis Code V10.79 : Personal history of ...

Personal history of other lymphatic and hematopoietic neoplasms. ... You are viewing the 2007 version of ICD-9-CM V10.79. More recent version(s) ...
Read more

Cytometry Part B: Clinical Cytometry - Wiley Online Library

The Cytometry Part B: Clinical Cytometry supplement (72B, Supplement 1, 2007) titled ‘2006 Bethesda International Consensus Conference on Flow Cytometric ...
Read more

Transgenic expression of Helicobacter pylori CagA induces ...

Proc Natl Acad Sci U S A. 2008 Jan 22; 105(3): 1003–1008. Published online 2008 Jan 11. doi: 10.1073/pnas.0711183105. PMCID: PMC2242726
Read more