Neoplastic WBC Disorders

malignant proliferation of lymphoid tissue--lymphocytes and their precursors and derivatives

malignant proliferation of the bone marrow which often spill over into the blood

presence of Reed-sternberg cells

arises in a single lymph node or chain of nodes; characterized by contiguous spread within lymph node groups

mirror image nuclei and prominent nucleoli

infectious mononucleosis

amount of tumor burden and its distribution in the body

localized lymph node involvement--better prognosis

widespread disease with bone marrow involvement--worse prognosis

• A - absence
• B - presence of systemic symptoms (fever, weight loss)

• - arise in lymphoid tissue with capacity to spread to other nodes, solid organs, bone marrow, and blood.
• - multiple nodal involvement
• - more frequent extra nodal spread
• - affects all stages

• 85% - B lymphocytes
• 15% - T cell origin

lymphoma develops when there is a monoclonal expansion of lymphocytes that have been "arrested", or have aquired a genetic rearrangement which alters growth regulations, at a particular stage in transformation.

• - Patterns of growth: nodular (older, better prognosis) and diffuse
• - two cell sizes: small (better prognosis) and large
• - two nuclear features: cleaved and non-cleaved

• I - single lymph node involvement
• II - two or more lymph nodes on same side of diaphram
• III - lymph node regions on both sides of diaphragm
• IV - multiple foci of involvement of one or more extralymphatic organs or tissues with or without lymphatic involvement

• painless enlargement of lymph nodes, extranodal spread causing enlarged liver or spleen. bone marrow involvement more common.
• lymphoma cells circulating in peripheral blood represent a 'leukemic phase' of the disease.
• Tx: chemotherapy and less often radiotherapy.

malignant neoplasms of hematopoietic tissue that arises in the bone marrow

• course: rapid, fatal, survival in months
• blood: immature cells
• white cells: often increased, decreased in 30%
• bone marrow: >20% blasts

• course: long survival in years
• blood: mature cells
• white cells: often increased
• bone marrow: blasts usually not increased

• - proliferating cell is a primative lymphoid cell
• - 40% of acute leukemias
• - most frequent type in children <15
• - peak incidence age 4

• 1. early B precursor
• 2. pre-B
• 3. mature B
• 4. T cell

pre-B cell type, aged 2-10

• - proliferating cell is a primitive myeloid cell
• - has cytoplasmic inclusions called Auer rods, which are diagnostic.
• - 60% of acute leukemias
• - predominates in adults under 60 (most common: 15-39)
• - current therapy: bone marrow transplant

• - proliferating cell is a mature-appearing but immunologically incompetent lymphocyte.
• - monoclonal so all cells have the same cell surface phenotype
• - 95% B cell type and most commonly express IgM kappa
• - 2/3 of chronic leukemias, most common over 60
• - male:female is 2:1
• - median survival 4-6 years

• - proliferating cell is an immature hematopoietic cell
• - stem cell pool increased 10-20x normal but fail to respond to normal growth regulators
• - Philadelphia chromosome in all proliferating cells
• - 1/3 of chronic leukemias
• - enlargement of spleen always present

• - Blast crisis: marked by increase in immature cells in the blood and marrow, decreased response to treatment
• - equivalent to acute leukemia
• - myeloid lineage 2/3 and lymphoid lineage 1/3
• - bone marrow transplant performed during chronic phase

• 1. impairment of marrow function as abnormal cells suppress growth of normal cells
• 2. infiltration of body organs due to proliferation of the abnormal cells.

• 1. anemia: manifests as pallor, weakness, fatigue
• 2. thrombocytopenia: bleeding and bruises

result from clonal expansion of immunoglobin-secreting cells resulting in increases in serum monoclonal protein which may have adverse effects on renal and neurological function

proliferating cell is a plasma cell that produces immunoglobin. only one type is produced by the neoplastic cells. 60% is IgG, 20-25% IgA

• myeloma is characterized by multifocal destructive bone lesions. bone resorption results from secretion of osteoblast activating factors by the myeloma cells. can cause hypercalcemia.
• documenting monoclonal protein and skeletal lesions make the diagnosis