This document discusses the use of molecular cytogenetics techniques in the diagnosis and classification of hematological malignancies. It begins by outlining the indications for cytogenetic analysis in hematological neoplasms. It then describes several cytogenetic analysis methods including conventional cytogenetics, fluorescence in situ hybridization (FISH), multicolor FISH (mFISH), multicolor banding (mBAND), and array-based comparative genomic hybridization. The document discusses the approach to cytogenetic analysis in several hematological malignancies and lists some common translocations in lymphomas. It provides an overview of recurrent chromosomal abnormalities seen in several leukemias and lymphomas.
An array of presentation of lymphoma spillover in the peripheral smear and bone marrow. All types of lymphomas are discussed along with a bouquet of HPE pictures
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric...Dr Siddartha
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric Evaluation
Basavatarakam Indo-American Cancer Hospital and Research Institute
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
various cutaneous lymphomas though having low incidence but need to be diagnosed accurately. they can be mimiced by many non neoplastic conditions of skin. so discussing both T and B cell lymphomas
An array of presentation of lymphoma spillover in the peripheral smear and bone marrow. All types of lymphomas are discussed along with a bouquet of HPE pictures
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric...Dr Siddartha
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric Evaluation
Basavatarakam Indo-American Cancer Hospital and Research Institute
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
various cutaneous lymphomas though having low incidence but need to be diagnosed accurately. they can be mimiced by many non neoplastic conditions of skin. so discussing both T and B cell lymphomas
A short presentation on the diagnostic procedure involved in Leukemia identification and possible treatment available currently. This presentation includes the types of leukemia, risk factors, symptoms, treatment methods, and advanced techniques.
The methods of identification of cytogenetic changes that occur in various malignancies, the advantages and disadvantages of each methods and the implication of those cytogenetics with examples of acute leukemias (AML, ALL).
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Skeleton
• Indications of Cytogenetics in haematological neoplasm.
• Methods of cytogenetic analysis.
• Conventional Cytogenetic principle.
• FISH principle.
• mFISH , mBAND , Array based comparative genomic hybridization.
• Approach of Cytogenetics in Hematological malignancies.
• Translocations in lymphomas.
3. Indications of cytogenetic study
• Unknown cause of cytopenia.
• WHO classification of AML and ALL
• Risk stratification of ALL.
• MDS diagnosis ,Classification.
• Lymphoma diagnosis ,classification and staging work-up.
• Following up of treatment response.
4. Methods of Cytogenetic analysis
• Conventional Cytogenetics.(karyotyping)
• Fluorescence in situ hybridization (FISH).
• Multicolor FISH.
• Multicolor banding with high resolution.
• Array based comparative genomic hybridization.
5. Methods of cytogenetic analysis
• Classical cytogenetic is carried out on a cell that has entered into mitosis
Arrested in metaphase
• Individual chromosomes - recognized by their size
• Banding pattern following stain (e.g Geimsa staining [G-Banding] or
staining with fluorescent dye.
• Alternating dark and light bands are numbered from centromere toward
telomere to facilitate description of any abnormalities detected.
8. Methods of Cytogenetic analysis
• Cytogenetic analysis can be carried out on following type of tissues
1.Skin fibroblasts or phytohemagglutinin (PHA ) Stimulated lymphocytes (to study
constitutional abnormalities ).
2. Bone marrow cells.
3.Blood cells .
4. Cells isolated from lymph nodes or other organs suspected of infiltrated by
lymphoid or other neoplasm.
5.Cells isolated from serous effusions
9. Methods of cytogenetic analysis
• In studying suspected haematological neoplasms
• There are two reasons for seeking to detect constitutional abnormalities
• 1)Constitutional abnormality underlying a haematological neoplasm.
2)Irrelevant and previously undetected constitutional chromosomal
abnormality that has to be recognised.
To distinguish from an acquired chromosomal abnormality associated with a
neoplastic process.
10. Methods of cytogenetic analysis
• A bone marrow aspirate for cytogenetic analysis should be
• Anticoagulated by the addition of preservative free heparin or tissue culture
medium containing heparin.
• The specimen can be stored at room temperature for some hours or at 4 °C if
delay in analysis is expected.
• with the exception of samples from patients with suspected lymphoid malignancy
• which should be stored at room temperature as disease cells may die very rapidly
at low temperatures.
11. Methods of cytogenetic analysis
• If samples are being sent to central laboratory :
• Detailed clinical and haematological information
• Central laboratory is aware if there is clinical urgency in obtaining the
results and so that appropriate techniques are used.
12. Methods of Cytogenetics
• FISH (Flouroscent insitu hybridization )bridges classical cytogenetic
analysis and molecular diagnostic techniques.
• Chromosomes can be stained and visualised but the technique is also
dependent on recognition of specific DNA sequences
• By means of a fluorescent probe that can anneal to a specific DNA
sequence.
13. • FISH can be carried out on metaphase preparations or cells in interphase.
• FISH probes may identify the following :
• Centromeres of a specific chromosome ( useful for detecting trisomy or
monosomy.)
• Specific oncogenes (locus specific probe useful for detecting
translocations).
• whole chromosome Paimting probes.
Methods of Cytogenetics
14. • Advantages of FISH in comparison with conventional chromosomal
analysis include the following :
• Many more cells can be examined.
• Metaphases are not essential. So abnormalities can be detected in non
dividing cells. So Useful in chronic lymphocytic leukemia , in which cell
rarely divide in culture.
• FISH can be performed in a shorter period of time(May be critical in
rapidly confirming a diagnosis acute promyelocytic leukemia.)
Methods of cytogenetics
15. • Abnormalities that are too subtle to be detected by conventional cytogenetic
analysis may be detected example STIL-TAL Fusion in T-lineage ALL or
t(12;21) in B-Lineage ALL.
The main disadvantage of FISH is that only those abnormalities that are
specifically sought will be found , whereas conventional cytogenetics permits
all chromosomes to be evaluated.
Methods of cytogenetics
16. Centromere specific probe
• For determination of numerical aberrations, for identification of
centromere in Marker chromosomes.
18. Chromosome painting probes
• Determination of structural rearrangements( translocations and deletion of
large extent )
19. Multicolor FISH
Allows in one hybridization experiment distinguish according to different
colour of every pair of autosomes and sex chromosomes and then it is
possible to make analysis of whole genome and every structural and
numerical rearrangement.
21. mFISH
Analysis of complex chromosomal rearrangements in bone marrow cells of
patients with hematological malignancies will bring us detailed information
about involvement of specific chromosomes or their regions into genetic
rearrangements
22.
23. mBAND
Multicolor banding with high resolution.
Enables determination of exact breakpoints of chromosomal aberrations with
higher resolution than classical banding.
24. Array- Based comparative Genomic
hybridization(aCGH)
• New tool to search for recurrent gains and loss of chromosomal regions
throughout the genome
• Very high resolution of copy number changes at DNA level.
• Recently it is utilised in diagnostics of leukemias and the results revealed a
large spectrum of genomic imbalances , including the novel recurrent
deletions and amplifications.
25.
26. The impact of conventional and
molecular cytogenetic analysis
in onco-hematology
• help to specify diagnosis
• help to determine the prognosis
• help monitor effectiveness of treatment
32. • Approach for diagnosis of Acute leukemias
• Clinical features , complete blood count , Peripheral blood smear , bone
marrow aspirate smear.
Assessment of morphology and percentage of blasts
>20 % Blasts <20% Blasts
AML ,B-ALL , T-ALL ,Mixed phenotypic AML with recurrent genetic abnormalities
Leukemia.
33. Case 1
• A 35 year old boy presented with one day history of bleeding gum ,
subconjuctival bleed and pupuric rash.
• Investigations revealed following results : Hb 6.4 g/dl , TLC 26,500/mm3 ,
Platelet 35,000 mm3. Prothrombin time 20 seconds with a control of 13
seconds , partial thromboplastin time -50 seconds. Fibrinogen 10 mg/dl
• Peripheral smear suggestive of Acute myeloblastic leukemia .
• Most likely cytogenetic abnormality in this case ?
34. Acute myeloid leukemia
• Heterogenous group of malignant disease of haemopoeisis
• Accumulation of immature myeloid cells (Myeloblasts) in the bone marrow
• Diagnosed in all age groups
• Most commonly affects the people older than 60 years (Median age 64-68 years)
• Specific chromosomal aberrations with clear prognostic significance
stratification of therapy according to cytogenetic findings
35. FAB Classification of AML
• M0 –Minimally differentiated AML
• M1-AML without differentiation
• M2-AML with maturation
• M3-Acute promyelocytic leukemia
• M4-Acute myelomonocytic leukemia
• M5-Acute monocytic leukemia
• M6-Acute ertyhtroleukemia
• M7-Acute megakaryocytic leukemia
36. Acute myeloid leukemia
• Clinical findings :
• AML may develop at any age , but is more in common in adults
• Symptoms : Anemia , neutropenia and thrombocytopenia
40. Lab findings in AML
• Hemoglobin: is decreased (5 to 9 g/dl)
• Peripheral smear :
• RBC :Normocytic normochromic anemia
• Total WBC count : markedly raised.
• Differential count : More than 20% Myeloid blasts
• Auer rods : Azurophilic needle like structures of varying length and
width
41.
42.
43.
44. Bone marrow findings in AML
Cellularity : hypercellular due to proliferation of blasts.
Erythropoeisis : markedly suppressed.
Myelopoeisis : Myeloblasts constitute more than 20 % of cells
Megakaryopoeisis : gradually decreased.
45. Cytogenetic findings in AML
Chromosomal
aberrations
Genes FAB category Prognosis
t(8;21)(q22;q22) RUNX1-RUNX1T1 M2 Favourable
inv(16)(p13;1q22)or
t(16;16)(p13.1;q22)
CBFB-MYH1 M4 Favourable
t(15;17)(q22;12) PML-RARA M3 Good
t(9;11)(p22;q23) MLLT3-MLL M4,M5 Intermediate
t(6;9)(p23;q34) DEK-NUP 214 - Poor
Inv(3)(q21q26.2) or
t(3;3)(q21.3;q26.2)
GATA 2,MECOM - Poor
t(1;22)(p13;q13) RBM15-MKL1 - Variable
AML with mutated NPM1 - Favourable
AML with mutated
CEBPA
- Favourable
46. Acute myeloid leukemia
• Conventional Cytogenetics.
• Normal karyotype Aberrant karyotype
• Insufficient metaphases
Targeted FISH
Subtype specific FISH: PML/RARA, or other molecular cytogenetic
,CBFB etc. Techniques.
47. Case 2
• A 4 year old boy admitted with a history of abdominal pain and fever for
two months ,maculopapular rash for ten days and dry cough, dyspnea and
wheezing for three days.
• On examination liver and spleen were enlarged 4cm and 3 cm respectively
below the costal margin.
• Hb -10.0 g/dl
• Leukocyte count 70 x 109 /L
48. • Bone marrow examination revealed a cellular marrow comprising of 45 %
Blasts and 34% Eosinophil precursors.
• The blasts stained negative for myeloperoxidase and non specific esterase
• Positive for CD19,CD 10, CD 22 and CD20
• What is the diagnosis ?
• Most likely cytogenetic abnormality in this case ?
49. Acute lymphoblastic leukemia
• Accumulation of immature lymphoid cells in the bone marrow and mostly
also in peripheral blood.
• Most common malignancy in children representing 25 % of pediatric
cancer.
• 80 % of pediatric leukemias
• Heterogenous disease –distinct therapeutic and prognostic implications
• Chromosomal aberrations – found upto 90 % of cases
50. Clinical findings in ALL
• Age and sex : ALL is the most common hematological malignancy of children.
• Most commonly found between 1 and 5 years of age and second peak in adults
found between 30 and 40 years.
• Hepatosplenomegaly.
• Lymphadenopathy : 75% of patients.
• Mediastinal mass
• CNS involvement : may spread to meninges.
• Testicular enlargement
51. Lab findings in ALL
• Hemoglobin : progressively decreases and may be reduced even to 3g/dl.
• Total WBC count : Total white cell count is markedly raised ranging from 20 x
109 /L to 200 X 109/ L
• Peripheral smear :
• RBCs : Normocytic normochromic
• WBCs : Total count is usually markedly increased. Few may present with
pancytopenia. Blasts may replace normal myeloid series and can cause
neutropenia.
52.
53. • Lymphoblasts : minimum requirement for diagnosis by WHO criteria is 20%
blasts or more.
• Platelets : Thrombocytopenia
• Bone Marrow :
• Cellularity : Bone marrow is markedly hypercellular due to proliferation of blasts
which replace normal hematopoietic cells.
• Erythropoiesis and myelopoiesis : Reduced
• Megakaryopoiesis : Reduced
Lab findings in ALL
55. Risk stratification in ALL
Low-Risk Intermediate risk High-Risk Very High Risk
Hyperdiploidy Age 1-10 years E2A/PBX fusion BCR/ABL fusion with
high TLC
TEL/AML1 fusion TLC 50,000/mm
without genetic risk
factors
T-ALL MLL rearrangement
Age <1year, >10 year
And TLC
>50,000/cu.mm without
genetic risk factors
56. Acute lymphoblastic leukemia
• Conventional Cytogenetics.
Normal karyotype
Insufficient metaphases
B-ALL FISH Aberrant karyotype
• RUNX1
• Hyperdiploidy
• MLL
Targeted FISH
T-ALL or other molecular cytogenetic
TCR genes (TP16(9p21),ABL1(9q34) Techniques.
57. Case 3
• A 60 yr old man with fatigue , weight loss and heaviness in left hypochondrium
for 6 months.
• The hemogram showed Hb.10 g/dl TLC 5 lakhs/mm3 , Platelet count 4
lakhs/mm3 .
• DLC neutrophil 55% , lymphocytes 4 % , monocytes 2 % , basophils 6%,
metamyelocytes 10 % , myelocytes 18 % , promyelocytes 2 % and blast 3%.
• What is the diagnosis ?
• The most likely cytogenetic abnormality in this case is ?
58. Chronic myeloid leukemia
• 15-20 % of all cases
• Mainly in Adults(Median Age 65 years)
• Tri-phasic disease :
CP - chronic phase (relatively benign, 3-9 years)
Acute Phase - More malignant accelerated phase
• Blast Crisis - Terminal blast crisis
• Blasts increase rapidly (crowd out healthy cells)
59. • One of the best-studied malignancies - has served as a paradigm for
elucidation how genetic changes cause cells to become malignant:
Philadelphia chromosome t(9;22)(q34;q11) - BCR/ABL fusion
• One of the first malignancies in which a therapy targeting the underlying
molecular defect has improved the clinical outcome of patients: Gleevec™
(Novartis) used for therapy
• t(9;22)(q34;q11) in 90-95% of patients
• BCR/ABL fusion gene.
60. Clinical findings
• Commonest leukemia and 25-30 % of all leukemias in India.
• Age : fifth and sixth decades of life.
• Males are more commonly affected than females.
• Onset : Gradual with vague nonspecific symptoms
• Anemia , fatigue , weakness , weight loss , anorexia and fullness of abdomen due to
splenomegaly.
• Rarely present with bleeding.
• Leukostatic symptoms : Due to sludging in the pulmonary or cerebral vessels –Dyspnea ,
drowsiness .
61. Lab findings
• Hemoglobin : less than 11 g/dl.
• Peripheral smear :
• RBCs: Normocytic normochromic.
• WBCs : Leuocytosis. Total leucocyte count usually exceeds 100 x 109 /L
shift to left.Predominant cells are neutrophils and myelocytes.
Blasts are usually less than 10%
Basophils and eosinophilia usually seen.
• Platelets : range from normal to increased. Thrombocytosis.
62. Lab findings
• Bone marrow findings :
• Cellularity : Hypercellular
• M: E ratio exceeds 20 :1
• Erythropoiesis : decreased
• Megakaryocytes : Normal or increased dwarf megakaryocytes : small form of
megakaryocytes.
Sea blue histiocytes (Gaucher cells/pseudogaucher cells ) : scattered large storage
histiocytes with wrinkled green-blue cytoplasm
63.
64. Pseudo-gaucher cells ,sea blue histiocytes
Scattered amongst marrow
cells are macrophages with
linear striations or granular
cytoplasm (pseudo gaucher
cells ) some with sea blue
colored granules resembling
histiocytosis.
65. Chronic myeloid leukemia
• Conventional Cytogenetics.
• Normal karyotype Aberrant karyotype
• Insufficient metaphases
• Normal karyotype Without t(9;22) Targeted FISH or other molecular
cytogenetic techniques.mFISH , mBAND
array comparative genomic hybridization.
FISH : BCR/ABL1
69. Case 4
• A 80 year old Asymptomatic man present with a total leucocyte count of 1
lakh and with 80 % lymphocytes ?
70. Chronic lymphocytic leukemia
• Tumor composed of monomorphic small B lymphocytes in the peripheral
blood , bone marrow and lymphoid organs (spleen and lymph nodes )
• Age : 50 -60 years
• Present with non specific symptoms –fatigue , weight loss , anorexia.
• Generalized lymphadenopathy
• Few cases hepatosplenomegaly
71. Chronic lymphocytic leukemia
• Cytogenetics in CLL :
• Conventional cytogenetics is difficult.
• As only few dividing neoplastic lymphocytes.
• FISH can detect abnormalities in non dividing cells.
• No single cytogenetic abnormality specific for CLL.
• Common abnormalities include 13q-, 11q-,trisomy 12 , 17p-
• 11q- and 17p- are related with poor outcome.
72. Laboratory findings
• Hb usually below 13 g/dl , it may decrease below 10g/dl
• Peripheral smear
• RBCs: Normocytic normcohromic
• WBC : Lymphocytosis. Lymphocytes are mature in majority of cases.
• Smudge cells or basket cells : disintegrated lymphocytes represent the
spread out nuclearmaterial. Due to rupture of neoplastic lymphoid cells
while making the peripheral smear due to its fragile nature
73. • Bone marrow : hypercellular marrow
Infiltrated by lymphocytes
Erythropoeisis: Normal
Myelopoeisis : Normal
Megakaryopoeisis : Normal
74. Myelodysplastic syndromes
• Heterogeneous group of acquired clonal stem cell disorder characterized
by progressive cytopenias , dysplasia in one or more cell lines, ineffective
hematopoeisis and high risk of transformation to AML
75. Myelodysplastic syndromes
• Role of cytogenetics :
• Presumptive diagnosis of MDS in the presence of persistent unexplained cytopenia
• Absence of morphological features.
• Specific Cytogenetic abnormality is present :
• Unbalanced : -7, or del7q- or del5q , -13q del or 13q, del11q , del 12p, del 9q
• Balanced : t(11;16),t(3;21),t(1;3),t(2;11)
• Abnormality of >3 chromosomes have poor prognosis and increased risk of
progression to AML
76. Other Hematologic malignancies
• Burkitt lymphoma.
• Diffuse large B-cell lymphoma
• Follicular lymphoma
• Mantle cell lymphoma
• Marginal Zone lymphoma
79. Minimal residual disease
• Minimal residual disease (MRD) is the name given to small numbers <0.01 %
of leukaemic cells (cancer cells from the bone marrow) that remain in the person
during treatment, or after treatment when the patient is in remission (no
symptoms or signs of disease).
• It is the major cause of relapse in cancer and leukemia.
• very sensitive molecular biology tests are available, based
on DNA, RNA or proteins.
• These can measure minute levels of cancer cells in tissue samples, sometimes as
low as one cancer cell in a million normal cells.
80. Recent advances in Molecular Cytogenetics for
Hematological malignancies
• Gene Expression Profiling Technique of gene expression profiling (GEP)
enables
• study of thousands of genes expressed in a tumor simultaneously.
• In the context of hematologic malignancies, GEP has been used to classify
tumors into various genetic subtypes.
• This technique is based on DNA microarray.
• In the field of Hematology GEP has been best utilized for diffuse large B
cell lymphoma.
• .
81. Recent advances in Molecular Cytogenetics for
Hematological malignancies
• Now GEP is being used for stratification of cases of various hematologic
neoplasm like plasma cell disorders,
• chronic lymphoproliferative disorders and lymphoma, into high and low
risk groups.
• However, at present availability of GEP is restricted to few research
centers only limiting its wide use in clinical practice
82. PCR
• The applications of PCR in hematologic malignancies include
• Detection of fusion genes
• Detection of mutations
• The best example of fusion gene is BCR-ABL1 in CML. The fusion gene
produces mRNA transcript which can be quantified using real time RT-PCR thus
allowing determination of response to treatment .(Major molecular response—as
defined by >3 log reduction in bcr-abl transcript), monitoring of residual disease
and treatment failure (2-5 fold increase in BCR-ABL1 transcripts)..
83. Next Generation Sequencing (NGS)
• Sanger sequencing (now called first generation sequencing) could sequence only a single DNA fragment at a time by
capillary electrophoresis.
• In NGS millions of DNA fragments can be sequenced simultaneously. Thus, it is a high throughput parallel sequencing
technique and allows thousands of genomes to be studied in a short time.
• Through NGS one can study not only the genome but also the transcriptome (from RNA) and epigenome (DNA
methylation sites). The commonly used NGS methods include:
• Genomics—whole genome sequencing, exome sequencing, targeted sequencing
• Transcriptomics—mRNA sequencing
• Epigenomics—CHIP sequencing (chromatin immunoprecipitation) to study DNA–protein interactions.
• NGS is unraveling several novel mutations in genes involved in hematologic malignancies. The list of such mutated
genes like IDH1, IDH2, DNMT3A, and SF3B1 is continuously increasing .
84. Disease Genetic abnormality Current genetic
technology
Clinical utility
CML Philadelphia chromosome
only
Conventional
Cytogenetics
To diagnose CML
Bcr-abl gene
rearrangement
FISH To diagnose CML
AML Chromsomal aberrations Conventional karyotyping Prognostication of AML
patient
Selection of optimal
therapy
ALL Chromosomal aberrations
(Translocations)
Conventional
Karyotpye/FISH
For prognostication
CLL Chromsomal aberrations
( Deletions/translocations)
FISH Prognostication
MDS Various chromosomal
deletions and
translocations
FISH Diagnosis of MDS and
assessment of prognosis
Summary
85. References
• 1. Bain J B. Dacie and Lewis Practical Hematology 12th ed. China: Elsevier limited 2017.p.137-40.
• 2.Rodak B. Hematology clinical principles and applications 4th ed. China: Elsevier limited 2012
.p.455-58.
• 3.Mckenzie S. Clinical laboratory hematology 3rd ed. New jersey : Pearson Education 2015 .p.895-
897.
• 4.Michalova K.(2019).Classical and molecular cytogenetics in oncology,Europe: Clinical
Biochemistry Laboratory diagnostics. Available from : Charles university
[Accessed 22 Oct 2019].
• 5. Kawathalkar S. Essentials of Clinical Pathology 2nd ed. New Delhi: Jaypee Brothers Medical
publishers (p) Ltd;2018 .p.213-16.
86. References
• 6.Nayak R. Essentials in Hematology and clinical pathology 2nd ed. New
Delhi: Jaypee brothers medical publishers (p) Ltd 2017.p.158-70.
• 7. Prakash G, Kaur A, Malhotra P, Khadwal A, Sharma P, Suri V, Varma
N, Varma S. Current Role of Genetics in Hematologic Malignancies.
Indian J Hematol Blood Transfus 2016;32(1):18-31.