Diseases Of Wbc


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Diseases Of Wbc

  1. 1. Diseases of WBC & Lymph Nodes<br />Pathology-B Lab Ravi A Patel<br />
  2. 2. M++<br />Hodgkin’s Disease-Spleen<br />TB- Lymph node<br />Non-Hodgkin’s disease<br />Papillary carcinoma <br />metastatic to lymph node<br />Multiple Myeloma<br />
  3. 3. What is it ? <br /> – NHL represents a monoclonal proliferation of lymphoid cells and be of B-cell origin(70 %) or T-cell origin(30 %).<br />-- The incidence of this tumour increases with age.<br />-- Clinical treatment depends on the grading(reflection of proliferation rate)- Higher the grade, higher the proliferation rate.<br />Organ involved- Lymph node<br />Extra nodal involvement is common– Bone marrow(more common 60% in low grade than high grade disease), gut, thyroid, lung, skin, testis, Brain and rarely bone.<br />Extra nodal involvement is more common in T-cell disease<br />
  4. 4. Clinical manifestation:-<br />-- Lymph node enlargement which may be associated with systemic upset – weight loss, sweats, fever and itching.<br />-- Compression syndromes may occur– GUT obstruction, ascites, superior vena caval obstruction and spinal cord compression. <br />-- Hepatosplenomegaly may be present.<br />Diagnosis:- <br />Routine bone marrow aspiration with trephine(surgical instrument used to make hole in bone)<br />Immunophenotyping of surface antigen to distinguish T & B cell tumours.<br />Immunoglobulin determination<br />Measurement of uric acid level(some very aggressive high grade NHLs are associated with very high urate levels, which can precipitate Renal failure when treatment is started)<br />HIV testing(Appropriate only if risk factors are present)<br />
  5. 5. Management:- <br />Asymptomatic patients may not require therapy. Indication of treatment include marked systemic symptoms, lymphadenopathy(causing discomfort), bone marrow failure or compression syndromes.<br />Low grade NHL – following are the options<br />Radiotherapy- used for localized stage 1 disease which is rare.<br />Chemotherapy(chlorambucil- most patient respond to this) – Main stay therapy<br />Monoclonal antibody therapy- Rituximab showed improvement in 60% of the patients.<br />Marrow Transplantion<br />High Grade NHL- patients with high grade NHL need treatment at initial presentation<br />Chemotherapy(90 % of the patients need this) mainstay combination intravenous therapy(Cyclophosphamide, doxorubicin, vincristine& prednisolone)<br />Radiotherapy<br />Monoclonal Antibody therapy-Rituximab(increases the survival rate in combination with the Chemotherapy.<br />Marrow Transplantation<br />
  6. 6. HPO<br />Majority of the<br />Tumour cells<br />Have the <br />Appearance of<br />Small<br />Round <br />Lymphocytes.<br />But they are irregular<br />And have cleaved <br />Nuclear outlines<br />
  7. 7. Prolymphocyte<br />(large cell)<br />With a centrally <br />Placed nucleolus<br />HPO<br />
  8. 8. LPO<br />Diffuse<br />Nodal <br />Architecture<br />
  9. 9. It is malignancy of B-cell origin. <br />Histologic hallmark:- Reed sternberg cells(large malignant cells of B-cell origin)<br />
  10. 10. Clinical Manifestation<br />Painless rubbery lymphadenopathy, usually in the neck or supraclavicular fossae, may fluctuate in size..<br />Young patients with Nodular sclerosing may have large Mediastinal mass which are surprisingly asymptomatic but may cause dry cough and some breathlessness.<br />Hepatosplenomegaly may be present.<br />Spread is contiguous from one node to other.<br />Rare extra nodal involvement.<br />
  11. 11. Diagnostic investigation:-<br />Full blood count may be completely normal.Anormochromic,normocytic anaemia may be present together with lymphopenia which is a bad prognosis factor.<br />ESR may be raised<br />Renal function tests are required to ensure function is normal prior to treatment.<br />Liver function test may be abnormal.<br />Chest X-ray may show mediastinal mass<br />CT scan of chest and abdoment to permit staging.<br />Lymph node biopsy.<br /><ul><li>Management</li></ul>Treatment options include Radiotherapy, chemotherapy or a combination of both.<br />
  12. 12. WHO pathological classification & incidence of Hogkin lymphoma<br />
  13. 13. HPO<br />Apart <br />From the<br />RS cells<br />Other cellular <br />Infiltrates like <br />Lymphocyte are<br />present<br />
  14. 14. HPO<br />
  15. 15. HPO<br />
  16. 16. LPO<br />
  17. 17. Clinical difference<br />
  18. 18. 20x<br />100x<br />H<br />O<br />D<br />G<br />K<br />I<br />N<br />S<br />N<br />O<br />N<br />H<br />O<br />D<br />G<br />K<br />I<br />N<br />S<br />40x<br />40x<br />
  19. 19. What is it ?<br />It is a malignant proliferation of plasma cells.<br />Normal plasma cells are derived from B-cells and produce immunoglobulins which contain heavy and light chains.<br />Normal immunoglobulins are polyclonal which means that a variety of heavy chains are produced and each may kappa or lamba type.<br />In Myeloma plasma cells produce immunoglobulin of a single heavy and light chain(monoclonal protein called Paraprotein)<br />In some cases only light chain is produced and this appears in the urine as Bencejonesprotenuria.<br />
  20. 20. Pathology:- <br />Majority of the malignant plasma cells are present in the bone marrow(although some are also present in circulation)<br />The malignant plasma cells produce cytokines which stimulate osteoclasts and result in net bone absorption. The resulting lytic lesions cause bone pain, fractures and hypercalcemia.<br />
  21. 21. Clinical Manifestation <br />Bone pain/Fractures due to lytic lesions<br />Spinal cord compression<br />Bony collapse<br />Extradural mass<br />Paraproteinemia<br />Immune paresis<br />Bencejonesprotenuria<br />Renal failure<br />Paraprotein deposition<br />Hypercalcemia<br />Infection<br />Amyloid<br />Amyloid<br />Hyperviscosity- Retinal bleeds,Bruising,heartfailure,cerebral ischemia.<br />
  22. 22.
  23. 23. Diagnostic investigation<br />Diagnosis of Myeloma requires one of the following criteria<br />Increased malignant plasma cells in the bone marrow<br />Serum and/or urinary paraprotein<br />Skeletal lesions.<br />
  24. 24.
  25. 25. Management<br />If patients are asymptomatic treatment may not be required. If symptomatic then measures below should be considered.<br />Immediate support<br />High fluid intake to treat renal impairment and hypercalcemia<br />Analgesia for Bone pain<br />Allopurinol to prevent urate nephropathy<br />Chemotherapy<br />Radiotherapy<br />Marrow transplantation<br />
  26. 26. HPO<br />
  27. 27. HPO<br />
  28. 28. HPO<br />
  29. 29. HPO<br />
  30. 30. LPO<br />
  31. 31. HPO<br />
  32. 32. HPO<br />
  33. 33. Papillary carcinoma is the most common of the malignant thyroid tumours and accounts for 90% of the irradiation induced thyroid cancer.<br />It may be multifocal and spread to regional lymph nodes.<br />Origin of Tumour:- Follicular cells of Thyroid gland<br />
  34. 34. Papillary Carcinoma metastatic to lymph node<br />From Thyroid gland Lyphoid follicle with germinal center<br />It metastasize evenly<br />
  35. 35. Manifestation<br />Cervical lymphadenopathy<br />With/without thyroid enlargement<br />Diagnosis-<br />Palpable lymph nodes<br />Lymph node biopsy<br />Isotope scanning may be required.<br />Management- usually by total thyroidectomy<br />
  36. 36. HPO<br />Characterically<br />Orphan annie<br />Nuclei..<br />
  37. 37. Orphan Annie- Nuclei<br />HPO<br />
  38. 38. HPO<br />Psamomma Body<br />
  39. 39. HPO<br />
  40. 40. HPO<br />
  41. 41. HPO<br />
  42. 42. Lymphadenitis is the most frequent form of extra pulmonary tuberculosis usually occuring in the cervical region(“ Scrofula”)<br />HIV patients always demostrate multifocal disease, systemic symptoms and either pulmonary or other organ involvement due to active tuberculosis.<br />It may take upto 3 year time from initial infection for TB of Lymph nodes, GIT, bones and joints.<br />
  43. 43. Clinical Manifestation<br />Mostly Scrofula(Lymphadenitis of cervical lymph nodes) followed by axillary and inguinal.<br />Nodes are usually painless<br />General observation<br />Weight loss, night sweats and fever.<br />Diagnosis<br />Tuberculin test is strongly positive in these patients.<br />Tissue biopsy <br />Management- <br />4 drug therapy<br />Isoniazid, Rifampin, Ethambutol, Pyrizinamide<br />
  44. 44. LPO<br />Granuloma<br />
  45. 45. LPO<br />Granuloma<br />
  46. 46. HPO<br />
  47. 47. HPO<br />
  48. 48. HPO<br />
  49. 49. HPO<br />
  50. 50. Reference<br />Davidson’s Principles and Practice of Medicine<br />Robbins- Basic Pathology<br />
  51. 51. Thanking to the entire Universe<br />Beautiful<br /> Aurora<br />