Quality in Life: The quality of a persons life is directly related to their commitment to excellence

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Quality in LifeThe quality of a persons
life is directly related to their commitment to
excellence regardless of their chosen field of
endeavor
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HEMATO-ONCOLOGY
Neoplasia of Hemopoietic system

• Dr. VM Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Normal Blood Film
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Haematological Neoplasia

• Leukemias - Acute Chronic
• Lymphomas - Hodgkins Non-Hodgkins (T cell, B
  cell, histiocytic others)
• Myeloproliferative syndromes (MPS)
• Myelodysplastic syndromes (MDS)

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Leukemia Classification

• Acute Leukemias
• Myeloid - M0, M1, M2, M3, M4, M5, M6, M7
• Lymphoid - L1, L2, L3.
• Chronic Leukemias
• Myeloid - CML
• Lymphoid- CLL, PLL, HCL,

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Leukemia - Clinical Features

• Anemia (low RBC)
• Fever - Infections (low WBC)
• Bleeding tendency (low PLT)
• Tender bones, lymphadenopathy, organomegaly Gum
  hypertrophy etc. (organ infiltration)

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AML-M5 - Gum Hypertrophy
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AML- Marked Purpura
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ALLCervical Lymphadenopathy
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Mediastinal Lymphnodes-ALL
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ALL-Acute Lymphocytic Leuk.

• Common in Children.
• FAB classification L1, L2 L3
• B cell, Tcell histiocytic types.
• CD10 ve, Pre B cell type common.
• Lymphadenopathy, bleeding tendency
• Moderate Hepatosplenomegaly

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ALL-L1
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ALL-L2
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ALL-L3
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AML-Acute Myeloid Leuk.

• Malignancy of myeloid progenitor cells.
• Adults common
• Hepatosplenomegaly moderate
• No significant lymphadenopathy
• Bleeding tendency
• Gum bleeding common in M5/M4
• FAB classification - M0 to M7.

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AML-Acute Myeloid Leuk.

• M0 - AML No maturation (
• M1 - AML Min.Maturation(3 Peroxidase ve)
• M2 - AML With full maturation
• M3 - A.Promyelocytic leukemia
• M4 - A.Myelomonocytic leukemia
• M5 - A.Monocytic L(a-Monocytic, b-M.blastic)
• M6 - A. Erythroleukemia
• M7 - A. Megakaryocytic leukemia.

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AML-M0 - Undifferentiated
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AML-M1 - without maturation
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AML-M2 - with maturation
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AML-M3 - Auer Rods
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AML-M3 - Auer Rods
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AML-M3 - Promyelocytic
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AML-M4 - Myelomonocytic
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AML-M5b - Monoblastic Leuk
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AML-M6 Erythroleukemia
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AML-M7 Megakaryocytic
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Chronic Myeloid Leukemia

• Middle age 40-60y
• Philadelphia chromosome, t(922)
• Leucocytosis (50x109/L), abnormal cells
• Marked splenomegaly
• Anemia, Bleeding
• Hypermetabolism,
• Hyperuricemia- gout, renal impairment.

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Chronic Myeloid Leukemia
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Chronic Myeloid Leukemia
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Chronic Lymphocytic Leukemia

• Elderly age
• Marked lymphoid proliferation
• Non functional, excess life span.
• Spleen, lymph node liver enlargement
• Common B cell (CD5 ve)
• Immunodeficiency, infections.
• Anemia, thrombocytopenia at later stages.
• Rare types are HCL,PLL, T-CLL

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CLL
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CLL Blood Film
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Hodgkins Lymphoma

• Lymphadenopathy, painless, firm
• Pel-Ebstein fever, Eosinophilia,
• Reed-Sternberg cells - B lymphocytes
• Histological Types
• Lymphocyte predominant.
• Nodular Sclerosis.
• Mixed cellularity.
• Lymphocyte depleted.

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Hodgkins lymphoma
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Hodgkins lymphoma cells
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Non-Hodgkins Lymphoma

• According to cell type
• T cell NHL
• B cell NHL
• Miscellaneous NHL
• According to Clinical grade
• Low grade NHL
• High grade NHL
• Intermediate grade NHL
• Ex Lennerts lymphoma is a low grade Tcell NHL.
• Burkitts lymphoma is a high grade B cell
  NHL

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Diffuse - - Follicular
NHL- Histologic types
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Small Intermed. Large
NHL- Histologic types
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Myeloma Bone Marrow
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Burkitts Lymphoma L.N.
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Myelodysplastic Syndromes

• Excess proliferation with dysplasia
• Ineffective Myelopoiesis - Marrow hyperplasia
  with pancytopenia.
• FAB classification
• RA Refractory Anemia (Blasts
• RARS RA with Ring Sideroblasts (
• RAEB RA with excess blasts (
• RAEB in T RAEB in transformation (5)

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MDS - Pseudo Pelger-Huët
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MDS - Dysplastic Erythroblasts
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MDS - Excess Marrow Iron (Perls stain)
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MDS RARS - Ring Sideroblast
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Myeloproliferative Syndromes

• Excess proliferation of marrow cell lines.
• Primary Secondary
• Primary MPS
• Polycythemia rubra vera (PV)
• Chronic Myeloid Leukemia (CML)
• Essential Thrombocythemia (ET)
• Myelofibrosis (MF)

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MPS - P. Rubra Vera (PV)
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MPS E.T. Bleeding
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BM PS
MPS E.T. Thrombocytosis
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MPS M.F. Organomegaly
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MPS M.F. - Gout
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MPS MF - Marrow fibrosis
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MPS MF - Reticulin stain
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MPS MF - Radio Iron Study
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MPS Classification
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CML - Blood Film
Basophils
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Thank You...