Cancer is a multistage process transforming normal cells into malignancy
Aneuploidy is a change in chromosome number
Translocations are when chromosomes join or swap ends
Karyotyping is the viewing of chromosomes and is carried out by
o Cells put on slide and centrifuged at 1000rpm
o Cells fixed with alcohol and stained with Giemsa
o Count cells under microscope
Cancers evade immune responses by
o Release of cancer antigens
o Cancer antigen presentation
o Priming and activation
o Trafficking of T cells to tumours
o Infiltration of T cells
o Recognition of cancer cells by T cells
o Killing of cancer cells
Cancer is a heterogenous disease as only a handful of common mutations of different genes
have similar effects
B Cell Lymphoid Neoplasms
Acute lymphoblastic leukaemia
Chronic lymphocytic leukaemia
Small lymphocytic lymphoma
Follicular lymphoma
Diffuse large B cell lymphoma
Marginal zone lymphoma
Burkitt’s lymphoma
Multiple myeloma
, Germinal Centres
During proliferation, B cell receptor locus is mutated at in increased rate
Newly mutated B cells migrate to the light zone where they compete for antigen presented
on T cell
Non-competitive B cells die
Positively selected B cells differentiate into memory B cells and plasma cells
Follicular Lymphoma
Lymphoma derived from germinal centre B cells
Its an indolent disease which is mostly incurable
o However it may transform into an aggressive disease
80% have a translocation between IgH locus and BCL2 on chromosome 18 and 14
Follicular lymphoma is diagnosed by biopsy
Symptoms
o Swollen lymph nodes
o Pain in chest
o Bone pain
o Skin lumps
o Coughing
o Fatigue
o Fever
The IHC shows centroblasts and centrocytes dividing poorly along with overexpression of
BCL2
o It also shows an infiltrate on lymphocytes predominantly CD20+ B cells with co-
expression of CD10, BCL6 and BCL2
Can be classified by WHO/REAL
o grade 1 - <5 centroblasts per high power field (hpf)
o grade 2 - 6-15 centroblasts per hpf
o grade 3 >15 centroblasts per hpf
grade 3A - centrocytes still present
grade 3B - follicles consists mostly of centroblasts
Can be classified by Ann Arbor staging
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