FACULTY OF MEDICINE AND HEALTH SCIENCES

MBBS PROGRAM
2017 - 2018

Systemic Pathology

PRACTICAL GUIDE BOOK

Prepared by:

Dr. Shwe Sin

Part 1: Leukaemias

Learning Objectives

At the end of the class, students should be able to:

1. Identify Acute Leukaemias (AML,ALL)

2. Identify Chronic Leukaemias (CML,CLL)

Part 2: Lymphomas

Learning Objectives

At the end of the class, students should be able to:

1. Identify Hodgkin lymphoma

2. Identify Non-Hodgkin lymphoma

Part 3: Multiple Myeloma

Learning Objectives

At the end of the class, students should be able to:

1. Identify Multiple Myeloma

I. Acute Myeloid Leukaemia (AML)
AML: M4

Photomicrograph: Peripheral Blood Film

Neutrophil

Myeloblasts

Magnification: High power

 Myeloblast

Magnification: High power

A 45-year-old male complained of pallor and frequent episodes of fever of 3 weeks

duration. Physical examination showed that he looked pale and had petechial spots all over
the chest.

Q. Describe the findings of peripheral blood film shown in Photomicrograph.

Bone marrow aspirates show blast cells with typical features (large cell with large
nucleus and thin cytoplasm with granules and 2-3 prominent nucleoli). RBC
population is reduced and platelets are not seen.

Q. List laboratory tests to confirm the diagnosis.

Bone marrow aspiration and trephine biopsy

Immunocytochemistry/ Immunohistochemistry
Fluorescence In Situ Hybridization
Karyotype analysis
DNA Microarray
Flow Cytometry
PCR

Q. State the underlying pathophysiology of frequent episodes of fever.

Due to infection and neutropenia because of suppression of white cell series in

bone marrow.
II. Acute lymphoblastic leukaemia (ALL)
Photograph: A 4-year-old boy

Photomicrograph: Peripheral blood film

 Lymphoblasts

Magnification: High power

A 4-year-old boy complained of frequent episodes of fever and swelling around the neck
of 3 weeks duration. Physical examination showed that he looked pale and cervical lymph
nodes enlargement. Complete blood count (CBC) and peripheral blood film examination
was requested by his pediatrician.

Q. Describe the findings of peripheral blood film shown in Photomicrograph.

Peripheral blood film shows blast cells with typical features (large cell with large
nucleus and thin rim of cytoplasm).

Q. State the etiologic factors of leukaemias.

Inherited factors
Genetic mutations
Environmental influences e.g chemical exposure or radiation
III. Chronic lymphocytic leukaemia (CLL)
CLL: Bilateral Axillary Lymphadenopathy

CLL: Cervical Lymphadenopathy

Q. Describe the gross findings shown in the photograph.

There is bilateral swelling at axillary area/ Cervical area.

Q. Describe the expected findings in peripheral blood film examination.

There is leukocytosis with lymphocytosis (70-99 %) with smudge or smear cells

also present. RBC population reduced with anaemia. Platelet count is also reduced.
IV. Chronic Myeloid Leukaemia (CML)
Photomicrograph: Peripheral blood film

Magnification: High power

Q. Describe the findings seen in peripheral blood film examination.

WBC- Markedly increased WBC count, all series of granulopoiesis can be seen
with basophilia.
RBC- anaemia
Platelet count is usually increased

Q. State the neutrophil alkaline phosphatase activity (NAPA).

Reduced

Q. State the common chromosomal abnormality seen in CML.

Philadelphia (Ph) Chromosome Reciprocal translocation between parts of

long arm of chromosome 22 & 9 [t (9;22)]
V. Lymphoma

FNAC Lymph node

Non-Hodgkin Lymphoma
 Burkitt Lymphoma

Histology Lymphnode
Q. State two types of lymphoma.

Hodgkin lymphoma
Non-Hodgkin lymphoma

Q. Name the characteristic tumour giant cell seen in Hodgkin lymphoma.

Reed-Sternberg tumour giant cell

Q. State the staging system that commonly used in lymphoma.

Ann-Arbor staging
 VI. Multiple Myeloma
Bone Marrow Examination findings

Typical Plasma Atypical Plasma

Cell Cell

Magnification: High power

Peripheral Blood Film Examination (RBC rouleaux formation)

Q. List the complication of multiple myeloma.

Bone pain and pathological fracture (most common)

Anaemia
Renal failure with hypercalcaemia
Abnormal bleeding
Recurrent bleeding
Amyloidosis
Hyperviscosity syndrome