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Nenádorové procesy krvetvorby

Nenádorové procesy krvetvorby. Trepanobiopsie kostní dřeně, diagnostický přínos. vrozené metabolické a jiné vady kostní dřeně a kostí, cytopenie anemie leukemie nádorové metastázy Hodgkinova choroba, nehodgkinské lymfomy. NORMÁLNÍ DŘEŇ. Normal bone marrow – cellularity.

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Nenádorové procesy krvetvorby

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  1. Nenádorové procesy krvetvorby

  2. Trepanobiopsie kostní dřeně, diagnostický přínos • vrozené metabolické a jiné vady kostní dřeně a kostí, cytopenie • anemie • leukemie • nádorové metastázy • Hodgkinova choroba, nehodgkinské lymfomy

  3. NORMÁLNÍ DŘEŇ

  4. Normal bone marrow – cellularity AGE SITE CELLURARITY (haemopoietic cells/fat) Neonate All bones, liver, spleen 100/0 Child Most bones 70/30 Adult Axial skeleton 50/50 Old age Axial skeleton 30/70

  5. Normal bone marrow CELLULARITY CHANGES WITH AGE

  6. Normal bone marrow CELL TYPES – BONE OSTEOBLASTS OSTEOCLASTS

  7. Plazmocyty

  8. Normal bone marrow CELL TYPES NORMOBLAST ERYTHROBLAST EOSINOPHIL PLASMA CELL MYELOCYTE NEUTROPHIL MEGAKARYOCYTE

  9. Granulocytic cell differentiation IMMATURE PRECURSOR MYELOBLAST PROMYELOCYTE MYELOCYTES No granules No granules Slightly larger cell Coarser chromatin Primary granules Nucleoli not seen Secondary granules NEUTROPHIL BAND FORM METAMYELOCYTE Lobes separated by Nucleus lobated Indented nucleus narrow structures

  10. Erythroid differentiation EARLY NORMOBLAST NORMOBLAST ERYTHROCYTE PRONORMOBLAST Increasing haemaglobin Dense dark nucleus Anucleate Increasing nuclear chromatin Megakaryocytic differentiation SENESCENT MEGAKARYOCYTE MEGAKARYOBLAST PROMEGAKARYOCYTE MEGAKARYOCYTE 20mm 80mm Mature lobated Often hyperchromatic Oval or reniform Lobes appearing form Bare nucleus nucleus Emperipolesis End stage megakaryocyte

  11. ANÉMIE

  12. APLASTICKÁ ANÉMIE

  13. Aplastic anaemia The relative increase in plasma cells is polyclonal

  14. Anaemias – 1 AUTO IMMUNE HAEMOLYTIC IRON DEFICIENCY CHRONIC DISEASE

  15. Anaemias – 2 Can simulate acute leukaemia but blasts are erythroid MEGALOBLASTIC ANAEMIA

  16. MYELODYSPLASTICKÝ SYNDROM

  17. Klasifikace myeloidních neoplazií -upraveno dle WHO Myelodysplastické syndromy (MDS) • Refrakterní anemie (RA) a) s prstenčitými sideroblasty (RARS) b) bez prstenčitých sideroblastů • Refrakterní cytopenie (myelodysplastický syndrom) s dysplazií jedné nebo více řad („multilineage dysplasia”, RCMD) • Refrakterní anemie (myelodysplastický syndrom) a exscesem blastů (RAEB) • 5q-syndrom • Myelodysplastický syndrom, neklasifikovatelný

  18. MDS – 1 WITH MICROMEGAKARYOCYTES AND MEGAKARYOBLASTS

  19. MDS – 2 DYSERYTHROPOIESIS IRREGULAR ERYTHROID COLONIES HUGHLIGHTED BY IMMUNOSTAIN FOR GLYCOPHORIN C ABNORMAL SHAPES & SIZES OF NORMOBLASTS PLEOMORPHIC ERYTHROBLAST

  20. MYELOPROLIFERATIVNÍ CHOROBY

  21. Klasifikace myeloidních neoplazií dle WHO Myeloproliferativní choroby („MPCh”) • Chronická myeloidní leukemie filadelfský chromozom (Ph1)[(9;22)(q34;q11),BCR/ABL] pozitivní • Chronická neutrofilní leukemie • Primární myelofibróza • Pravá polycytémie (polycythaemia vera) • Esenciální trombocytémie • Chronická eozinofilní leukemie, NOS • Mastocytóza • Myeloproliferativní choroba, neklasifikovatelná

  22. CML ATYPICAL MEGAKARYOCYTES

  23. Myeloproliferative disease 9 22 Chronic myeloid leukaemia bcr c-abl bcr/abl fusion gene Philadelphia chromosome THE PHILADELPHIA CHROMOSOME

  24. PRV – 1

  25. PRV – 2 ABNORMAL MEGAKARYOCYTIC PROLIFERATION H&E GIEMSA CD31

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