122. Clinical and anatomical classification of leukemias. Pathological differences between acute and chronic leukemias.

Leukemia (leukemia) is a highly malignant systemic tumor of the hematopoietic system, in which there is an uncontrolled proliferation of atypical, immature hematopoietic cells (leukemic cells) in CM and other lymphoreticular tissue (LV, spleen, etc.).

Classification of leukemias.

1. The degree of differentiation of tumor cells and the nature of the course:

a) acute - the substrate of the tumor is made up of young, very immature cells, it proceeds acutely.

b) the chronic substrate of the tumor is morphologically mature or close to normal cells in maturity, the number of blasts is increased

2. The number of leukocytes in the peripheral blood:

a) leukemic (more than 50-80*109/l leukocytes, including blasts)

b) subleukemic (50-80*109/l leukocytes, including blasts)

c) leukopenic (the content of leukocytes in peripheral blood is below normal, but there are blasts)

d) aleukemic – tumor cells in the peripheral blood may be absent

3. The origin (histo-, cytogenesis) of tumor cells.

Acute leukemia is characterized by:

proliferation of undifferentiated or poorly differentiated blast cells

malignancy of the course,

in the peripheral blood and in the myelogram – leukemic failure (a sharp increase in the number of blasts and single mature elements in the absence of transitional maturing forms),

the diagnosis of acute leukemia is based on the detection of blast cells in CM,

It is characterized by the replacement of CM with young blast elements and their infiltration of the spleen, liver, lymph nodes, kidneys, brain, etc. organs.

For chronic:

proliferation of differentiated leukemic cells,

the relative goodness of the course.

123. Pathological anatomy of acute leukemia: definition, classification, changes in the hematopoietic organs. Outcomes, complications, clinical significance.

1) Acute leukemia OL is an acute leukemia, the substrate of which consists of young, very immature cells.

2) Classification of OL:

undifferentiated

myeloblastic

lymphoblastic

monoblastic

erythroblastic

megakarioblastic

3) General morphological characteristics of OL:

leukemic infiltration of the bone marrow in the form of focal and diffuse infiltrates from cells with light nuclei containing several nucleoli

diffuse or focal leukemic infiltrates in the spleen, liver, L.U. with an increase in these organs

leukemic infiltration of mucous membranes and the development of purulent-necrotic processes of the oral cavity, tonsils, sometimes the development of sepsis

blasts make up 10-20% of bone marrow cells

displacement of normal hematopoiesis cells in the bone marrow, thinning and resorption of reticular fibers, often myelofibrosis

hemorrhagic syndrome up to cerebral hemorrhages and gastrointestinal bleeding

in peripheral blood and bone marrow – the phenomenon of leukemic failure of hiatus leucemicus – the presence of only blast and differentiated forms and the absence of intermediate

4) Pathomorphology of acute myeloblastic leukemia.

1. In 85% of cases it occurs in adults

2. Pyoid bone marrow

3. Leukemic infiltrates mainly in the bone marrow, liver, and spleen

4. Severe hemorrhagic syndrome

5. Pronounced purulent-necrotic processes

6. Remissions are short-lived, not frequent. It is easier for children.

5) Complications and causes of death in acute myeloblastic leukemia:

1. Hemorrhage in vital organs

2. Complications associated with necrotic ulcerative processes

3. Joining the infection

4. Suppression of the KM function

5. Complications of therapy