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

Chronic leukemia is a primary tumor disease of the hematopoiesis system, the substrate of which is mature and maturing cells of the myeloid or lymphoid series.

General morphological characteristics:

1. Cytological differentiation of tumor cells

2. Longer stage course:

a) monoclonal, benign stage – the presence of one clone of tumor cells, lasts for years, benign, chronic

b) polyclonal, malignant, stage of blast crisis – the appearance of secondary clones, rapid malignant course, the appearance of multiple blasts

Highlight:

Myelocytic origin: 1) chronic myeloid (passes through two stages: monoclonal benign and polyclonal malignant. The cells of the spinal cord contain the so-called Ph chromosome (Philadelphia), in the second stage blast forms appear. Observed: pyoid red brain, leukemic stasis and thrombi, autoinfection)

2) chronic erythromyelosis (tumor of red and white sprouts of hematopoietic tissue, erythrocaryocytes, myelocytes, promyelocytes and blasts are found)

3) erythremia (usually in the elderly, characterized by an increase in the mass of red blood cells in the bloodstream, an increase in the number of platelets, granulocytes, arterial hypertension, a tendency to thrombosis, splenomegaly, all organs are sharply full-blooded)

4) true polycythemia (Vacquez-Osler syndrome) (erythremia fever)

Lymphocytic origin: 1) chronic lymphocytic leukemia (develops from B-lymphocytes, has a benign course, the content of leukocytes in the blood is sharply increased, especially the fraction of lymphocytes, autoimmune reactions, blast crisis, infectious complications, hemolytic conditions occur)

2) lymphomatosis of the skin (Cesari's disease) (characterized by infiltration of tumor T-lymphocytes primarily of the skin, the content of leukocytes in the blood increases, Cesari cells appear, peripheral lymph nodes and spleen increase)

3) paraproteinemic leukemias (originate from cells of the B-lymphocytic system, capable of producing paraproteins):

a) myeloma disease (the proliferation of myeloma cells in and outside the CM, leads to bone destruction, there are plasmocytic, plasmoblastic, polymorphocellular and small cell myelomas. Bence-Jones protein is found in urine)

b) primary macroglobulinemia (Waldenstrom's disease) (tumor cells produce pathological macroglobulin IgM)

c) heavy chain disease (Franklin's disease) (tumor cells produce a paraprotein corresponding to the Fc fragment of the IgG heavy chain)

Monocytic inflammation: 1) chronic monocytic leukemia (usually in elderly people, it proceeds for a long time and is benign, ends with a blast crisis and the appearance of blast cells in the blood and internal organs)

2) histiocytosis (histiocytosis X) (borderline lymphoproliferative diseases of hematopoietic tissue)

Complications and causes of death:

1. infectious complications

2. organ dysfunction

3. compression of vital organs by enlarged lymph nodes

5. Complications of steroid and cytostatic therapy