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Leukemias Leukemia - Tumor Disease of the Blood System Is Characterized by Three Main Features: 1

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Leukemias Leukemia - Tumor Disease of the Blood System Is Characterized by Three Main Features: 1 Leukemias Leukemia - tumor disease of the blood system is characterized by three main features: 1. Hyperplasia - proliferation of tumor, or a germ hematopoiesis in places where it should be in a normal state (in the bone marrow); 2. Anaplasia - is when the processes of proliferation (cell proliferation) prevails over the differentiation process; 3. Metaplasia - tumor proliferation, of any germ hematopoiesis in places where it should not be (inside the body, the brain, etc.), with an expanding germ hematopoiesis displaces local tissue elements, replacing them with a. Currently, this process is called metastasis. Unlike leucocytosis, leukemoid reactions and other reactive hematopoietic tissue growths at the base of leukemia is uncontrolled (unlimited) cell proliferation in violation of their ability to differentiation and maturation. Loss of ability to mature leukemia cells can take place much more than normal blood cells, the number of cycles of division, and that creates a huge cell production that characterizes leukemia. The etiology of leukemia to date is not certain. On the tumor nature of leukemia indicated by the presence of the general laws that unite leukemias and tumors: a violation of the cell's ability to differentiate; morphological and metabolic anaplasia cells; common etiological factors contributing to the development of leukemia and tumors, and others. The possible etiologic factors causing the development of leukemia, include ionizing radiation, a number of chemicals, viruses. Some importance in the development of leukemia is attached to genetic factors, hereditary and acquired immune deficiency action blastomogenic metabolite of tryptophan and tyrosine. Theories of the origin of leukemia. Radiation theory. The role of ionizing radiation in causing leukemia was proved experimentally. As single (at a dose of 2 Gy or higher) and chronic (2-3 months) irradiating X-rays in low doses can induce leukemia in laboratory animals (rats, mice). It traces the increased incidence of acute and chronic myeloid leukemia among residents of Hiroshima and Nagasaki have Radiologists. The data on the increase in the frequency of leukemia in patients treated with high doses of X-rays, yttrium, radium for malignant neoplasms and ankylosing spondylitis, as well as in children who received irradiation of the thymus at an early age, and others. Described a higher incidence of acute leukemia among patients eritremii after treatment of radioactive phosphorus. Chemical theory. Experimentally proved possible to induce leukemia in animals by administration of carcinogens (dimetilbenzantratsen, methylcholanthrene et al.). Also in experiment demonstrated the possibility of stimulation leukogenesis metabolites of tryptophan and tyrosine (ML Rauschenbach). However, the role of these substances has not been proven in human leukogenesis. At the same time, the accumulated data indicating an increased risk of leukemia disease (usually sharp) in people with long-term occupational exposure to benzene and volatile organic solvents (drivers, workers of the leather and footwear industry, etc.). In recent years there has been a marked increase in cases of acute leukemia in patients with malignant tumors treated with cytotoxic drugs such as tsiklosfosfan, hlorbutin, methotrexate, mielosan, adriamycin and others. The drugs capable of inducing leukemia are also phenylbutazone, chloramphenicol, and others. Virus theory connects the occurrence of leukemia with the activation (under the influence of radiation and chemical factors) leukogenetic latent viruses. There is no doubt proved a viral origin of leukemia in many species of animals - birds, mice, rats, hamsters, cats, cattle. To date, isolated and thoroughly characterized by several types of viruses that cause different types of leukemia in animals. Typically, this RNA viruses and DNA viruses, which belong to the herpes virus. The role of viruses in the origin of leukemia in humans remains largely controversial. Against viral etiology of human leukemia says, first of all, the fact of the impossibility of direct inoculation of leukemia Accidental transfusion of persons suffering from leukemia, and the lack of convincing evidence of leukemia contagious. Do not also described cases of transmission of leukemia from the sick mother to the fetus and the newborn during breast-feeding. Genetic theory has sufficiently convincing arguments, indicating the possibility of a genetic predisposition to leukemia. There are cases of family leukemia, proved the role of ethnic features in the development of lymphocytic leukemia. By the occurrence of leukemia predispose disease characterized by spontaneous chromosome breaks and nondisjunction somatic or sex chromosomes (Down syndrome, Fanconi anemia, Klinefelter syndrome, Turner et al.). Mice were obtained, in which the frequency of spontaneous leukemia is close to 100%. The pathogenesis of leukemia. According mutationally-clonal theory of the origin of leukemia leukemic factor (ionizing radiation, chemical, virus, etc.) Causes a mutation (DNA damage, violation of the genetic code), one of the hematopoietic progenitor cells II-III classes. As a result, the information is broken division and cell differentiation, observed their way out from under the control of the regulatory systems of the body. This leads to uncontrolled proliferation of certain cell varieties. Thus, the components of the substrate leukemia tumor cells are monoclonal offspring originally mutated cells and retain all the typical signs of it. In step monoclonic tumor cells sensitive to chemotherapy. In favor of the clonal nature of leukemia are the following facts: the possibility of transplantation of leukemia in mice by administering a leukemia cells; Production of homogeneous immunoglobulin multiple myeloma and Waldenstrom's macroglobulinemia; the same type of leukemia cells (bearing surface immunoglobulins of a class and subclass) in chronic lymphocytic leukemia; the presence of specific chromosomal changes in cancer cells (for example, ring chromosomes as the radiation damage marker) in acute leukemia that occurred in patients with erythema treated with radioactive phosphorus, and others. Convincing evidence of clonal origin of leukemia is to detect the vast majority of patients with chronic myeloid leukemia (80-90% of cases), abnormal (with a shortened long arms) a so-called Philadelphia (Ph1) chromosome in all myeloid cells, including granulocyte, erythroid and megakaryocytic sprouts, possibly except T lymphocytes. This fact is undeniable proof of the origin of chronic myeloid leukemia from one abnormal clone, which is the ancestor of pluripotent stem cell progenitor myelopoiesis (CFU-GEMM). In the development of leukemia (tumor progression) qualitative changes constituting the substrate of the tumor cell due to the instability of their genetic apparatus. Activities of the latter, in turn, is subject to change under the influence violates the structure of chromosomes (changes in the structure, the appearance of aneuploid) and epigenetic, that is not associated with changes in gene structure, violations - the transition of the previously inactive in the cell genes in an active state (a phenomenon derepression genes). These changes of tumor cells leads to the appearance of new clones. As a result, developing polyclonal tumor becomes malignant. Individual clones of tumor cells out from under the control of regulatory systems of the body become resistant to the ongoing cytostatic therapy, metastasize to organs and tissues in normal hematopoiesis is not involved, forming foci of extramedullary hematopoiesis. Classification of leukemia, particularly hematopoiesis and cellular composition of peripheral blood in different types of leukemia. I. Morphogenetic classification of leukemia on AI Vorobiev, YI Lorna. (Similar to the burgeoning germ hematopoiesis). 1. Acute and chronic plasmoblastic and plasmocytic leukemia. Plasmoblast grows, proplasmocyte, plasmocyte. 2. Acute lymphoblastic and chronic lymphocytic leukemia. To grow different types of lymphocytes: lymphoblasts, according to them prolymphocytes and lymphocytes. 3. Acute histiomonoblastic leukemia and chronic monocytic leukemia Monoblast grows, promonocyte, monocytes, histiocytes. 4. Acute myeloblastic leukemia and chronic myeloid leukemia. Grow cells - myeloblasts, promyelocytes, myelocytes, young, band, segmented neutrophils. A variety of acute myeloid leukemia is acute promyelocytic leukemia. Myeloblasts azurophilic grows with grit. 5. Acute erythroblastic and chronic erythrocytic leukemia Grow cells red germ hematopoiesis - erythroblasts, pronormocyte, normocytes (basophilic, polychromatic, oxyphilic), polychromatic erythrocytes and mature red blood cells 6. Erythromyeloleukemia acute and chronic (mixed leukemia). There is a proliferation of white granular germ hematopoiesis and red germ hematopoiesis. The cellular composition of bone marrow and peripheral blood mixed, there are all forms of granular white blood cells and red blood cells. Grow cells - myeloblasts, promyelocytes, myelocytes, young, band, segmented neutrophils. Grow cells rad germ hematopoiesis - erythroblasts, pronormocyte, normocytes (basophilic, polychromatic, oxyphilic), polychromatic erythrocytes and mature red blood cells. 7. Acute megakaryoblastic and chronic megakaryocytic leukemia - proliferation platelet hemopoietic stem - megakaryoblast, promegakaryocyte, megakaryocyte and platelets. 8. Acute leukemia with morphologically undifferentiated cells. Grow cells: first class
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