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Hi there everyone. Um, I hope you can all hear this and see if the slides. Ok, if there's any issues with the slides or anything during the presentation, just let me know and we can have a look through that. Um, so my name's Matt, I'm af one in Taunton in Somerset. And today we're going to be talking through malignant hematology and a few malignant hematological conditions. So hopefully this content will all be relevant for your UK MLA exams. I know they're all coming up soon. Um, so we will get started. So for our presentation today, we're gonna be having a brief look over three conditions. These are all core conditions from your UK MLA content and there are a few questions throughout. So our first question is up on the screen, I'll just read through it quickly, then I'll give you a few minutes to have a think through. Hopefully, this will be something that's, uh, the right level. Um, but if there are any other questions, then just pop them in the chat afterwards and we can have a look. So a 21 year old male visits, a GP practice with concerns about a lump under through the armpit that is rubbery and non tender. The lumper is not associated with recent illness or infection, but the patient has been sweating more at night and has lost weight. What would be the gold standard investigation to determine the most likely cause of his symptoms? So, one is ct abdomen, pelvis, two fine needle aspiration biopsy. Three is full blood count, four, excisional window biopsy or five bone marrow biopsy. So I'll just give you a minute to have a look through that. Have a think about what your answer would be and then we'll ok. So I hope that's enough time for you all to have had a look through the question and have a think about what's going on. So just have a quick look through. So when we think about lymphadenopathy or um lymph nodes that have become enlarged or swollen, then the way that we differentiate between malignant versus non malignant is a few different things. So, one of the things that we think about is time course, if the lymph nodes have been there for less than two weeks, then we'd be less concerned. But lymph nodes that stay there and stay visible for more than two weeks become more concerning other things we think about are infection. So recent infection, as I'm sure you're all aware, um especially viral infections can cause lymphadenopathy. In this case, we've got a 21 year old male. The patient's also been sweating more at night and has lost weight. Oh, apologies if there's an issue with the audio or the slides, I think we've just got an issue with the audio and our slides. Apologies. Um Just let me know if you can see the slides now. Great. Thank you. Sorry. So we'll just get back to it. So having a look through the different options, we're looking for the gold standard. So when we think about the gold standard, we're thinking about what's going to mean that we have almost complete certainty about the investigation. So hopefully you all got the excision or node biopsy was the correct answer. So looking through the answers, Ct Abdo Pelvis, we use this for staging. So we think about Ann Arbor staging and CT Abdo Pelvis is generally the first line used in that fine needle aspiration biopsy is another option. However, if by using a fine needle aspiration, we find that only a small amount of cells are seen and the cells can be damaged from the biopsy. So by using excisional node biopsy, it allows us to get a selection of slides and by looking under the microscope at the slides, we're able to see the reed Sternberg cells with ch path and mic. OK. So we're gonna talk for our first condition, lymphoma. So as you can see lymphoid cancers, there's a white, a large selection of lymphoid cancers. Um The two most common that you might get asked about in exams are Hodgkin lymphoma and non Hodgkin's lymphoma. So we'll start off with Hodgkin's lymphoma. So Hodgkin's lymphoma is made up of malignant tumors. The lymphatic system which are characterized by the presence of reed Sternberg cells. So, these cells are large abnormal lymphocytes that can be multinucleated as in have multiple nuclei and they're very positive, predict high positive predictive value for Hodgkin's lymphoma. As you can see from the image, they're significantly different from normal lymphocytes. Hodgkin's lymphoma can then be further differentiated into classical and nodular lymphocyte, predominant lymphoma. It's much rarer and doesn't involve read ERM B cells and it's less likely that you'd be asked about this on examination. Classical Hodgkin's lymphoma is much more common.