Hematopathology Practice Questions

Q: A 70-year-old male has a pathological fracture of the femur. Radiographs show a lytic lesion with a circumscribed, punched-out appearance. What is the most likely histological finding in curettings from the fracture site?

Sheets of atypical plasma cells. ### Explanation The clinical presentation of a **70-year-old male** with a **pathological fracture** and **punched-out lytic lesions** on radiography is a classic description of **Multiple Myeloma**. [1] **Why Option B is Correct:** Multiple Myeloma is a plasma cell dyscrasia characterized by the neoplastic proliferation of a single clone of plasma cells. These cells secrete osteoclast-activating factors (like RANKL), leading to bone resorption and the characteristic "punched-out" lesions. Histologically, curettings from these lesions show **sheets of atypical plasma cells** (large cells with eccentric nuclei, "clock-face" chromatin, and a prominent perinuclear halo or Golgi zone). **Why Other Options are Incorrect:** * **Option A:** Diminished and thinned trabeculae are characteristic of **Osteoporosis**. While it causes fractures in the elderly, it presents with generalized osteopenia rather than focal, circumscribed lytic lesions. * **Option C:** Prostatic adenocarcinoma typically causes **osteoblastic (sclerotic)** lesions in the bone, which appear radio-opaque (white) on X-ray, not lytic (dark). * **Option D:** Malignant cells forming osteoid is the hallmark of **Osteosarcoma**. This typically occurs in a younger age group and presents with a "sunburst" appearance or Codman’s triangle on radiography. **High-Yield NEET-PG Pearls:** * **CRAB Criteria:** Calcium elevation, Renal insufficiency, Anemia, and Bone lesions. * **Bence-Jones Proteins:** Immunoglobulin light chains found in urine (not detected by standard dipstick). * **M-Spike:** Found on Serum Protein Electrophoresis (SPEP), usually IgG or IgA. * **Skull X-ray:** Often shows multiple "punched-out" lytic lesions (Raindrop skull).

Q: Anemia of chronic disease is characterized by?

Increased bone marrow iron. **Explanation:** **Anemia of Chronic Disease (ACD)**, also known as Anemia of Inflammation, is primarily driven by the cytokine **Hepcidin** [1]. In chronic inflammatory states (infections, malignancy, autoimmune diseases), IL-6 stimulates the liver to produce Hepcidin. Hepcidin degrades ferroportin, the channel responsible for releasing iron from macrophages and enterocytes [2]. This leads to **iron sequestration** within the Reticuloendothelial System (RES) [1]. **Why Option C is Correct:** Because iron is trapped within the macrophages of the bone marrow and cannot be utilized for erythropoiesis, a Prussian blue stain of the bone marrow will show **increased storage iron**. This is the hallmark that distinguishes ACD from Iron Deficiency Anemia (IDA) [1]. **Why Other Options are Incorrect:** * **A. Increased sideroblasts:** In ACD, there is a *decrease* in sideroblasts (erythroid precursors with iron granules) because iron is trapped in macrophages and unavailable to the developing RBCs. * **B. Increased TIBC:** Total Iron Binding Capacity (TIBC) is a measure of Transferrin. In ACD, TIBC is **decreased** (or low-normal) as the body attempts to limit iron availability to potential pathogens. (TIBC is *increased* in IDA). * **D. Increased protoporphyrin:** While Free Erythrocyte Protoporphyrin (FEP) can be elevated in ACD due to lack of iron to complete the heme ring, it is not the defining characteristic compared to the definitive finding of increased marrow iron stores. **NEET-PG High-Yield Pearls:** * **Ferritin:** Increased (it is an acute-phase reactant) [1]. * **Serum Iron:** Decreased. * **Transferrin Saturation:** Decreased. * **MCV:** Usually Normocytic, but can become Microcytic in chronic cases [2]. * **Treatment:** Treat the underlying cause; Erythropoietin (EPO) may be used in specific cases like CKD [2].

Q: A 40-year-old female presented with the following findings: Hb 9.8 gm%, TLC 15,700/cumm, Platelet count 3 lac/cumm. Peripheral smear showed increased neutrophils with 14% blasts, 15% myelocytes and metamyelocytes with some dysplasia. Cytogenetic study revealed t(8;21). What is your diagnosis?

AML. **Explanation:** The key to this diagnosis lies in the cytogenetic finding of **t(8;21)**. According to the WHO classification of myeloid neoplasms, the presence of specific recurrent genetic abnormalities—namely **t(8;21), inv(16), or t(15;17)**—is diagnostic of **Acute Myeloid Leukemia (AML)** regardless of the blast count [1]. While the peripheral smear shows 14% blasts (which is below the traditional 20% threshold), the genetic marker overrides the blast percentage requirement. **Why other options are incorrect:** * **CML (Chronic Myeloid Leukemia):** Characterized by the Philadelphia chromosome **t(9;22)** and a "myelocyte bulge." While this patient has myelocytes and metamyelocytes, the t(8;21) is pathognomonic for AML (specifically AML-M2 in the FAB classification). * **MDS (Myelodysplastic Syndrome):** Although dysplasia is mentioned, the presence of t(8;21) automatically upgrades the diagnosis to AML [1]. MDS typically presents with cytopenias, not leukocytosis [2]. * **ALL (Acute Lymphoblastic Leukemia):** This involves a proliferation of lymphoblasts. The presence of myelocytes, metamyelocytes, and t(8;21) (a myeloid marker) points exclusively to a myeloid lineage [1]. **High-Yield Pearls for NEET-PG:** * **WHO Exception Rule:** AML can be diagnosed with <20% blasts if t(8;21), inv(16), or t(15;17) is present [1]. * **AML with t(8;21):** Often associated with **RUNX1-RUNX1T1** fusion gene, good prognosis, and the presence of **Auer rods** [1]. * **Morphology:** Frequently shows large blasts with prominent granules and "maturation" (presence of myelocytes/metamyelocytes), which can mimic CML or MDS [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-621. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Question 1

A 36-year-old woman presents with a 1-week history of cough and fever. On physical examination, her temperature is 38.3°C. She has diffuse crackles in all lung fields. A chest radiograph shows bilateral extensive infiltrates. Her CBC reveals a WBC count of 56,000/mm³ with 63% segmented neutrophils, 16% bands, 7% metamyelocytes, 3% myelocytes, 1% blasts, 8% lymphocytes, and 2% monocytes. A bone marrow biopsy shows normal maturation of myeloid cells. Which of the following is the most likely diagnosis?

Accepted Answer

Leukemoid reaction

Answer

Chronic myelogenous leukemia

Answer

Hairy cell leukemia

Answer

Hodgkin lymphoma, lymphocyte depletion type

Question 2

Which cell is not seen in Hodgkin lymphoma?

Accepted Answer

Langerhans cell

Answer

Reed-Sternberg cell

Answer

Lacunar cell

Answer

L&H cell

Question 3

Lupus anticoagulants may cause all of the following except:

Accepted Answer

Increased prothrombin time

Answer

Recurrent abortion

Answer

False positive VDRL results

Answer

Arterial thrombosis

Question 4

Which of the viruses is not commonly implicated in the pathogenesis of Non-Hodgkin's lymphomas?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Human T-cell leukemia virus-1 (HTLV-1)

Answer

Epstein-Barr virus (EBV)

Answer

Human herpesvirus-8 (HHV-8)

Question 5

Increase in MCHC is associated with which of the following?

Accepted Answer

Hereditary spherocytosis

Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Anemia of chronic disease

Question 6

A 70-year-old male has a pathological fracture of the femur. Radiographs show a lytic lesion with a circumscribed, punched-out appearance. What is the most likely histological finding in curettings from the fracture site?

Accepted Answer

Sheets of atypical plasma cells

Answer

Diminished and thinned trabecular bone

Answer

Metaplastic prostatic adenocarcinoma

Answer

Malignant cells forming osteoid bone

Question 7

Anemia of chronic disease is characterized by?

Accepted Answer

Increased bone marrow iron

Answer

Increased sideroblasts

Answer

Increased TIBC

Answer

Increased protoporphyrin

Question 8

Leukemoid reaction is seen in which of the following conditions?

Accepted Answer

Acute infection

Answer

Erythroleukemia

Answer

Myelomatosis

Answer

Hemorrhage

Question 9

Neutrophilic leucocytosis is seen in all conditions EXCEPT

Accepted Answer

Hay fever

Answer

Sepsis

Answer

Myocardial infarction

Answer

Pyogenic osteomyelitis

Question 10

A 40-year-old female presented with the following findings: Hb 9.8 gm%, TLC 15,700/cumm, Platelet count 3 lac/cumm. Peripheral smear showed increased neutrophils with 14% blasts, 15% myelocytes and metamyelocytes with some dysplasia. Cytogenetic study revealed t(8;21). What is your diagnosis?

Accepted Answer

AML

Answer

CML

Answer

MDS

Answer

ALL

Hematopathology — MCQs

Hematopathology — MCQs

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