Hematopathology Practice Questions

Q: Classical markers for Hodgkin's disease are

CD 15 and CD 30. ***CD 15 and CD 30*** - These are **classical markers** specific for Reed-Sternberg cells, which are characteristic of Hodgkin's lymphoma [1][2]. - The presence of both markers is essential for **diagnosing Hodgkin's disease** and differentiating it from non-Hodgkin lymphomas [1]. *CD 20 and CD 30* - **CD 20** is primarily associated with B-cell non-Hodgkin lymphomas and is not a classical marker for Hodgkin's disease. - Hodgkin's lymphoma typically does not express **CD 20**, making this combination inappropriate for diagnosis. *CD 15 and CD 20* - While **CD 15** is a classical marker for Hodgkin's, **CD 20** is linked to B-lineage cells, which are not prominently present in Hodgkin's disease. - Diagnosis relies on the presence of **CD 30** alongside **CD 15**, highlighting the key difference. *CD 15 and CD 22* - Although **CD 15** is associated with Hodgkin's disease, **CD 22** is not a marker indicative of this lymphoma type. - **CD 22** is more relevant to B-cell malignancies; thus, it is not part of the classical markers for Hodgkin's lymphoma. **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. 614-616. [2] 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, p. 616.

Q: Which of the following is not a B-cell marker?

CD 34. ***CD 19*** - CD 19 is a core B-cell marker crucial for B-cell development and differentiation in the immune response [1]. - It is universally present on all B-cell lineages, making it a reliable marker for identifying B-cells [1]. *CD 10* - CD 10, also known as the common acute lymphoblastic leukemia antigen (CALLA), is not exclusive to B-cells but can be found in **various cell types**, including early B-cells and T-cells [1]. - It is primarily used as a marker in certain leukemias rather than a definitive B-cell marker. *CD 34* - CD 34 is a marker for **hematopoietic stem cells** and progenitor cells, not specifically for B-cells. - While it can indicate early stages of B-cell lineages, it is not utilized as a definitive marker for B-cells themselves. *CD 20* - CD 20 is a well-established marker found on the surface of **mature B-cells** and is often targeted in therapies for B-cell malignancies [1]. - It plays a critical role in B-cell activation and differentiation, thus confirming it as a B-cell marker [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, p. 598.

Q: A 10-year-old boy presents with a palpable mass in the abdomen. On imaging, the para-aortic lymph nodes are found to be enlarged. A biopsy from the lymph node shows a starry sky appearance. What is the likely underlying abnormality?

cMYC gene translocation. ***Translocation involving cMYC gene*** - The **starry sky appearance** in a lymph node biopsy is often associated with **Burkitt lymphoma** [2], which is caused by a translocation involving the cMYC gene [1]. - This translocation leads to **overexpression of cMYC** [1], promoting rapid cellular proliferation characteristic of this aggressive lymphoma. *Translocation involving BCR-ABL genes* - This abnormality is associated with **Chronic Myeloid Leukemia (CML)**, not lymphoma, and does not present with a **starry sky appearance**. - In CML, the hallmark finding is the presence of **Philadelphia chromosome** and myeloid cell overproduction. *Rb tumor suppressor gene mutation* - Rb gene mutations are typically noted in **retinoblastoma** or osteosarcoma, not in lymphomas presenting with a starry sky pattern. - These tumors often have different clinical presentations and do not typically involve lymph nodes as a primary finding. *Tumor suppressor gene Tp53 mutation* - Mutations in the Tp53 gene are commonly involved in **various cancers**, including sarcomas and breast cancer, but are not linked to the **starry sky appearance** seen in lymphomas. - While critical for **cell cycle regulation**, Tp53 mutations do not directly correlate with the typical findings in Burkitt lymphoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 324-325. [2] 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, p. 606.

Q: In which of the following conditions is an elevated leukocyte alkaline phosphatase (LAP) score typically observed?

Leukemoid reaction. ***Leukemoid reaction*** - A **leukemoid reaction** is characterized by a marked increase in the leukocyte count (usually >50,000/µL) due to a severe infection or inflammation, and is associated with a **high leukocyte alkaline phosphatase (LAP) score**. - This elevated LAP score helps differentiate it from **chronic myeloid leukemia (CML)**. *CML* - **Chronic myeloid leukemia (CML)** typically presents with a **low leukocyte alkaline phosphatase (LAP) score**, even with a high white blood cell count. - CML is a **myeloproliferative neoplasm** caused by the **Philadelphia chromosome (BCR-ABL1 fusion gene)**. *Eosinophilia* - **Eosinophilia** is an increase in the number of eosinophils, usually occurring in response to allergies, parasitic infections, or certain cancers. - It is not directly associated with changes in **alkaline phosphatase** levels. *Malaria* - **Malaria** is a parasitic infection that can cause various hematological changes, including anemia and thrombocytopenia. - It does not typically lead to an **elevated leukocyte alkaline phosphatase (LAP) score**.

Q: The most common translocation in acute promyelocytic leukemia (APML) is:

t(15;17). ***t (15:17)*** - The most common translocation in **acute promyelocytic leukemia (APML)** is the **t(15;17)**, which fuses the promyelocytic leukemia (PML) gene with the promyelocyte-retinoic acid receptor (RARA) gene [1]. - This genetic alteration is associated with a **specific clinical presentation** of APML, including bleeding diathesis and a high risk of coagulopathy [2]. *t (8:14)* - This translocation is commonly associated with **Burkitt lymphoma**, not APML. - It involves the **MYC gene**, leading to uncontrolled cell division, which is unrelated to the pathophysiology of APML. *t (8:21)* - Associated with **acute myeloid leukemia (AML)**, particularly the M2 subtype. - This translocation involves the **RUNX1 (AML1) gene** and does not pertain to APML's characteristic genetic changes. *t (9:22)* - Known as the **Philadelphia chromosome**, it is implicated in **chronic myeloid leukemia (CML)** and some types of ALL (acute lymphoblastic leukemia). - This translocation involves the **BCR-ABL fusion gene** which is distinctly different from the genetic abnormalities found in APML. **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. 620-622. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 326.

Q: The size of the red blood cells is measured by?

Mean Corpuscular Volume (MCV). ***Mean Corpuscular Volume (MCV)*** - **MCV** is a direct measure of the average **volume** or size of individual **red blood cells**. - It is crucial for classifying anemias as **microcytic** (low MCV), **normocytic** (normal MCV), or **macrocytic** (high MCV). *Erythrocyte Sedimentation Rate (ESR)* - **ESR** measures the rate at which **red blood cells** settle in a tube in one hour, indicating the presence of **inflammation** or infection. - It is not a direct measure of **red blood cell size** but rather an indirect marker of systemic inflammation. *Mean Cell Hemoglobin (MCH)* - **MCH** indicates the average amount of **hemoglobin** in each individual **red blood cell**. - While related to size, it specifically quantifies the hemoglobin content, not the cell's volume or physical dimension. *Mean Corpuscular Hemoglobin Concentration (MCHC)* - **MCHC** measures the average concentration of **hemoglobin** within a given volume of **red blood cells**, reflecting the color intensity. - It helps determine if red blood cells are **hypochromic** (low MCHC) or normochromic, rather than directly measuring their size.

Q: Which genetic alteration is associated with a poor prognosis in acute myeloid leukemia?

Monosomy 7. ***Correct: Monosomy 7*** - **Monosomy 7** or **deletion 7q (del 7q)** are classified as **adverse/poor-risk cytogenetic abnormalities** in acute myeloid leukemia (AML) per the European LeukemiaNet (ELN) risk stratification - Consistently associated with **poor prognosis**, lower complete remission rates, and shorter overall survival - These alterations indicate **genomic instability** and often lead to **resistance to conventional chemotherapy** - Patients typically require consideration for **allogeneic stem cell transplantation** when eligible *Incorrect: Deletion of chromosome 5* - **Deletion 5q (del 5q)** or **monosomy 5** are also classified as adverse-risk abnormalities in AML - However, **monosomy 7** is more consistently cited as a marker for **very poor prognosis** in AML - Note: **Isolated 5q- syndrome** in myelodysplastic syndromes (MDS) has a better prognosis and responds to lenalidomide, but in AML context it indicates unfavorable outcome *Incorrect: t(8;21) translocation* - The **t(8;21)(q22;q22)** translocation is a **favorable-risk (core-binding factor AML)** genetic alteration [1] - Associated with **good prognosis** and high complete remission rates with standard chemotherapy [1] - Involves fusion of **RUNX1-RUNX1T1 genes** (previously AML1-ETO), creating a specific AML subtype with distinct morphology (often FAB M2 with abnormal eosinophils) [1] *Incorrect: Nucleophosmin mutation (NPM1)* - **NPM1 mutations** without concurrent **FLT3-ITD** (or with low FLT3-ITD allelic ratio) are classified as **favorable-risk** in AML [1] - Associated with **good response to intensive chemotherapy** and improved overall survival, particularly in younger patients with normal karyotype AML [1] - NPM1-mutated AML represents approximately 30% of adult AML cases [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, p. 620.

Q: Aplastic anemia in hereditary spherocytosis is precipitated by.

Parvo virus. ***Parvo virus*** - **Parvovirus B19** specifically infects and destroys erythroid precursors in the bone marrow, leading to a temporary cessation of red blood cell production [1]. - In individuals with **hereditary spherocytosis**, who already have shortened red blood cell lifespans, this transient aplasia can trigger a severe **aplastic crisis** due to the inability to compensate for ongoing hemolysis [1]. *HIV* - While HIV can affect bone marrow function over time, it typically causes **myelosuppression** and pancytopenia through various mechanisms, rather than an acute, severe **aplastic crisis** predominantly affecting erythroid lineage, as seen in hereditary spherocytosis. - HIV infection is more commonly associated with **chronic anemia of inflammation** or **opportunistic infections** affecting marrow, not a direct precipitant of acute aplastic anemia in this context. *Adenovirus* - Adenoviruses are more commonly associated with **respiratory**, **gastrointestinal**, and **ocular infections**. - They are not a recognized cause of **aplastic crisis** or severe erythroid aplasia in patients with hereditary spherocytosis. *Influenza virus* - Influenza virus primarily causes **respiratory tract infections** and can lead to systemic symptoms and complications like pneumonia. - It is not implicated in causing **pure red cell aplasia** or an **aplastic crisis** in the setting of hereditary spherocytosis.

Q: ESR is increased in

Multiple myeloma. ***Multiple myeloma*** [1] - **Erythrocyte sedimentation rate (ESR)** is commonly elevated due to inflammatory cytokines and the presence of abnormal proteins affecting blood viscosity [1]. - Patients often present with **bone pain** and can have **hypercalcemia**, which further contributes to an increased ESR [2]. *Thalassemia* - Typically presents with **microcytic anemia** but does not significantly elevate the ESR [3]. - The chronic hemolysis in thalassemia often results in a normal or slightly raised ESR, not markedly increased as seen in malignancies. *Polycythemia vera* - Characterized by excessive red blood cell production, leading to increased blood viscosity, but usually results in a **low or normal ESR**. - The inflammatory response is minimal, and the only changes in ESR are due to viscous blood rather than true inflammation. *Sickle cell anemia* - While patients may experience vasocclusive crises leading to inflammation, the overall ESR is generally normal or only mildly elevated. - The primary issue in sickle cell anemia is the **sickle-shaped red blood cells**, not significant changes in ESR levels [3].

Question 1

Classical markers for Hodgkin's disease are

Accepted Answer

CD 15 and CD 30

Answer

CD 15 and CD 20

Answer

CD 20 and CD 30

Answer

CD 15 and CD 22

Question 2

Which of the following is not a B-cell marker?

Accepted Answer

CD 34

Answer

CD 10

Answer

CD 20

Answer

CD 19

Question 3

A 10-year-old boy presents with a palpable mass in the abdomen. On imaging, the para-aortic lymph nodes are found to be enlarged. A biopsy from the lymph node shows a starry sky appearance. What is the likely underlying abnormality?

Accepted Answer

cMYC gene translocation

Answer

Mutation in the Rb tumor suppressor gene

Answer

BCR-ABL gene translocation

Answer

Mutation in the Tp53 tumor suppressor gene

Question 4

In which of the following conditions is an elevated leukocyte alkaline phosphatase (LAP) score typically observed?

Accepted Answer

Leukemoid reaction

Answer

Eosinophilia

Answer

Malaria

Answer

CML

Question 5

Which of the following statements is true regarding eosinophilic granuloma?

Accepted Answer

Eosinophilic granuloma is associated with Langerhans cell histiocytosis.

Answer

Eosinophilic granuloma primarily affects adults.

Answer

Eosinophilic granuloma is characterized by a predominant neutrophilic infiltrate.

Answer

Eosinophilic granuloma is a benign condition that resolves spontaneously.

Question 6

The most common translocation in acute promyelocytic leukemia (APML) is:

Accepted Answer

t(15;17)

Answer

t(8;21)

Answer

t(8;14)

Answer

t(9;22)

Question 7

The size of the red blood cells is measured by?

Accepted Answer

Mean Corpuscular Volume (MCV)

Answer

Mean Cell Hemoglobin (MCH)

Answer

Mean Corpuscular Hemoglobin Concentration (MCHC)

Answer

Erythrocyte Sedimentation Rate (ESR)

Question 8

Which genetic alteration is associated with a poor prognosis in acute myeloid leukemia?

Accepted Answer

Monosomy 7

Answer

Nucleophosmin mutation (NPM1)

Answer

Deletion of chromosome 5

Answer

T(8:21) translocation

Question 9

Aplastic anemia in hereditary spherocytosis is precipitated by.

Accepted Answer

Parvo virus

Answer

HIV

Answer

Adenovirus

Answer

Influenza virus

Question 10

ESR is increased in

Accepted Answer

Multiple myeloma

Answer

Polycythemia

Answer

Thalassemia

Answer

Sickle cell disease

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?