Hematopathology — MCQs

A 68-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count 27 × 10^9/L, and total leukocyte count 40 × 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23, and negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by?

Q1416

BCR-ABL fusion gene is MOST CHARACTERISTICALLY seen in?

Q1417

The 'hair on end' appearance is characteristically seen in which of the following conditions?

Q1418

Which of the following Non-Hodgkin's lymphomas was historically classified as intermediate grade in the Working Formulation?

Q1419

Which of the following findings is characteristic of megaloblastic anemia?

Q1420

A 62-year-old man presents with back pain for 4 months. Laboratory tests show a white blood cell count of 3700/microliter, hemoglobin of 10.3 g/dL, hematocrit of 31.1%, mean corpuscular volume of 85 fL, and a platelet count of 110,000/microliter. His total serum protein is 8.5 g/dL, with an albumin level of 4.1 g/dL. A chest radiograph shows lucencies in the vertebral bodies. A sternal bone marrow aspirate yields a dark red jelly-like material. Which cell type is most likely to be numerous in this aspirate?

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1411: In which type of Hodgkin's Lymphoma are lacunar cells typically observed?

A. Mixed cellularity type
B. Lymphocyte predominant type
C. Nodular Sclerosis type (Correct Answer)
D. All of the options

Explanation: ***Nodular Sclerosis Type*** - **Lacunar cells** are characteristically seen in **Nodular Sclerosis Hodgkin lymphoma**, which is the most common subtype [1][3]. - These cells are large **Reed-Sternberg cells** with a distinctive morphology, typically found in **fibrous areas** of the lymph node [1]. *Mixed cellularity type* - This subtype is associated with a diverse cell population but does not primarily feature **lacunar cells** [2][4]. - It predominantly contains **Reed-Sternberg cells** without the specific morphology seen in nodular sclerosis [2]. *Lymphocyte predominant* - Lymphocyte predominant type mainly consists of **lymphocytes** with few Reed-Sternberg cells, and lacks **lacunar cells** [5]. - The histology is significantly different, exhibiting a more lymphocytic composition and not the classic lucent spaces [5]. *All of the above* - This option is incorrect as neither **Mixed cellularity** nor **Lymphocyte predominant** types contain **lacunar cells** [2][4][5]. - Lacunar cells are a distinctive feature solely of the **Nodular Sclerosis type** in Hodgkin lymphoma [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. 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, pp. 616-618. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 558-559. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 559-560. [5] 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. 618.

Question 1412: What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

A. T cells
B. Immature B cells (Correct Answer)
C. Immature T cells
D. Both T & B cells

Explanation: ***Immature B cells*** - B acute lymphoblastic leukemia (B ALL) is primarily derived from the **malignant transformation of precursor B lymphocytes** [1]. - The disease is characterized by the presence of **immature B cell blasts** in the bone marrow and peripheral blood [1]. *T cells* - T cells are involved in a different lineage of leukemia known as T-ALL, not B ALL [1]. - The pathophysiology of B ALL specifically relates to **B cell precursors**, not T cell involvement. *Both T & B cells* - This option is incorrect as B ALL specifically originates from **B cell lineage**, and T cells are unrelated to its pathogenesis [1]. - The presence of both T and B cells together characterizes mixed lineage leukemias, which is not the case here. *Immature T cells* - Immature T cells are precursors for **T acute lymphoblastic leukemia (T-ALL)**, not for B ALL [1]. - B ALL does not involve T cell precursors; the focus is solely on **immature B cells** [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. 596-600.

Question 1413: Starry sky appearance is seen in which of the following?

A. Burkitt's Lymphoma (Correct Answer)
B. Diffuse Large B Cell Lymphoma
C. Anaplastic Large Cell Lymphoma (ALCL)
D. Follicular Lymphoma

Explanation: ***Burkitts lymphoma*** - The **starry sky appearance** is a characteristic histopathological finding due to interspersed macrophages containing **phagocytosed apoptotic cells** and necrotic debris in Burkitt's lymphoma [1]. - It is associated with **MYC gene translocation** and presents typically in children or young adults, commonly affecting the **jaw or abdomen**. *CIL* - CIL (chronic inflammatory leukocytosis) does not exhibit a **starry sky appearance**; it typically reflects a reactive process without specific histological features. - The histology is more characterized by **increased white blood cell counts** rather than tissue architecture alterations seen in lymphomas. *Diffuse large B cell lymphoma* - While this lymphoma can show **varied morphology**, it does not have a **starry sky appearance** as a defining feature, rather presenting with **large atypical B-cells**. - The histological appearance is generally of a **diffuse infiltrate**, which lacks the classic starry sky histology. *ALCL* - Anaplastic large cell lymphoma (ALCL) is characterized by **large, pleomorphic cells** but does not show a starry sky appearance. - The histological pattern primarily focuses on **large anaplastic lymphoid cells** rather than the scattered macrophages seen in Burkitt'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, p. 606.

Question 1414: The subtype of Hodgkin's disease which is histogenetically distinct from all the other subtypes is:

A. Lymphocyte predominant (Correct Answer)
B. Nodular sclerosis
C. Mixed cellularity
D. Lymphocyte depleted

Explanation: ***Lymphocyte predominant*** - This subtype is characterized by the presence of **popcorn cells** (a variant of Reed-Sternberg cells) and is histogenically distinct from other forms of Hodgkin's lymphoma [1]. - It typically features a **predominance of lymphocytes**, contrasting with the other subtypes that may show mixed cellularity or different cell backgrounds [1]. *Lymphocyte depleted* - This subtype has a high number of **Reed-Sternberg cells** and is often associated with **immunocompromised states**, making it less distinct than lymphocyte predominant [2]. - It typically presents with a poor prognosis and is characterized by **depletion** of lymphocytes rather than predominance [2]. *Nodular sclerosis* - This is one of the most common subtypes of Hodgkin's lymphoma, featuring **fibrosis** and often affecting mediastinal lymph nodes. - While distinct, it shares histopathological features with other standard forms of Hodgkin's lymphoma, thus not being **histogenically distinct**. *Mixed cellularity* - This subtype presents a heterogeneous mix of cells, including **Reed-Sternberg cells** and leukocytes, and is the most frequent subtype after nodular sclerosis [2]. - It is associated with lower lymphocyte predominance, thus lacking the unique histological characteristics found in lymphocyte predominant 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, p. 618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 559-560.

Question 1415: A 68-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count 27 × 10^9/L, and total leukocyte count 40 × 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23, and negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by?

A. A monomorphic lymphoid proliferation with admixed proliferation centers (Correct Answer)
B. A polymorphous population of lymphocytes, plasma cells, eosinophils and scattered large binucleated cells
C. A predominantly follicular pattern with variably-sized follicles effacing nodal architecture
D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate

Explanation: ***A monomorphic lymphoid proliferation with admixed proliferation centers*** - The clinical and laboratory findings suggest **chronic lymphocytic leukemia (CLL)** [1], characterized by a predominance of **mature lymphoid cells** [2] and a nodular infiltrate in the bone marrow. - Histopathological examination would typically show a **monomorphic proliferation** of small, mature lymphocytes [1], which efface the lymph node architecture. *A diffuse proliferation of medium to large lymphoid cells with high mitotic rate.* - This description aligns more with **aggressive lymphomas**, such as diffuse large B-cell lymphoma, rather than CLL. - CLL is characterized by **low mitotic activity** and predominantly small, mature lymphocytes [2], not medium to large cells. *A predominantly follicular pattern with variably-sized follicles effacing nodal architecture* - This finding is typical of **follicular lymphoma**, where the architecture features multiple follicles rather than a monomorphic infiltrate. - The malignant cells in CLL do not form **follicular patterns** but rather disrupt the normal architecture with a more uniform appearance [1]. *A polymorphous population of lymphocytes, plasma cells, eosinophils and scattered large binucleated cells* - A polymorphous pattern suggests a **reactive lymphadenopathy** or conditions such as Hodgkin lymphoma, which show mixed cellularity. - CLL is characterized by **uniformity** in cell type [1] with little to no diversity in the lymphocyte population, making this option unsuitable. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613. [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. 602.

Question 1416: BCR-ABL fusion gene is MOST CHARACTERISTICALLY seen in?

A. CML (Correct Answer)
B. AML
C. Chronic Lymphocytic Leukemia (CLL)
D. Acute Lymphoblastic Leukemia (ALL)

Explanation: ***CML*** - The **BCR-ABL gene mutation** is characteristic of **Chronic Myeloid Leukemia (CML)**, resulting from a translocation between chromosomes 9 and 22 [1]. - This mutation leads to the production of the **BCR-ABL fusion protein**, which promotes cell proliferation and inhibits apoptosis [1]. *AML* - Acute Myeloid Leukemia (AML) does not typically exhibit the **BCR-ABL fusion gene**; rather, it is associated with various other genetic mutations. - Key features of AML include **myeloblast proliferation** and it presents with different cytogenetic abnormalities like **FLT3 or NPM1 mutations**. *CLL* - Chronic Lymphocytic Leukemia (CLL) is characterized by the accumulation of **mature lymphocytes**, not the **BCR-ABL mutation**. - It is often associated with mutations such as **TP53** and **NOTCH1**, distinct from myeloid malignancies. *ALL* - Acute Lymphoblastic Leukemia (ALL) is primarily linked with **chromosomal translocations** involving **the TCF3** gene or others, but not specifically with **BCR-ABL**. - In ALL, **lymphoid progenitor cells** proliferate, whereas CML is primarily a **myeloid process** associated with the BCR-ABL gene [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. 624-625.

Question 1417: The 'hair on end' appearance is characteristically seen in which of the following conditions?

A. Sickle cell anaemia
B. Hereditary spherocytosis
C. Thalassemia major (Correct Answer)
D. G6PD deficiency

Explanation: ***Thalassemia major*** - The "hair-on-end" appearance on skull X-rays is caused by **extramedullary hematopoiesis** to compensate for severe anemia [2]. This leads to bone marrow expansion, particularly in the cranium, with perpendicular new bone formation [2]. - This characteristic radiological finding is a hallmark of **chronic hemolytic anemias**, especially those like thalassemia major [2], where there is ineffective erythropoiesis and significantly increased red blood cell turnover [3]. *Sickle cell anemia* - While sickle cell anemia can also cause **bone marrow expansion** and some changes in bone [1], the "hair-on-end" appearance is much less common and less pronounced compared to thalassemia major. - The primary bone changes in sickle cell disease are often related to **avascular necrosis** and **infarction**, not typically the prominent periosteal reaction seen in thalassemia [1]. *G6PD deficiency* - G6PD deficiency causes **intermittent hemolytic crises** triggered by oxidative stress, rather than chronic severe hemolytic anemia. - The bone marrow expansion is usually not severe or chronic enough to lead to the characteristic "hair-on-end" appearance seen in thalassemia major. *Hereditary spherocytosis* - Hereditary spherocytosis is characterized by abnormal red blood cell shape leading to premature destruction in the spleen, resulting in **chronic hemolytic anemia**. - While chronic hemolysis can induce some bone marrow expansion, the "hair-on-end" appearance is rare and not a classic feature, unlike in thalassemia major. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 644-645. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 648-649. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648.

Question 1418: Which of the following Non-Hodgkin's lymphomas was historically classified as intermediate grade in the Working Formulation?

A. Small non-cleaved cell lymphoma
B. Diffuse, small cleaved cell lymphoma (Correct Answer)
C. Lymphoblastic lymphoma
D. Large cell immunoblastic lymphoma

Explanation: ***Diffuse, small cleaved cell lymphoma*** - This subtype was classified under the **intermediate-grade** category in the Working Formulation, which was an older classification system for non-Hodgkin lymphomas. - The Working Formulation aimed to group lymphomas based on their **prognostic behavior**, with intermediate grade indicating a moderate clinical course. *Small non-cleaved cell lymphoma* - This lymphoma, now recognized as **Burkitt lymphoma**, was classified as **high-grade** in the Working Formulation due to its aggressive nature and rapid progression [3]. - It is characterized by a very high **proliferative rate** and aggressive clinical course [3]. *Lymphoblastic lymphoma* - This aggressive lymphoma was also classified as **high-grade** in the Working Formulation [2]. - It arises from immature lymphoid precursors and is notorious for its rapid growth and tendency to involve the **bone marrow** and **CNS** [2],[3]. *Large cell immunoblastic lymphoma* - This aggressive subtype was categorized under the **high-grade** category in the Working Formulation. - It is histologically defined by large, immature-appearing immunoblasts and typically has an **unfavorable prognosis** if left untreated [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 563-564. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 560-561. [3] 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.

Question 1419: Which of the following findings is characteristic of megaloblastic anemia?

A. Macrocytic red blood cells
B. Reticulocytopenia
C. Hypersegmented neutrophils
D. All of the options (Correct Answer)

Explanation: ***All of the above*** - In megaloblastic anemia, various atypical red blood cell characteristics can be observed, including **Cabot rings**, **Howell-Jolly bodies**, and **basophilic stippling** [1]. - These features arise due to ineffective erythropoiesis and increased reticulocyte production, which are hallmark traits of megaloblastic changes [1]. *Cabot ring* - These are **red cell inclusions** that can be seen in conditions associated with **disrupted hemoglobin synthesis** or **abnormal nucleic acid metabolism**, but are not specific to megaloblastic anemia. - More commonly observed in conditions like **lead poisoning** or **myelodysplastic syndromes**. *Howell Jolly bodies* - These are nuclear remnants seen in red blood cells, typically present after **splenectomy** or in cases of **hemolytic anemia**, rather than specifically indicating megaloblastic anemia. - While they can be seen in megaloblastic anemia, they are not definitive; they signify **poor splenic function**. *Basophilic stippling* - Generally associated with **lead poisoning**, **thalassemias**, and certain types of **anemia**, but not exclusively indicative of megaloblastic anemia. - It results from **RNA remnants** in red blood cells and is more frequently noted in other forms of anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Question 1420: A 62-year-old man presents with back pain for 4 months. Laboratory tests show a white blood cell count of 3700/microliter, hemoglobin of 10.3 g/dL, hematocrit of 31.1%, mean corpuscular volume of 85 fL, and a platelet count of 110,000/microliter. His total serum protein is 8.5 g/dL, with an albumin level of 4.1 g/dL. A chest radiograph shows lucencies in the vertebral bodies. A sternal bone marrow aspirate yields a dark red jelly-like material. Which cell type is most likely to be numerous in this aspirate?

A. Osteoblasts
B. Plasma cells (Correct Answer)
C. Giant cells
D. Fibroblasts

Explanation: ***Plasma cells*** - The presence of **dark red jelly-like material** in the bone marrow aspirate indicates a possible **myeloma**, which is characterized by an abundance of plasma cells [1]. - The lucencies in the vertebral bodies combined with low white blood cell count and **anemia** further support a diagnosis related to plasma cell dyscrasias like multiple myeloma [1][2][3]. *Osteoblasts* - Osteoblasts are responsible for **bone formation** and would not be expected to be numerous in this scenario where there is evidence of **bone loss** (lucencies). - Their presence would typically indicate **active bone remodeling**, not consistent with the findings of anemia and low cellularity in the context presented. *Fibroblasts* - Fibroblasts are involved in **connective tissue formation** and repair, and their numbers are not typically indicative of any hematologic disorders. - They do not directly relate to the findings of **anemia** and **bone lesions**, making them unlikely to be predominant in this aspirate. *Giant cells* - Giant cells, often associated with **inflammatory responses** or granulomatous conditions, do not correlate with the clinical picture of myeloma or the findings outlined in the case. - Their presence would suggest a different pathological process, unrelated to the presence of **plasma cells** in bone marrow aspirate [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 617-618. [3] 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. 606-609.

Practice by Chapter

Anemias: Classification and Approach

Practice Questions

Hemolytic Anemias

Practice Questions

Myeloproliferative Neoplasms

Practice Questions

Myelodysplastic Syndromes

Practice Questions

Acute Leukemias

Practice Questions

Chronic Leukemias

Practice Questions

Lymphomas and Lymphoid Neoplasms

Practice Questions

Plasma Cell Disorders

Practice Questions

Bleeding Disorders

Practice Questions

Thrombotic Disorders

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free