Hematopathology Practice Questions

Q: A 34-year-old woman presents with fatigue, night sweats, and a painless right cervical lymph node enlarged to 4 cm over three months. Excisional biopsy is performed. The biopsy demonstrates a diffusely effaced nodal architecture with a mixed inflammatory background of lymphocytes, plasma cells, and eosinophils. Scattered large cells with abundant pale cytoplasm, prominent eosinophilic 'owl-eye' nucleoli, and a mirror-image binucleated morphology are identified. Which of the following cell types is most directly responsible for the characteristic constitutional symptoms in this condition?

Neoplastic large cells producing IL-6, IL-13, and TNF-α. ***Neoplastic large cells producing IL-6, IL-13, and TNF-α*** - The patient presents with **Classical Hodgkin Lymphoma**, where the neoplastic **Reed-Sternberg (RS) cells** secrete cytokines such as **IL-6, IL-13, and TNF-α**. - These specific cytokines are directly responsible for the **B symptoms** (constitutional symptoms) including **fever, night sweats, and weight loss** seen in this patient. *Binucleated giant cells secreting IL-5 and eotaxin* - While **Reed-Sternberg cells** do secrete **IL-5 and eotaxin**, these factors primarily function to recruit **eosinophils** to the tumor microenvironment. - Recruitment of eosinophils explains the **mixed inflammatory background** but does not directly cause the systemic **constitutional symptoms**. *Activated cytotoxic T-lymphocytes releasing perforin and granzyme B* - **Cytotoxic T-cells** are part of the reactive infiltrate and use **perforin and granzyme B** to induce apoptosis in target cells. - This mechanism is characteristic of **cell-mediated immunity** or certain T-cell lymphomas and is not the driver of **B symptoms** in Hodgkin lymphoma. *Follicular dendritic cells secreting CXCL13 and IL-21* - **Follicular dendritic cells** and their associated cytokines are typically involved in the pathogenesis of **Angioimmunoblastic T-cell lymphoma (AITL)**. - These markers help in forming **germinal centers** and recruiting T-follicular helper cells, rather than producing the systemic effects of **Hodgkin lymphoma**. *Plasma cells producing monoclonal IgG with systemic deposition* - This describes conditions like **Multiple Myeloma** or **AL Amyloidosis**, where monoclonal proteins cause systemic organ dysfunction. - In **Hodgkin lymphoma**, the plasma cells in the background are **polyclonal and reactive**, not the primary neoplastic drivers of systemic symptoms.

Q: Infant with anemia, poor growth and bleeding from nose was brought to emergency. On examination hepatosplenomegaly was noted, and serum chitotriosidase levels are elevated. Bone marrow examination was done. Diagnosis is:

Gaucher disease type 1. ***Gaucher disease type 1*** - **Anemia**, **poor growth**, **bleeding from nose** (due to thrombocytopenia), and **hepatosplenomegaly** are classic features of Gaucher disease [1]. - **Elevated serum chitotriosidase** is a highly sensitive and specific biomarker for Gaucher disease, and bone marrow examination would reveal **Gaucher cells** (lipid-laden macrophages) [1]. *Metachromatic leukodystrophy* - This is a **lysosomal storage disorder** primarily affecting the **nervous system**, leading to demyelination. - It typically presents with neurological symptoms like developmental regression, ataxia, and spasticity, not primarily hematological or visceral involvement. *Neuronal ceroid lipofuscinosis* - This is a group of **neurodegenerative disorders** characterized by the accumulation of lipopigments in neurons and other cells. - Clinical features include progressive intellectual decline, seizures, visual impairment, and motor dysfunction, without significant hepatosplenomegaly or bleeding diathesis. *Gaucher disease type 2* - While also a type of Gaucher disease, **Type 2 (neuronopathic)** is characterized by severe, rapidly progressive neurological involvement in infancy. - Although it shares features like hepatosplenomegaly, the prominent neurological symptoms and rapid deterioration are key differentiating factors not explicitly mentioned as primary complaints here. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163.

Q: The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

Serum electrolytes. ***Serum electrolytes*** - The image shows a **green-top vacutainer**, which typically contains **lithium heparin** as an anticoagulant. - **Lithium heparin** is the preferred anticoagulant for collecting samples for **serum electrolyte** measurements, as it does not interfere with the analysis of ions like sodium, potassium, and chloride. *Serum lactate* - Serum lactate measurements usually require a **gray-top tube** containing **sodium fluoride** and **potassium oxalate** to inhibit glycolysis and stabilize lactate levels. - A green-top tube with lithium heparin is not ideal for lactate analysis due to continued glycolysis in the absence of a glycolysis inhibitor. *Serum cholesterol* - Serum cholesterol, along with other lipid profiles, is typically collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**, which has a gel barrier. - While cholesterol can be measured from a heparinized plasma sample, a plain red-top or SST is more commonly used for routine lipid panels. *Serum uric acid* - Serum uric acid measurement can be performed on a sample collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**. - Although lithium heparin tubes can sometimes be used, plain serum tubes are generally preferred as they yield serum directly without an anticoagulant. *Coagulation studies* - Coagulation studies (PT, PTT, INR) require a **blue-top tube** containing **sodium citrate** as the anticoagulant. - The citrate-to-blood ratio must be precise (1:9) for accurate coagulation testing, making the blue-top tube specifically designed for this purpose. - A green-top tube with heparin cannot be used for coagulation studies as heparin itself is an anticoagulant that would interfere with the test results.

Q: Identify the tissue:

Thymus. ***Thymus*** - The presence of a **cortex** and **medulla**, along with **Hassall's corpuscles** (epithelial reticular cells arranged concentrically), is characteristic of the thymus [1]. - The thymus is responsible for **T-cell maturation** and selection [1]. *Lymph node* - Lymph nodes typically show a distinct **cortex** with lymphoid follicles (B-cell areas) and a **paracortex** (T-cell area), but lack Hassall's corpuscles. - They function in **filtering lymph** and initiating immune responses. *Tonsil* - Tonsils are characterized by **crypts** lined by stratified squamous epithelium and prominent **lymphoid follicles** beneath the epithelium, which are not the primary features here. - They are part of the **Waldeyer's ring** and serve as a first line of defense against inhaled and ingested pathogens. *Spleen* - The spleen has distinct **red pulp** (involved in filtering blood and removing old red blood cells) and **white pulp** (lymphoid areas with periarteriolar lymphoid sheaths and follicles), but does not contain Hassall's corpuscles. - It is a major site for **immune surveillance** and blood filtration. **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. 634.

Question 1

A 34-year-old woman presents with fatigue, night sweats, and a painless right cervical lymph node enlarged to 4 cm over three months. Excisional biopsy is performed. The biopsy demonstrates a diffusely effaced nodal architecture with a mixed inflammatory background of lymphocytes, plasma cells, and eosinophils. Scattered large cells with abundant pale cytoplasm, prominent eosinophilic 'owl-eye' nucleoli, and a mirror-image binucleated morphology are identified. Which of the following cell types is most directly responsible for the characteristic constitutional symptoms in this condition?

Accepted Answer

Neoplastic large cells producing IL-6, IL-13, and TNF-α

Answer

Binucleated giant cells secreting IL-5 and eotaxin

Answer

Activated cytotoxic T-lymphocytes releasing perforin and granzyme B

Answer

Follicular dendritic cells secreting CXCL13 and IL-21

Answer

Plasma cells producing monoclonal IgG with systemic deposition

Question 2

A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and a dry cough. Chest imaging reveals bilateral pleural plaques. A pleural biopsy is performed. Histological examination reveals elongated beaded structures with a golden-brown segmented coating within macrophages and lung parenchyma. Which of the following best describes the pathological significance of this finding?

Accepted Answer

It confirms prior fiber inhalation with iron-protein coating of the fiber core and is associated with mesothelioma risk

Answer

It represents dystrophic calcification within areas of prior granulomatous infection and indicates latent mycobacterial disease

Answer

It is a marker of iron overload due to repeated pulmonary hemorrhage and indicates hemosiderosis without fibrogenic risk

Answer

It represents a byproduct of lipid peroxidation within alveolar macrophages and indicates oxidative cell injury without malignant potential

Answer

It is a calcified mucus plug within small airways indicating chronic bronchitis with secondary mineralization

Question 3

Infant with anemia, poor growth and bleeding from nose was brought to emergency. On examination hepatosplenomegaly was noted, and serum chitotriosidase levels are elevated. Bone marrow examination was done. Diagnosis is:

Accepted Answer

Gaucher disease type 1

Answer

Metachromatic leukodystrophy

Answer

Neuronal ceroid lipofuscinosis

Answer

Gaucher disease type 2

Answer

Niemann-Pick disease

Question 4

The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

Accepted Answer

Serum electrolytes

Answer

Serum lactate

Answer

Serum cholesterol

Answer

Serum uric acid

Answer

Coagulation studies

Question 5

Identify the tissue:

Accepted Answer

Thymus

Answer

Lymph node

Answer

Tonsil

Answer

Spleen

Answer

Bone marrow

Hematopathology — MCQs

Hematopathology — MCQs

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