Hematopathology Practice Questions

Q: Which of the following features is shared in common between lymphocyte-rich and lymphocyte-predominant types of Hodgkin's lymphoma?

Good prognosis. Both **Lymphocyte-Rich Hodgkin Lymphoma (LRHL)** and **Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)** are characterized by an abundance of reactive lymphocytes and a relatively low burden of neoplastic cells [1], [2]. The shared clinical hallmark of these two subtypes is an **excellent prognosis** (Option D), as they typically present at an early stage and respond very well to treatment compared to the more aggressive Mixed Cellularity or Lymphocyte Depleted subtypes [2]. **Analysis of Incorrect Options:** * **Option A:** While NLPHL has a paucity of classic RS cells (showing "Popcorn" or LP cells instead), LRHL contains **diagnostic classic Reed-Sternberg cells** [1]. * **Option B:** LRHL is associated with **EBV in approximately 40%** of cases. In contrast, NLPHL is almost **never associated with EBV** [2]. * **Option C:** In LRHL, the RS cells follow the classic Hodgkin immunophenotype (**CD15+, CD30+, CD20-**). In NLPHL, the LP cells are **CD20+ and CD45+**, but negative for CD15 and CD30. **High-Yield Pearls for NEET-PG:** * **NLPHL** is now considered a distinct entity (often called "non-classic") because its cells (LP cells) express B-cell markers (CD20) [2]. * **LRHL** is a "classic" Hodgkin lymphoma; it looks like NLPHL morphologically (nodular growth, many lymphocytes) but has the immunophenotype of CHL (CD15/CD30 positive) [1]. * **Most common subtype:** Nodular Sclerosis. * **Best prognosis:** NLPHL / Lymphocyte Rich [2]. * **Worst prognosis:** Lymphocyte Depleted [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. 559-560. [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.

Q: HTLV-II has been implicated in the etiology of which condition?

Hairy cell leukemia. **Explanation:** **Human T-cell Lymphotropic Virus type II (HTLV-II)** is a retrovirus closely related to HTLV-I. While HTLV-I is the definitive causative agent of Adult T-cell Leukemia/Lymphoma (ATLL), **HTLV-II** has been specifically isolated from and implicated in the etiology of **Hairy Cell Leukemia (HCL)**, particularly certain atypical variants. Although the primary driver of HCL is the **BRAF V600E mutation**, the association with HTLV-II remains a classic high-yield association in viral oncogenesis. **Analysis of Incorrect Options:** * **B. AIDS:** This is caused by the Human Immunodeficiency Virus (HIV-1 and HIV-2), which targets CD4+ T-cells, leading to profound immunosuppression. * **C. Adult T-cell Lymphoma (ATLL):** This is caused by **HTLV-I**, not HTLV-II. HTLV-I is also associated with Tropical Spastic Paraparesis (TSP). * **D. Zinc deficiency:** This is a nutritional disorder leading to acrodermatitis enteropathica, impaired wound healing, and immune dysfunction; it has no viral etiology. **High-Yield Clinical Pearls for NEET-PG:** * **Hairy Cell Leukemia (HCL):** A B-cell neoplasm characterized by "hairy" cytoplasmic projections [1]. * **Key Marker:** **TRAP positive** (Tartrate-Resistant Acid Phosphatase). * **Immunophenotype:** CD11c, CD25, CD103, and Annexin A1 (most specific). * **Clinical Feature:** Massive splenomegaly and **"Dry tap"** on bone marrow aspiration due to increased reticulin fibrosis [1]. * **Genetic Hallmark:** **BRAF V600E** mutation is present in nearly 100% of classic HCL cases. **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. 612.

Q: What is the characteristic marker for hairy cell leukemia?

CD103. **Explanation:** **Hairy Cell Leukemia (HCL)** is a rare, chronic B-cell lymphoproliferative disorder characterized by the proliferation of mature B-cells with hair-like cytoplasmic projections [1]. **Why CD103 is the correct answer:** CD103 (an alpha-E integrin) is considered the most specific immunophenotypic marker for HCL. The diagnosis is typically confirmed via flow cytometry showing a "bright" expression of mature B-cell markers (CD19, CD20, CD22) along with a specific quartet of markers: **CD103, CD11c, CD25, and annexin A1.** Among these, Annexin A1 is the most specific immunohistochemical marker, while CD103 is the classic flow cytometry hallmark. **Analysis of Incorrect Options:** * **CD30:** A marker for activated lymphocytes; it is the hallmark for **Hodgkin Lymphoma** (Reed-Sternberg cells) and **Anaplastic Large Cell Lymphoma (ALCL)**. * **CD1:** Specifically CD1a is a marker for **Langerhans Cell Histiocytosis (LCH)** and cortical thymocytes. * **CD4:** A marker for **T-helper cells**. It is expressed in T-cell lineages and is relevant in conditions like Mycosis Fungoides or Adult T-cell Leukemia/Lymphoma (ATLL). **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Splenomegaly (often massive), Pancytopenia, and "Dry tap" on bone marrow aspiration (due to increased reticulin fibrosis) [1]. * **TRAP Stain:** Historically diagnosed using Tartrate-Resistant Acid Phosphatase (TRAP) positivity. * **Genetic Mutation:** Virtually 100% of cases harbor the **BRAF V600E** mutation. * **Treatment:** Highly sensitive to purine analogs like **Cladribine** (Drug of choice). **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. 612.

Question 1

Which of the following statements is not true regarding chronic myelogenous leukemia?

Accepted Answer

Bone marrow biopsy is essential for confirmation of diagnosis.

Answer

BCR-ABL fusion is involved in the oncogenesis.

Answer

Pseudo Gaucher cells may be present in the bone marrow examination.

Answer

Blast crisis in the disease may involve lymphoblasts.

Question 2

In the Ann Arbor staging system for Hodgkin's lymphoma, which stage is characterized by the involvement of lymph nodes on both sides of the diaphragm?

Accepted Answer

Stage III

Answer

Stage I

Answer

Stage II

Answer

Stage IV

Question 3

Which of the following features is shared in common between lymphocyte-rich and lymphocyte-predominant types of Hodgkin's lymphoma?

Accepted Answer

Good prognosis

Answer

Paucity of diagnostic Reed-Sternberg cells

Answer

Epstein-Barr virus (EBV) association

Answer

Reed-Sternberg cells are CD20 positive

Question 4

HTLV-II has been implicated in the etiology of which condition?

Accepted Answer

Hairy cell leukemia

Answer

AIDS

Answer

Adult T-cell lymphoma

Answer

Zinc deficiency

Question 5

Chronic myeloid leukemia (CML) is characterized by all of the following except:

Accepted Answer

Increased Leukocyte alkaline phosphatase

Answer

Leukocytosis

Answer

Thrombocytosis

Answer

Increased serum Vitamin B12

Question 6

Which chromosomal translocation is characteristic of Burkitt's lymphoma?

Accepted Answer

t(8;14)

Answer

t(9;22)

Answer

t(11;14)

Answer

t(14;18)

Question 7

Which is the most common defectively produced antibody in multiple myeloma?

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 8

All of the following are associated with Epstein-Barr virus (EBV), EXCEPT:

Accepted Answer

Lymphoplasmacytic lymphoma

Answer

Hodgkin's disease

Answer

Post-organ transplant lymphoma

Answer

Extranodal NK/T cell lymphoma, nasal type

Question 9

Prolonged prothrombin time (PT) and normal activated partial thromboplastin time (aPTT) may be seen in which of the following conditions?

Accepted Answer

Vitamin K deficiency

Answer

Thrombocytopenia

Answer

Disseminated Intravascular Coagulation (DIC)

Answer

Aspirin toxicity

Question 10

What is the characteristic marker for hairy cell leukemia?

Accepted Answer

CD103

Answer

CD30

Answer

CD1

Answer

CD4

Hematopathology — MCQs

Hematopathology — MCQs

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