Hematopathology Practice Questions

Q: In APML (Acute Promyelocytic Leukemia), all of the following are seen except:

CD 15/34 both seen in same cell. ***CD 15/34 both seen in same cell*** - This statement is incorrect because **Acute Promyelocytic Leukemia (APML)** is characterized by **CD34 negativity**, meaning CD34 is typically absent in APML cells. - While **CD15 may be positive** in APML, **CD34 is negative** in the vast majority of cases (unlike other AML subtypes where CD34 is often positive). - Therefore, **CD15 and CD34 are NOT both seen in the same cell** in APML. - The disease involves **immature myeloid cells** at the promyelocyte stage, which are beyond the most primitive stem cell stage (hence the lack of CD34 expression). *Retinoic acid is used in treatment* - **All-trans retinoic acid (ATRA)** is a cornerstone of treatment for APML. - ATRA induces differentiation of the **promyelocytes**, which helps overcome the **differentiation block** caused by the PML-RARA fusion protein. *15/17 translocation may be seen* - The characteristic genetic abnormality in APML is the **t(15;17) translocation** [1]. - This translocation results in the fusion of the **PML (promyelocytic leukemia) gene** on chromosome 15 with the **RARA (retinoic acid receptor alpha) gene** on chromosome 17 [2]. *Associated with Disseminated intravascular coagulation (DIC)* - APML is frequently associated with a high risk of developing **Disseminated Intravascular Coagulation (DIC)** [1]. - The abnormal promyelocytes release **procoagulant substances** that activate the coagulation cascade, leading to severe bleeding and thrombosis. **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. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 605-607.

Q: Necrotizing lymphadenitis is seen in

Kikuchi-Fujimoto disease. ***Kikuchi-Fujimoto disease*** - Kikuchi-Fujimoto disease (KFD), also known as **histiocytic necrotizing lymphadenitis**, is characterized by **necrotizing lymphadenitis** without granulocytic infiltration. - It typically presents with **cervical lymphadenopathy**, fever, and leukopenia, often in young women. *Kimura disease* - Kimura disease is characterized by chronic, painless **subcutaneous masses** and **lymphadenopathy**, often in the head and neck. - Histologically, it shows **follicular hyperplasia** and prominent **eosinophilic infiltration**, not necrotizing lymphadenitis. *Castleman disease* - Castleman disease is a group of rare disorders that involve **overgrowth of lymph node cells**, leading to enlarged lymph nodes. - Histologically, it presents with **hyaline vascular** or **plasma cell variants**, but not necrotizing changes. *Hodgkin's lymphoma* - Hodgkin's lymphoma is a type of cancer characterized by the presence of **Reed-Sternberg cells** within a heterogeneous inflammatory infiltrate. - While it affects lymph nodes, its characteristic features are specific giant cells and an inflammatory background, **not necrotizing lymphadenitis** as the primary finding [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. 592-593.

Q: Necrotizing lymphadenopathy is characteristically seen in:

Kikuchi disease. ***Kikuchi disease*** - Also known as **histiocytic necrotizing lymphadenitis**, it is characterized by **tender cervical lymphadenopathy** with histological evidence of **necrotizing lymphadenitis** with an influx of **histiocytes and immunoblasts**. - The disease is **self-limiting**, typically resolving in 1-4 months, though it can recur and is more common in **young women of Asian descent**. - Histology shows **paracortical necrosis** with abundant karyorrhectic debris and absence of neutrophils. *Non-Hodgkin's lymphoma* - This is a diverse group of **malignancies** originating from lymphocytes, primarily presenting as **lymphadenopathy** that is typically **painless** and can be widespread. - While some aggressive NHL subtypes may show areas of necrosis, the defining characteristic is **clonal proliferation of malignant lymphocytes** rather than the necrotizing histiocytic features of Kikuchi disease. *Castleman's disease* - This is a rare disorder characterized by the **overgrowth of lymphoid tissue**, presenting with **large, often solitary lymph nodes** (unicentric form) or generalized lymphadenopathy (multicentric form). - It is histologically distinguished by **hypervascularity** and **abnormal germinal centers** (onion-skinning pattern), not by necrotizing lymphadenopathy. *Kimura disease* - A **rare chronic inflammatory disorder** presenting with **subcutaneous nodules** and **lymphadenopathy**, commonly in the head and neck region [1]. - Histologically, it is characterized by **lymphoid hyperplasia with prominent eosinophilic infiltration** and increased vascularity, but **not necrosis** of lymph nodes [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. 592-593.

Q: Which of the following stains is used for reticulocyte staining?

Brilliant cresyl blue. **Correct Answer: Brilliant cresyl blue** - **Brilliant cresyl blue** is a **supravital stain** commonly used to visualize **reticulocytes** [1] - It precipitates the **ribosomal RNA** and other organelles present in reticulocytes, making them visible as a **reticular network** within the cell - This is one of the two most common stains used for reticulocyte counting (along with New methylene blue) *Incorrect: Indigo carmine* - **Indigo carmine** is a vital dye used for diagnostic procedures in **gastroenterology and urology** (e.g., to detect mucosal lesions or assess kidney function) - Used in endoscopic procedures as a **chromoscopic agent** to enhance visualization, but not for reticulocyte staining *Incorrect: Sudan black* - **Sudan black B** is a stain primarily used for detecting **lipids** and **lipofuscin** in various cells and tissues - Often utilized in **hematology** to differentiate myeloid cells from lymphoid cells based on their granule content, but not for reticulocytes *Incorrect: Methyl violet* - **Methyl violet** is a basic dye used as a **histological stain** and for staining **Gram-positive bacteria** in bacteriology - While it can stain cellular components, it is not specifically used for the identification or enumeration of reticulocytes **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-579.

Q: ALL L3 morphology is a malignancy arising from which cell lineage –

Mature B cell. ***Mature B cell*** - ALL L3, also known as **Burkitt-type ALL**, arises from a **mature B-cell lineage**. [1] - This is characterized by specific immunophenotypic markers (e.g., strong expression of **surface immunoglobulin** and **CD20**) and frequent chromosomal translocations involving the **MYC oncogene**, typically t(8;14). [1] *Mixed B cell & T cell* - This refers to **mixed phenotype acute leukemia (MPAL)**, which exhibits features of both B-cell and T-cell lineages. - MPAL is distinct from ALL L3, which is definitively B-cell in origin based on morphology and immunophenotype. *Immature T cell* - Malignancies arising from immature T cells are classified as **T-cell ALL**, which have a different morphology (L1 or L2) and distinct immunophenotype (e.g., expression of **cytoplasmic CD3**, CD1a, CD2, CD5, CD7). [1] - T-cell ALL is characterized by **T-cell receptor gene rearrangements** and typically presents with a mediastinal mass, unlike ALL L3. [1] *Precursor B cell* - Most cases of ALL (ALL L1 and L2) arise from **precursor B cells**, also known as B-lymphoblastic leukemia. [2] - These are characterized by lack of surface immunoglobulin expression and generally express **CD10, CD19, CD22**, and **TdT**, contrasting with the mature B-cell immunophenotype of ALL L3. [2] **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. [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. 596-598.

Q: Packed red cells are commonly stored in which preservative solution?

CPDA-1 solution. ***Correct: CPDA-1 solution*** - **CPDA-1** (Citrate-Phosphate-Dextrose-Adenine) is the standard anticoagulant and preservative solution taught in Indian medical curricula - Allows storage of packed red cells for **35 days** at 1-6°C - Contains citrate (anticoagulant), phosphate (buffer), dextrose (RBC energy), and adenine (ATP synthesis) - Most commonly referenced in NEET-PG examinations as the standard storage solution *AS-1 (Adsol) solution* - Additive solution used primarily in the United States for extended PRBC storage (42 days) - Added to red cells after plasma removal to maintain viability - While effective, it is not the primary solution taught in standard Indian medical education *SAG-M solution* - **SAG-M** (Saline-Adenine-Glucose-Mannitol) is an additive solution used primarily in Europe - Extends packed red cell storage to **42 days** - Functionally similar to other additive solutions but less commonly referenced in Indian medical curriculum *AS-3 (Nutricel) solution* - Another additive solution for red blood cell storage used in the US - Designed to extend shelf life to 42 days - Like AS-1, it is not the standard preservative solution taught in Indian medical education **Note:** Modern blood banking increasingly uses additive solutions (AS-1, AS-3, SAG-M) for extended storage, but CPDA-1 remains the fundamental preservative solution taught in medical education.

Q: Glycoprotein IIb-IIIa complex is deficient in

Glanzmann disease. ***Glanzmann disease*** - This condition is characterized by a deficiency or qualitative defect of the **glycoprotein IIb-IIIa (GPIIb-IIIa) complex** on the platelet surface [1]. - The GPIIb-IIIa complex is crucial for **platelet aggregation** as it acts as a receptor for **fibrinogen**, connecting platelets [1], [2]. *Bernard-Soulier syndrome* - This syndrome involves a deficiency of the **glycoprotein Ib-IX-V complex**, which is responsible for **platelet adhesion** to **von Willebrand factor (vWF)** on the subendothelium [1], [2]. - Patients present with **large platelets** and impaired platelet adhesion. *Gray platelet syndrome* - This is a rare bleeding disorder characterized by a deficiency of **alpha-granules** in platelets [4]. - Platelets in this condition appear 'gray' on a blood smear due to the lack of alpha-granules that contain growth factors and adhesion proteins [4]. *von Willebrand disease* - This is primarily a deficiency or dysfunction of **von Willebrand factor (vWF)**, which is essential for **platelet adhesion** and stability of **factor VIII** [3]. - It does not directly involve a deficiency of the GPIIb-IIIa complex itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 668-669. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, p. 128. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 669-670. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 581-582.

Question 1

In APML (Acute Promyelocytic Leukemia), all of the following are seen except:

Accepted Answer

CD 15/34 both seen in same cell

Answer

Retinoic acid is used in treatment

Answer

15/17 translocation may be seen

Answer

Associated with Disseminated intravascular coagulation (DIC)

Question 2

Radiation is most commonly associated with which of the following cancer?

Accepted Answer

Leukemia

Answer

Lymphoma

Answer

Lung carcinoma

Answer

Osteosarcoma

Question 3

Necrotizing lymphadenitis is seen in

Accepted Answer

Kikuchi-Fujimoto disease

Answer

Kimura disease

Answer

Hodgkin's lymphoma

Answer

Castleman disease

Question 4

Necrotizing lymphadenopathy is characteristically seen in:

Accepted Answer

Kikuchi disease

Answer

Non-Hodgkin's lymphoma

Answer

Castleman's disease

Answer

Kimura disease

Question 5

Fetomaternal transfusion of fetal RBCs in mother can be detected by: UPSC 08; TN 08; AIIMS 10

Accepted Answer

Betke-Kleihauer test

Answer

Electrophoresis

Answer

Indirect Coomb's test

Answer

Direct Coomb's test

Question 6

Which of the following stains is used for reticulocyte staining?

Accepted Answer

Brilliant cresyl blue

Answer

Indigo carmine

Answer

Sudan black

Answer

Methyl violet

Question 7

ALL L3 morphology is a malignancy arising from which cell lineage –

Accepted Answer

Mature B cell

Answer

Mixed B cell & T cell

Answer

Immature T cell

Answer

Precursor B cell

Question 8

Packed red cells are commonly stored in which preservative solution?

Accepted Answer

CPDA-1 solution

Answer

AS-1 (Adsol) solution

Answer

SAG-M solution

Answer

AS-3 (Nutricel) solution

Question 9

Glycoprotein IIb-IIIa complex is deficient in

Accepted Answer

Glanzmann disease

Answer

Gray platelet syndrome

Answer

von Willebrand disease

Answer

Bernard-Soulier syndrome

Question 10

Which among the following statements is wrong?

Accepted Answer

M components are detected in chronic myeloid leukemia.

Answer

In 20% of myelomas, only light chains are produced.

Answer

Light chains are synthesized in slight excess normally in plasma cells.

Answer

Qualitative assessment of M component can be done by electrophoresis.

Hematopathology — MCQs

Hematopathology — MCQs

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