Hematopathology Practice Questions

Q: Which of the following markers are seen in Primary effusion lymphoma?

CD30, CD138. **Primary Effusion Lymphoma (PEL)** is a rare, aggressive B-cell non-Hodgkin lymphoma caused by **Human Herpesvirus-8 (HHV-8)**, typically occurring in HIV-positive or immunocompromised patients [1]. ### **Why Option A is Correct?** PEL has a unique "null" phenotype or a **plasmablastic** immunophenotype. Although it is a B-cell malignancy, it characteristically lacks traditional B-cell markers (like CD19, CD20, and CD79a) [1]. Instead, it expresses markers of terminal B-cell differentiation: * **CD138 (Syndecan-1):** A plasma cell marker consistently expressed in PEL. * **CD30:** Frequently expressed (approx. 70% of cases), reflecting its activated/transformed state. * **Other markers:** EMA (Epithelial Membrane Antigen) and CD45 are often positive. ### **Why Other Options are Incorrect?** * **Options B & C (CD19, CD20):** These are pan-B-cell markers. PEL is defined by the **absence** of these surface markers (downregulated during plasmablastic transformation) [1]. Their presence would point toward other B-cell lymphomas like DLBCL. * **Option D (CD29):** CD29 is an integrin subunit not used as a diagnostic marker for PEL. ### **High-Yield Clinical Pearls for NEET-PG** 1. **Viral Association:** 100% of cases are associated with **HHV-8** (KSHV) [1]. Many are also co-infected with **EBV**. 2. **Clinical Presentation:** Presents as malignant effusions (pleural, pericardial, or peritoneal) **without** a detectable solid tumor mass or lymphadenopathy [1]. 3. **Morphology:** Cells show "plasmablastic" or "immunoblastic" features. 4. **Key Diagnostic Step:** Detection of **LANA-1** (Latent Nuclear Antigen-1) via immunohistochemistry confirms HHV-8 infection. **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. 604-605.

Q: What is the most common lymph node involved in Hodgkin's lymphoma?

Cervical. **Explanation:** **Hodgkin’s Lymphoma (HL)** typically presents as a painless, rubbery enlargement of lymph nodes. The disease characteristically follows a predictable, contiguous pattern of spread through the lymphatic system. **1. Why Cervical is Correct:** The **cervical lymph nodes** (specifically the upper cervical, supraclavicular, or mediastinal groups) are the most common site of involvement, seen in approximately **60-80% of cases** at the time of diagnosis [1]. This predilection is particularly strong in the Nodular Sclerosis and Mixed Cellularity subtypes [1]. The involvement is usually asymmetrical and often starts in the neck before spreading to the mediastinum. **2. Why Other Options are Incorrect:** * **Axillary (C):** While frequently involved, it is less common than cervical nodes (approx. 10-15%). * **Inguinal (A):** Involvement of the inguinal nodes is relatively rare in HL (approx. 6-10%) and is more commonly associated with Non-Hodgkin Lymphoma (NHL) or localized infections/malignancies of the lower extremities and pelvis. * **Sub-clavicular (D):** While supraclavicular nodes are common, "sub-clavicular" nodes are not a primary or most frequent site of presentation compared to the cervical chain. **Clinical Pearls for NEET-PG:** * **Bimodal Age Distribution:** HL shows two peaks—one in the 20s and another after age 50. * **Reed-Sternberg (RS) Cells:** The diagnostic hallmark (e.g., "Owl’s eye" appearance) [1]. * **Alcohol-Induced Pain:** A classic, high-yield clinical sign where pain occurs in the involved lymph nodes after alcohol consumption. * **Staging:** The **Ann Arbor Staging System** is used, and the presence of "B symptoms" (fever, night sweats, weight loss) indicates a worse prognosis [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. 616-618.

Q: Which of the following statements regarding Myelodysplasia is FALSE?

Patients with 5q deletion have a poor prognosis.. **Explanation:** **1. Why Option A is the Correct (False) Statement:** In Myelodysplastic Syndromes (MDS), the **5q deletion (5q- syndrome)** is actually associated with a **favorable prognosis** [1]. It typically occurs in elderly females and is characterized by severe macrocytic anemia, a normal or elevated platelet count, and a low risk of transformation to Acute Myeloid Leukemia (AML) [1]. These patients show an excellent therapeutic response to **Lenalidomide**. **2. Analysis of Other Options (True Statements):** * **Option B:** Dyserythropoiesis in MDS often manifests as **basophilic stippling**, ring sideroblasts, and nuclear budding/fragmentation [1]. * **Option C:** Dysmegakaryopoiesis is a hallmark of MDS. **Micromegakaryocytes** (Pawn ball megakaryocytes) with small, non-lobulated nuclei are classic bone marrow findings [1]. * **Option D:** Dysgranulopoiesis leads to the formation of **Pseudo-Pelger-Huët cells**, which are hyposegmented (bilobed or peanut-shaped) and hypogranular neutrophils seen in the peripheral blood [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition:** MDS is a clonal stem cell disorder characterized by "Ineffective Hematopoiesis" (Hypercellular marrow but peripheral cytopenia) [1]. * **IPSS Score:** Used for prognosis; based on blast percentage, cytogenetics, and number of cytopenias. * **Cytogenetics:** Good prognosis (5q-, 20q-, -Y); Poor prognosis (Complex karyotype, Chromosome 7 abnormalities) [1]. * **Ring Sideroblasts:** Defined as $\geq$ 5 iron granules encircling $\geq$ 1/3rd of the nucleus (Prussian Blue stain). * **Transformation:** MDS can transform into AML if blasts in the marrow reach $\geq$ 20% [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Question 1

Which of the following is a cause for disseminated intravascular coagulation (DIC)?

Accepted Answer

Malignancy

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Lymphoma

Answer

Massive blood transfusion

Question 2

Which CD marker is specific for the myeloid series?

Accepted Answer

CD117

Answer

CD34

Answer

CD45

Answer

CD99

Question 3

According to WHO, which of the following is not a B cell lymphoma?

Accepted Answer

Anaplastic large cell lymphoma

Answer

Burkitt's lymphoma

Answer

Follicular lymphoma

Answer

Mantle cell lymphoma

Question 4

Auer bodies are seen in which of the following subtypes of Acute Myeloid Leukemia (AML)?

Accepted Answer

M1-AML

Answer

M3-AML

Answer

M6-AML

Answer

Acute Lymphoblastic Leukemia (ALL)

Question 5

Which of the following markers are seen in Primary effusion lymphoma?

Accepted Answer

CD30, CD138

Answer

CD20, CD28

Answer

CD19, CD20

Answer

CD29, CD30

Question 6

What is the most common lymph node involved in Hodgkin's lymphoma?

Accepted Answer

Cervical

Answer

Inguinal

Answer

Axillary

Answer

Sub-clavicular

Question 7

Fresh frozen plasma is used in which of the following conditions?

Accepted Answer

Specific clotting factor deficiency

Answer

Acute blood loss

Answer

Nutritive support

Answer

Decreased blood volume

Question 8

Sezary syndrome is classified under which category?

Accepted Answer

T cell leukemia

Answer

Lymphoma

Answer

B cell leukemia

Answer

Pigmented disorder of skin

Question 9

Which of the following statements regarding Myelodysplasia is FALSE?

Accepted Answer

Patients with 5q deletion have a poor prognosis.

Answer

Erythroid cells with basophilic stippling are seen.

Answer

Micromegakaryocytes are seen in the bone marrow.

Answer

Hypolobulated neutrophils are seen in peripheral blood.

Question 10

Eosinophilic granuloma results from the proliferation of which cell type?

Accepted Answer

Histiocytes

Answer

Eosinophils

Answer

Lymphocytes

Answer

Fibroblasts

Hematopathology — MCQs

Hematopathology — MCQs

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