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. **Explanation:** Both **Lymphocyte-Rich Hodgkin Lymphoma (LRHL)** and **Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)** are characterized by an excellent clinical outcome [1]. They typically present at early stages (Stage I or II) and have a very high cure rate, making **"Good prognosis"** the defining shared feature. **Analysis of Options:** * **A. Paucity of diagnostic Reed-Sternberg (RS) cells:** This is true for **LRHL**, where classic RS cells are rare against a background of small lymphocytes [2]. However, **NLPHL** does not contain "classic" RS cells at all; instead, it features **L&H (Lymphocytic and Histiocytic) cells**, also known as "Popcorn cells" [1]. * **B. EBV Association:** LRHL is associated with EBV in about 40% of cases. In contrast, **NLPHL is almost never associated with EBV** [1], making this a distinguishing factor rather than a shared one. * **C. CD20 Positivity:** This is the hallmark of **NLPHL** (Popcorn cells are CD20+, CD45+, but CD15- and CD30-) [1]. In **LRHL**, the RS cells follow the classic immunophenotype: **CD15+, CD30+, and CD20 negative**. **High-Yield Pearls for NEET-PG:** * **NLPHL** is now considered a distinct entity from Classic Hodgkin Lymphoma (CHL) due to its B-cell marker expression (CD20) [1]. * **LRHL** is a subtype of **Classic Hodgkin Lymphoma** but mimics NLPHL morphologically [2]. * **Popcorn cells (L&H cells)** = NLPHL [1]. * **Most common subtype** of HL = Nodular Sclerosis. * **Best prognosis** = NLPHL / LRHL; **Worst prognosis** = Lymphocyte Depleted. **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. [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.

Q: The above marked structures are seen in all except?

Thalassemia. ***Thalassemia*** - The spleen remains **functionally intact** in thalassemia and actively removes **Howell-Jolly bodies** from circulation. - Despite splenomegaly from hemolysis, splenic function is preserved, effectively culling nuclear remnants from RBCs. *Sickle cell anemia* - **Functional asplenia** develops due to repeated **sickling crises** causing splenic autoinfarction and fibrosis. - The damaged spleen cannot remove **Howell-Jolly bodies**, leading to their persistence in peripheral blood. *Liver cirrhosis* - Advanced cirrhosis causes **splenic dysfunction** and **hyposplenism** due to portal hypertension and compromised splenic blood flow. - The dysfunctional spleen fails to filter **Howell-Jolly bodies**, allowing them to remain in circulation. *Chronic myeloid leukemia (CML)* - **Leukemic cell infiltration** of the spleen impairs its normal filtering function and causes splenic dysfunction. - The compromised spleen cannot effectively remove **Howell-Jolly bodies** from the bloodstream.

Q: Popcorn cells are characteristic of which of the following hematological malignancies?

Hodgkin’s lymphoma. **Explanation:** **Popcorn cells** (also known as L&H cells—Lymphocytic and Histiocytic variants) are the hallmark diagnostic feature of **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)**, a specific subtype of Hodgkin’s Lymphoma [1]. These cells are characterized by large, multi-lobed nuclei resembling a kernel of popped corn, with inconspicuous nucleoli. Unlike the classic Reed-Sternberg (RS) cells found in other subtypes, popcorn cells are **CD20 positive** and CD15/CD30 negative [1]. **Analysis of Options:** * **Option A (Correct):** Popcorn cells are a variant of RS cells specific to NLPHL [1]. While classic Hodgkin Lymphoma features "Owl-eye" RS cells, NLPHL is unique for these "popcorn" variants. * **Option B:** Non-Hodgkin’s Lymphoma (NHL) consists of a diverse group of B-cell and T-cell malignancies (like Follicular or Diffuse Large B-cell Lymphoma) that do not typically feature popcorn cells. * **Option C:** Burkitt’s Lymphoma is characterized by a **"Starry-sky" appearance** on low power, consisting of medium-sized B-cells with high mitotic activity and tingible body macrophages. * **Option D:** Multiple Myeloma is a plasma cell dyscrasia characterized by "Clock-face" chromatin in plasma cells, Mott cells, and Flame cells, rather than popcorn cells. **High-Yield Clinical Pearls for NEET-PG:** * **Immunophenotype of Popcorn Cells:** CD20+, CD45+, but **CD15- and CD30-** (the opposite of classic Hodgkin Lymphoma). * **Classic RS Cell:** Binucleated with prominent eosinophilic nucleoli ("Owl-eye"). * **Lacunar Cells:** Characteristic of the **Nodular Sclerosis** subtype of Hodgkin Lymphoma. * **Mnemonic:** NLPHL = **N**egative for 15/30, **L**&H cells, **P**opcorn appearance. **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. 614-618.

Question 1

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) is associated

Answer

Reed-Sternberg cells are CD20 positive

Question 2

All of the following statements about the Philadelphia chromosome in CML are true, except:

Accepted Answer

The Philadelphia chromosome with the oncogenic BCR-ABL gene is found on chromosome 9.

Answer

It is a reciprocal translocation between the long arm of chromosome 9 and the long arm of chromosome 22.

Answer

The breakpoint cluster region (BCR) is located on the long arm of chromosome 22.

Answer

The ABL gene is located on chromosome 9.

Question 3

Working formulation in staging of non-Hodgkin's lymphoma is based on which of the following?

Accepted Answer

Morphology of cells

Answer

Cell surface markers

Answer

Survival characteristics of cells

Answer

Cellular genetics

Question 4

What is true about follicular lymphoma?

Accepted Answer

Lymphadenopathy is the most common presentation.

Answer

BCL-2 positive

Answer

CD5 positive

Answer

More common in females than males.

Question 5

The above marked structures are seen in all except?

Accepted Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Liver cirrhosis

Answer

Chronic myeloid leukemia (CML)

Question 6

Non-specific esterase is positive in all categories of AML except?

Accepted Answer

M6

Answer

M3

Answer

M4

Answer

M5

Question 7

Popcorn cells are characteristic of which of the following hematological malignancies?

Accepted Answer

Hodgkin’s lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Burkitt’s lymphoma

Answer

Multiple myeloma

Question 8

Reticulocytes are stained by which method?

Accepted Answer

Supravital stain

Answer

Prussian blue stain

Answer

Hematoxylin and Eosin (H&E) stain

Answer

Reticulin stain

Question 9

Radiological examination shows evidence of bone infarct in a child. Which of the following conditions may be responsible?

Accepted Answer

Sickle cell disease

Answer

Iron deficiency anemia

Answer

Thalassemia

Answer

Hereditary spherocytosis

Question 10

Which of the following is NOT typically seen in Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Normal Activated Partial Thromboplastin Time (APTT)

Answer

Decreased fibrinogen

Answer

Thrombocytopenia

Answer

Elevated Prothrombin Time (PT)

Hematopathology — MCQs

Hematopathology — MCQs

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