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: Cell of origin of hairy cell leukemia is?

B-cell. Hairy Cell Leukemia (HCL) is a rare, chronic lymphoproliferative disorder characterized by the proliferation of mature B-lymphocytes. **1. Why B-cell is correct:** The cell of origin in HCL is a **mature memory B-cell** (post-germinal center). These cells exhibit characteristic "hairy" cytoplasmic projections. They express pan-B-cell markers such as **CD19, CD20, and CD22**. Crucially, they also express highly specific markers like **CD103** (most specific), **CD11c, CD25, and Annexin A1**. Almost all cases (approx. 95%) harbor the **BRAF V600E mutation**, which is a key diagnostic feature. **2. Why other options are incorrect:** * **T-cell & NK-cell:** While some rare T-cell leukemias can mimic the morphology of HCL (e.g., T-cell prolymphocytic leukemia), HCL is strictly a B-cell malignancy. T-cell and NK-cell markers (like CD3, CD4, CD8, or CD56) are negative in HCL. * **Dendritic reticulum cell:** These are antigen-presenting cells found in lymphoid follicles. While they interact with B-cells, they are not the progenitors of HCL. **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). * **Diagnosis:** TRAP (Tartrate-Resistant Acid Phosphatase) positive staining; "Fried egg appearance" on bone marrow biopsy. * **Treatment:** Cladribine (2-Chlorodeoxyadenosine) is the drug of choice. * **Key Association:** Increased risk of atypical mycobacterial infections (e.g., *Mycobacterium avium-intracellulare*).

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 one of the following lymphomas is associated with HTLV-virus infection?

Accepted Answer

Adult T-cell leukemia and lymphoma

Answer

Burkitt's lymphoma

Answer

B-cell lymphoma

Answer

Hodgkin's disease

Question 2

Prognosis of lymphoma depends on all of the following except:

Accepted Answer

Associated symptoms

Answer

Number of lymph node sites

Answer

Tumour size

Answer

Tumour stage

Question 3

HbH disease is characterized by which of the following genetic defects?

Accepted Answer

Deletion of three alpha-globin genes

Answer

Deletion of three alpha-globin genes and one beta-globin gene

Answer

Deletion of two alpha-globin and two beta-globin genes

Answer

Deletion of four alpha-globin genes

Question 4

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 5

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 6

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 7

Cell of origin of hairy cell leukemia is?

Accepted Answer

B-cell

Answer

T-cell

Answer

NK-cell

Answer

Dendritic reticulum cell

Question 8

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 9

Which of the following statements about acute hemolytic reactions is false?

Accepted Answer

Associated with fever, chills, and rigors.

Answer

Multi-organ failure can occur.

Answer

Intravascular hemolysis is typically observed.

Answer

Often mediated by complement activation.

Question 10

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

Hematopathology — MCQs

Hematopathology — MCQs

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