Hematopathology Practice Questions

Q: What is the most common site of MALToma?

Stomach. **Explanation:** **MALToma (Mucosa-Associated Lymphoid Tissue lymphoma)** is a type of extranodal marginal zone B-cell lymphoma. Under normal physiological conditions, the stomach lacks organized lymphoid tissue. However, chronic inflammation—most commonly due to **_Helicobacter pylori_ infection**—induces the formation of acquired MALT in the gastric mucosa [1]. Chronic antigenic stimulation leads to the proliferation of B-cells, eventually resulting in neoplastic transformation. * **Stomach (Correct):** It is the **most common site** for extranodal lymphomas, accounting for approximately 50% of all cases. Within the GI tract, the stomach is the site of origin for about 85% of MALTomas [1]. * **Neck & Mediastinum (Incorrect):** While nodal lymphomas (like Hodgkin or Diffuse Large B-cell Lymphoma) frequently involve cervical or mediastinal lymph nodes, MALToma is specifically an **extranodal** entity. * **Vertebra (Incorrect):** Bone involvement is characteristic of Multiple Myeloma or metastatic disease, not MALToma. **High-Yield Clinical Pearls for NEET-PG:** * **Association:** Strongly linked to **_H. pylori_** (80% of cases) [1]. Eradication of the bacteria with antibiotics can lead to complete regression of the tumor in early stages. * **Cytogenetics:** The most common translocation is **t(11;18)(q21;q21)**, involving the *API2-MLT* gene fusion. This translocation is typically associated with resistance to _H. pylori_ eradication therapy. * **Histology:** Characterized by **lymphoepithelial lesions** (invasion of gastric glands by neoplastic B-cells). * **Markers:** CD19+, CD20+, CD22+, and **CD5- / CD10-** (helps differentiate from Mantle cell and Follicular lymphoma). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.

Q: The Fleischer assay is used for which of the following conditions?

Paroxysmal nocturnal hemoglobinuria. **Explanation:** **Paroxysmal Nocturnal Hemoglobinuria (PNH)** is an acquired clonal hematopoietic stem cell disorder characterized by a mutation in the **PIGA gene**. This mutation leads to a deficiency of Glycosylphosphatidylinositol (GPI) anchors, which are necessary to attach protective proteins like **CD55 (DAF)** and **CD59 (MIRL)** to the red blood cell membrane [1]. Without these proteins, RBCs are highly susceptible to complement-mediated lysis. The **Fleischer Assay** (also known as the **Proaerolysin variant assay**) is a specialized diagnostic test for PNH. It utilizes a fluorescently labeled, inactive variant of **Aerolysin** (a bacterial toxin from *Aeromonas hydrophila*). Unlike the traditional Ham’s test or Sucrose Hemolysis test, which are now largely obsolete, the Fleischer assay (specifically **FLAER** - Fluorescent Proaerolysin) binds directly to the GPI anchors. In PNH, the absence of these anchors results in a lack of binding, which is then detected via flow cytometry [1]. This is currently the "Gold Standard" for diagnosis due to its high sensitivity and specificity. **Why other options are incorrect:** * **Hereditary Spherocytosis:** Diagnosed via the Osmotic Fragility Test or the **EMA (Eosin-5-maleimide) binding test**. * **Thalassemia:** Diagnosed via **Hb Electrophoresis** or HPLC to identify abnormal hemoglobin chains. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for PNH:** Flow cytometry using **FLAER**. * **Classic Triad:** Hemolytic anemia, pancytopenia, and venous thrombosis (often in unusual sites like the Budd-Chiari syndrome) [1]. * **Key Markers:** Deficiency of CD55 and CD59. * **Treatment:** Eculizumab (a monoclonal antibody against C5 complement). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651.

Q: Which of the following is NOT a cause of microcytic hypochromic anemia?

Sickle cell disease. Microcytic hypochromic anemia is characterized by a Mean Corpuscular Volume (MCV) < 80 fL and a Mean Corpuscular Hemoglobin Concentration (MCHC) < 32 g/dL. This occurs due to defects in hemoglobin synthesis (heme or globin). **Why Sickle Cell Disease is the correct answer:** Sickle cell disease (SCD) is a qualitative hemoglobinopathy [1] (substitution of valine for glutamic acid) [2]. It typically presents as a **Normocytic Normochromic Anemia** with a high reticulocyte count due to its hemolytic nature. While chronic hemolysis can lead to secondary iron deficiency (microcytosis), the primary disease process itself is normocytic. **Analysis of other options:** * **Iron Deficiency Anemia (IDA):** The most common cause of microcytic hypochromic anemia worldwide due to defective heme synthesis [2]. * **Aplastic Anemia:** This is a bone marrow failure syndrome characterized by pancytopenia. It typically presents as **Normocytic** or occasionally **Macrocytic** anemia (due to stress erythropoiesis), but never microcytic. * **Hereditary Spherocytosis:** This is a red cell membrane defect. It typically presents as **Normocytic** anemia, but it is unique for having an **elevated MCHC** (hyperchromic appearance) due to membrane loss and cellular dehydration. *(Note: The question as provided contains a technical discrepancy. Both A, B, and D are typically NOT microcytic. However, in the context of NEET-PG, if forced to choose the "most" correct among non-microcytic options, SCD is often grouped with hemolytic anemias which are normocytic.)* **NEET-PG High-Yield Pearls:** * **Mnemonic for Microcytic Anemia (TAILS):** **T**halassemia, **A**nemia of chronic disease (late), **I**ron deficiency, **L**ead poisoning, **S**ideroblastic anemia. * **Mentzer Index (MCV/RBC):** 13 suggests Iron Deficiency Anemia. * **Hereditary Spherocytosis:** Look for increased MCHC and a positive Osmotic Fragility Test.

Question 1

What is the most common site of MALToma?

Accepted Answer

Stomach

Answer

Neck

Answer

Mediastinum

Answer

Vertebra

Question 2

The Fleischer assay is used for which of the following conditions?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

All of the above

Question 3

What is the typical TIBC (Total Iron-Binding Capacity) in Anemia of chronic disease compared to Iron deficiency anemia?

Accepted Answer

Decreased in Anemia of chronic disease and increased in Iron deficiency anemia

Answer

Increased in both

Answer

Decreased in both

Answer

Increased in Anemia of chronic disease and decreased in Iron deficiency anemia

Question 4

Deficiency or inhibition by blocking antibodies of ADAMTS-13 (a metalloprotein) is found in which of the following conditions?

Accepted Answer

Thrombotic Thrombocytopenic Purpura

Answer

Idiopathic Thrombocytopenic Purpura

Answer

Henoch Schonlein Purpura

Answer

Hemophilia

Question 5

An 18-year-old patient's hemogram shows Hb 12 g/dL, RBC count of 6 million/µL, decreased MCV of 56 fL, decreased MCH of 29 pg, and RDW of 14%. What is the most probable diagnosis?

Accepted Answer

Beta-thalassemia trait

Answer

Iron deficiency

Answer

Folate deficiency

Answer

Normal laboratory parameters

Question 6

Hypopigmentation, gray streaks of hair, degranulation defect of neutrophils, and neuropathy are seen in which of the following conditions?

Accepted Answer

Chediak-Higashi syndrome

Answer

Aleukemic Leukemia

Answer

Chronic granulocytic leukemia

Answer

Lazy leukocyte syndrome

Question 7

What is the most common site of lymph node enlargement in Hodgkin's lymphoma?

Accepted Answer

Mediastinal

Answer

Axillary

Answer

Cervical

Answer

Abdominal

Question 8

Which of the following is NOT a cause of microcytic hypochromic anemia?

Accepted Answer

Sickle cell disease

Answer

Aplastic anemia

Answer

Iron deficiency anemia

Answer

Hereditary spherocytosis

Question 9

Which is the most common subtype of acute myeloid leukemia according to the FAB classification?

Accepted Answer

M2

Answer

M3

Answer

M4

Answer

M5

Question 10

Which of the following is NOT a cause for Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Cholera

Answer

Septicemia

Answer

Visceral carcinoma

Answer

Antepartum hemorrhage

Hematopathology — MCQs

Hematopathology — MCQs

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