Hematopathology Practice Questions

Q: Which condition is characterized by a "starry sky" appearance on histopathology?

Burkitt's lymphoma. **Explanation:** **Burkitt’s Lymphoma (Correct Answer):** The "starry sky" appearance is the classic histopathological hallmark of Burkitt’s lymphoma [1]. This pattern is created by a high rate of tumor cell proliferation and apoptosis. The "stars" are **tingible body macrophages**—large, pale-staining phagocytes that have ingested apoptotic tumor debris [1]. The "sky" is formed by a dense, dark background of small, monotonous, non-cleaved B-lymphocytes [1]. **Analysis of Incorrect Options:** * **Paget’s Disease of Bone:** Characterized by a **"mosaic" or "jigsaw puzzle" pattern** of bone due to irregular prominent cement lines caused by repeated episodes of bone resorption and formation. * **Cherubism:** Shows a histopathology similar to Central Giant Cell Granuloma, featuring fibrous stroma with numerous **multinucleated giant cells**, but lacks the starry sky pattern. * **Garré’s Osteomyelitis:** Also known as proliferative periostitis, it is characterized by an **"onion-skin" appearance** due to the formation of duplicate layers of cortical bone. **NEET-PG High-Yield Pearls:** * **Genetics:** Strongly associated with **t(8;14)** translocation, involving the **c-myc** oncogene. * **Variants:** The Endemic (African) variant is 100% associated with **Epstein-Barr Virus (EBV)** and typically involves the jaw. * **Immunophenotype:** B-cell markers (CD19, CD20, CD22) and strongly positive for **Ki-67** (nearly 100% growth fraction). * **Cytology:** "Royal blue" cytoplasm with cytoplasmic vacuoles on fine-needle aspiration (FNA). **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.

Q: In iron deficiency anemia, what is typically observed?

Increased protoporphyrin. **Explanation:** In Iron Deficiency Anemia (IDA), the correct finding is **Increased Free Erythrocyte Protoporphyrin (FEP)**. **Why the correct answer is right:** Heme synthesis occurs in the mitochondria, where the enzyme **Ferrochelatase** inserts ferrous iron ($Fe^{2+}$) into a Protoporphyrin IX ring [1]. In IDA, there is a lack of available iron to complete this reaction. Consequently, Protoporphyrin cannot be converted into Heme, leading to its accumulation within the red blood cells. This makes FEP a sensitive marker for "iron-deficient erythropoiesis." **Why the incorrect options are wrong:** * **B. Increased iron:** In IDA, serum iron levels are **decreased** due to depleted body stores. * **C. Increased ferritin:** Ferritin is the storage form of iron. It is the **first parameter to decrease** in IDA, reflecting the exhaustion of iron stores. (Note: Ferritin is an acute-phase reactant and may be falsely normal/high in inflammation). * **D. Increased transferrin saturation:** Transferrin saturation (Serum Iron/TIBC) **decreases** (typically <15%) because serum iron is low while the Total Iron Binding Capacity (TIBC) increases as the liver produces more transferrin to compensate for the deficiency [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign of IDA:** Decreased Serum Ferritin. * **Gold Standard investigation:** Bone marrow aspiration with **Perl’s Prussian Blue stain** (showing absent haemosiderin in macrophages). * **Mentzer Index:** (MCV/RBC count) >13 suggests IDA, whereas <13 suggests Thalassemia trait. * **Blood Picture:** Microcytic hypochromic anemia with increased RDW (Anisocytosis) [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 587-591.

Q: Cyclin D1 translocation is seen in which of the following conditions?

Mantle cell lymphoma. **Explanation:** **Mantle Cell Lymphoma (MCL)** is characterized by the hallmark cytogenetic abnormality **t(11;14)(q13;q32)** [1]. This translocation involves the fusion of the **CCND1 gene** (on chromosome 11) with the **IgH (Immunoglobulin Heavy chain) promoter** (on chromosome 14). This leads to the constitutive overexpression of **Cyclin D1** [1], a protein that promotes the transition of cells from the G1 phase to the S phase of the cell cycle by phosphorylating the Retinoblastoma (Rb) protein. In normal B-cells, Cyclin D1 is not expressed; thus, its detection via immunohistochemistry is a diagnostic gold standard for MCL. **Analysis of Incorrect Options:** * **Follicular Lymphoma:** Characterized by **t(14;18)**, leading to the overexpression of the **BCL-2** anti-apoptotic protein. * **Hodgkin Lymphoma:** Typically lacks specific diagnostic translocations. It is characterized by Reed-Sternberg cells expressing CD15 and CD30 (in Classical HL). * **Melanoma:** While Cyclin D1 can be overexpressed in some melanomas due to gene amplification (notably in acral lentiginous types), it is not defined by a characteristic translocation like MCL. The most high-yield mutations for melanoma are **BRAF (V600E)** and **c-KIT**. **High-Yield Clinical Pearls for NEET-PG:** * **MCL Marker:** CD5 positive, CD23 negative (helps differentiate from CLL/SLL which is CD23+). * **Morphology:** Presence of "centrocyte-like" cells; can present as **Lymphomatous Polyposis** in the GI tract. * **Aggressive Nature:** MCL is generally considered an aggressive, incurable B-cell lymphoma with a poor 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. 610-612.

Question 1

Which of the following cell types is NOT typically found in myelodysplastic syndrome?

Accepted Answer

Megakaryocytes with normal single multilobulated nuclei

Answer

Ringed sideroblasts

Answer

Pseudo-Pelger-Huet cells

Answer

Pawn ball megakaryocytes

Question 2

Howell-Jolly bodies may be seen after which procedure?

Accepted Answer

Splenectomy

Answer

Hepatectomy

Answer

Pancreatectomy

Answer

Cholecystectomy

Question 3

What type of anemia is caused by antibodies against blood group antigens?

Accepted Answer

Hemolytic disease of the newborn

Answer

Hereditary spherocytosis

Answer

G6PD deficiency

Answer

Alpha thalassemia major

Question 4

Which condition is characterized by a "starry sky" appearance on histopathology?

Accepted Answer

Burkitt's lymphoma

Answer

Paget's disease of bone

Answer

Cherubism

Answer

Garré's osteomyelitis

Question 5

Which of the following is NOT included in the differential diagnosis of a Reticulocyte Index > 2.5?

Accepted Answer

Macrocytic anemia

Answer

Hemolysis

Answer

Hemoglobinopathy

Answer

Blood loss

Question 6

In iron deficiency anemia, what is typically observed?

Accepted Answer

Increased protoporphyrin

Answer

Increased iron

Answer

Increased ferritin

Answer

Increased transferrin saturation

Question 7

Absolute lymphocytosis is seen in which of the following conditions?

Accepted Answer

Tuberculosis (TB)

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Chronic Lymphocytic Leukemia (CLL)

Answer

Brucellosis

Question 8

A female with recurrent abortion and isolated prolonged APTT is most likely associated with which of the following?

Accepted Answer

Lupus anticoagulant

Answer

Disseminated intravascular coagulation (DIC)

Answer

Von Willebrand disease

Answer

Hemophilia

Question 9

All are features of hemolytic anemia, except?

Accepted Answer

Increased haptoglobin

Answer

Hemoglobinuria

Answer

Jaundice

Answer

Hemosiderinuria

Question 10

Cyclin D1 translocation is seen in which of the following conditions?

Accepted Answer

Mantle cell lymphoma

Answer

Follicular lymphoma

Answer

Hodgkin lymphoma

Answer

Melanoma

Hematopathology — MCQs

Hematopathology — MCQs

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