Hematopathology Practice Questions

Q: What are the cytogenetic abnormalities associated with lymphoplasmacytoid lymphoma?

t(9;14)(p13;q32). **Explanation:** **Lymphoplasmacytoid Lymphoma (LPL)**, often associated with **Waldenström Macroglobulinemia**, is a B-cell neoplasm characterized by the proliferation of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells. [1] **Why Option A is correct:** The characteristic cytogenetic abnormality in LPL is **t(9;14)(p13;q32)**. This translocation involves the **PAX5 gene** on chromosome 9 and the **Immunoglobulin Heavy Chain (IgH) locus** on chromosome 14. This results in the overexpression of PAX5, a transcription factor essential for B-cell proliferation and differentiation, leading to the development of the lymphoma. **Analysis of Incorrect Options:** * **Option B: t(2;5)(p23;q35):** This is the hallmark of **Anaplastic Large Cell Lymphoma (ALCL)**, involving the *ALK* gene on chromosome 2 and the *NPM* gene on chromosome 5. * **Option C: t(11;14)(q13;q32):** This is diagnostic for **Mantle Cell Lymphoma**, leading to the overexpression of **Cyclin D1** (*PRAD1/BCL-1*). * **Option D: t(14;18)(q32;q21):** This is the classic translocation seen in **Follicular Lymphoma**, resulting in the overexpression of the anti-apoptotic protein **BCL-2**. **High-Yield Clinical Pearls for NEET-PG:** * **MYD88 L265P Mutation:** While t(9;14) is a known translocation, the **MYD88 L265P somatic mutation** is found in >90% of LPL cases and is a more frequent diagnostic marker in modern practice. * **Clinical Presentation:** Patients often present with **hyperviscosity syndrome** (due to monoclonal IgM paraprotein), hepatosplenomegaly, and lymphadenopathy. [1] * **Dutcher Bodies:** Look for PAS-positive intranuclear inclusions (Dutcher bodies) in malignant cells, which are highly suggestive of LPL. **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. 609-610.

Q: In anemia due to lead poisoning, what will the bone marrow characteristically show?

Basophilic stippling. **Explanation:** **Correct Answer: D. Basophilic stippling** Lead poisoning (Plumbism) interferes with the activity of the enzyme **5'-nucleotidase**, which is responsible for the degradation of ribosomal RNA. This inhibition leads to the persistence of ribosomal RNA aggregates within the cytoplasm of erythrocytes, appearing as fine, blue granules known as **basophilic stippling**. While this is classically seen in the peripheral smear, it is a characteristic finding in the erythroid precursors of the bone marrow in lead-affected erythropoiesis. **Analysis of Incorrect Options:** * **A. Dwarf megakaryocyte (Micromegakaryocyte):** These are characteristic of **Myelodysplastic Syndromes (MDS)** and certain types of Myeloid Leukemias. They are not associated with lead toxicity. * **B. Ring sideroblasts:** While lead poisoning inhibits ferrochelatase (leading to iron accumulation in mitochondria), **Ring sideroblasts** are the hallmark of **Sideroblastic Anemia**. In the context of NEET-PG, if both are options, Basophilic Stippling is the more "characteristic" morphological finding for lead, whereas Ring Sideroblasts are more specific to MDS (RARS) or hereditary sideroblastic anemia. * **C. Pelger-Huet anomaly:** This refers to hyposegmented neutrophils (pince-nez appearance). It is seen in **MDS (Pseudo-Pelger Huet)** or as a benign autosomal dominant condition. **Clinical Pearls for NEET-PG:** * **Enzymes inhibited by Lead:** δ-aminolevulinic acid dehydratase (ALA-D) and Ferrochelatase. * **Clinical Signs:** Burtonian lines (lead lines on gums), wrist drop/foot drop (peripheral neuropathy), and colic [1]. * **Radiology:** "Lead lines" at the metaphysis of long bones in children [1]. * **Treatment:** Chelation therapy with Succimer (oral), Ca-EDTA, or British Anti-Lewisite (BAL). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-419.

Question 1

Why do patients with sickle cell trait not manifest the same symptoms as those with sickle cell disease?

Accepted Answer

50% HbS is required for the occurrence of sickling.

Answer

HbA prevents sickling.

Answer

50% sickles are formed.

Answer

HbA prevents polymerization of HbS.

Question 2

Schistocytes in peripheral smear are seen in all except:

Accepted Answer

Sickle cell anemia

Answer

Disseminated Intravascular Coagulation (DIC)

Answer

Thrombotic Thrombocytopenic Purpura (TTP)

Answer

Hemolytic Uremic Syndrome (HUS)

Question 3

Diagnosis of Hodgkin's disease is confirmed by?

Accepted Answer

Lymph node biopsy

Answer

CT scan

Answer

Bone marrow biopsy

Answer

Lymphangiography

Question 4

Hemoglobinuria may be seen in all of the following conditions EXCEPT?

Accepted Answer

Hereditary spherocytosis

Answer

Mismatched blood transfusion

Answer

Paroxysmal cold hemoglobinuria

Answer

Thermal burns

Question 5

What are the cytogenetic abnormalities associated with lymphoplasmacytoid lymphoma?

Accepted Answer

t(9;14)(p13;q32)

Answer

t(2;5)(p23;q35)

Answer

t(11;14)(q13;q32)

Answer

t(14;18)(q32;q21)

Question 6

In anemia due to lead poisoning, what will the bone marrow characteristically show?

Accepted Answer

Basophilic stippling

Answer

Dwarf megakaryocyte

Answer

Ring sideroblasts

Answer

Pelger-Huet anomaly

Question 7

A 25-year-old asymptomatic female underwent a preoperative coagulation test. Her bleeding time (BT) is 3 minutes, prothrombin time (PT) is 15/14 seconds, activated partial thromboplastin time (aPTT) is 45/35 seconds, platelet count is 2.5 lac/mm3, and factor VIII levels were 60 IU/dL. She most likely has:

Accepted Answer

Factor VIII inhibitors

Answer

Factor IX deficiency

Answer

Von-Willebrands disease type III

Answer

Lupus anticoagulant

Question 8

All the following cause extravascular hemolysis except?

Accepted Answer

Blood transfusion reaction

Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

Autoimmune hemolytic anemia

Question 9

Splenosis means:

Accepted Answer

Rupture of spleen and distribution of its tissue on peritoneum

Answer

Infection of spleen

Answer

Presence of accessory spleen

Answer

Non-functioning spleen

Question 10

Neoplastic cells with multilobulated nuclei ('clover leaf' or flower cells) are seen in which of the following?

Accepted Answer

Adult T-cell leukemia (ATLL)

Answer

Diffuse large B cell lymphoma (DLBCL)

Answer

Anaplastic large cell lymphoma (ALCL)

Answer

Mycosis fungoides

Hematopathology — MCQs

Hematopathology — MCQs

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