Hematopathology Practice Questions

Q: All are true about the slide shown except:

ABVD chemotherapy. ***ABVD chemotherapy*** - ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) is the standard chemotherapy regimen for **Hodgkin lymphoma**, not Burkitt lymphoma. - Burkitt lymphoma is typically treated with intensive, short-course chemotherapy regimens, often including high-dose methotrexate, cyclophosphamide, and cytarabine [3]. *Occurs due to c-Myc gene activation* - **Burkitt lymphoma** is characterized by translocations involving the **c-Myc oncogene**, most commonly t(8;14) [1]. - This translocation leads to the overexpression of the c-Myc protein, promoting uncontrolled cell proliferation [1]. *Non-Hodgkin's lymphoma* - Burkitt lymphoma is a highly aggressive type of **B-cell non-Hodgkin lymphoma (NHL)** [3]. - It is one of the fastest-growing human tumors. *Burkitt lymphoma* - The "starry sky" appearance on a biopsy, with numerous tingible body macrophages amidst a monotonous population of small, non-cleaved lymphocytes, is a classic histological feature of **Burkitt lymphoma** [2]. - This appearance is due to the rapid proliferation of lymphoma cells and the presence of macrophages phagocytosing apoptotic tumor cells [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 324-325. [2] 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. [3] 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. 605-606.

Q: A 45-year-old female has complaints of painless cervical lymphadenopathy with fever and weight loss. A lymph node biopsy was performed. All of the following statements are true regarding this condition except:

CD15+, CD20+ and CD30+. ***CD15+, CD20+ and CD30+*** - Hodgkin's lymphoma Reed-Sternberg cells are typically **CD15+ and CD30+**, but **CD20−** (negative). - The claim that RS cells are CD20+ is **incorrect** — CD20 positivity would instead suggest a B-cell non-Hodgkin lymphoma. - This makes the statement FALSE, confirming it as the correct exception. *5-year survival rate is high* - Hodgkin's lymphoma generally has a **high 5-year survival rate** (>85% in early stages) due to its excellent responsiveness to chemotherapy (ABVD) and radiation therapy. - This statement is **TRUE**, so it is not the exception. *Reed-Sternberg cells are pathognomonic for Hodgkin's lymphoma* - Classic **Reed-Sternberg cells** (large binucleated giant cells with prominent "owl-eye" nucleoli) are the hallmark finding of Hodgkin's lymphoma and are considered **pathognomonic** in the appropriate clinical context. - This statement is **TRUE**, so it is not the exception. *LP must be done to rule out meningeal involvement* - **Lumbar puncture (LP)** is NOT routinely performed in Hodgkin's lymphoma; it is reserved for aggressive non-Hodgkin lymphomas (e.g., diffuse large B-cell lymphoma) or when neurological symptoms are present. - While this statement is also false, **Option A (CD20+) is more definitively incorrect** and is the standard teaching point. *EBV association is seen in some cases* - **Epstein-Barr Virus (EBV)** is associated with approximately **30–40% of classical Hodgkin's lymphoma cases**, particularly the mixed cellularity subtype. - EBV-encoded RNA (EBER) can be detected in Reed-Sternberg cells in these cases. - This statement is **TRUE**, so it is not the exception. **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. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. pp. 559–560.

Q: Spot the diagnosis.

Dimorphic anemia. ***Dimorphic anemia*** - This term refers to the coexistence of two types of anemia, typically **iron deficiency anemia** (microcytic, hypochromic) [2] and **megaloblastic anemia** (macrocytic) [1]. - This can occur when there is a deficiency of both **iron** and **vitamin B12** or **folate** [1][2]. *Thalassemia* - Thalassemia is a **genetic disorder** characterized by reduced or absent synthesis of globin chains, leading to **microcytic, hypochromic anemia** [3]. - It is not typically associated with the presence of two distinct red cell populations (microcytic and macrocytic) simultaneously. *Megaloblastic anemia* - Megaloblastic anemia is caused by impaired DNA synthesis, most commonly due to **vitamin B12** or **folate deficiency**, leading to **macrocytic red blood cells** [1]. - While it explains the macrocytic component, it does not account for the presence of a microcytic, hypochromic population. *G6PD deficiency* - G6PD deficiency is an **X-linked genetic disorder** that causes **hemolytic anemia** due to oxidative stress, often triggered by certain drugs, foods, or infections. - It typically presents with **normocytic or macrocytic anemia** during hemolytic episodes, and is not characterized by a dimorphic picture of microcytic and macrocytic cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 587-588.

Q: Which of the following hematological condition is shown below?

Megaloblastic anemia. ***Megaloblastic anemia*** - The image likely displays **hypersegmented neutrophils** and **macrocytic red blood cells**, which are characteristic features of **megaloblastic anemia** [1]. - This condition results from impaired DNA synthesis, often due to **vitamin B12** or **folate deficiency**. *Multiple myeloma* - This condition is characterized by the proliferation of **plasma cells** in the bone marrow, leading to **rouleaux formation** of red blood cells and **punched-out lesions** in bones [2]. - While rouleaux can be seen, the primary features of megaloblastic anemia (hypersegmented neutrophils, macro-ovalocytes) are distinct. *CML* - **Chronic Myeloid Leukemia (CML)** is a myeloproliferative neoplasm characterized by the presence of the **Philadelphia chromosome** (BCR-ABL fusion gene) [3]. - Peripheral blood smears typically show a **leukocytosis** with a full spectrum of myeloid maturation, including increased **basophils** and **eosinophils**, which are not the defining features of the image. *Metastasis* - **Metastasis** refers to the spread of cancer cells from a primary tumor to distant sites, often involving the bone marrow. - While bone marrow involvement can lead to various hematological abnormalities, the specific features of **hypersegmented neutrophils** and **macrocytic red blood cells** are not directly indicative of metastasis but rather of a primary hematological disorder like megaloblastic anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614. [2] 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. 606-607. [3] 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. 624-625.

Question 1

All are true about the slide shown except:

Accepted Answer

ABVD chemotherapy

Answer

Occurs due to c-Myc gene activation

Answer

Non-Hodgkin's lymphoma

Answer

Burkitt lymphoma

Answer

High proliferation index (Ki-67 near 100%)

Question 2

A 45-year-old female has complaints of painless cervical lymphadenopathy with fever and weight loss. A lymph node biopsy was performed. All of the following statements are true regarding this condition except:

Accepted Answer

CD15+, CD20+ and CD30+

Answer

5-year survival rate is high

Answer

Reed-Sternberg cells are pathognomonic for Hodgkin's lymphoma

Answer

LP must be done to rule out meningeal involvement

Answer

EBV association is seen in some cases

Question 3

Which of the following is seen in the peripheral smear?

Accepted Answer

Band cells, tear drop cells, hyposegmented neutrophils

Answer

Smudge cells, tear drop cells, hyposegmented neutrophils

Answer

Lacunar cells, tear drop cells, atypical lymphocytes

Answer

Reed-Sternberg cells, tear drop cells, atypical monocytes

Answer

Auer rods, schistocytes, hypersegmented neutrophils

Question 4

Spot the diagnosis.

Accepted Answer

Dimorphic anemia

Answer

Thalassemia

Answer

Megaloblastic anemia

Answer

G6PD deficiency

Answer

Iron deficiency anemia

Question 5

A 6-year-old girl presents with bilateral cervical lymphadenopathy and fever for 3 weeks, night sweats and weight loss. Photomicrograph of lymph node biopsy is given. Diagnosis is:

Accepted Answer

Hodgkin's lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Chronic lymphocytic leukemia

Answer

Acute lymphocytic leukemia

Answer

Reactive lymphadenitis

Question 6

A 12-year-old boy presents with bilateral cervical lymphadenopathy for the last 2 years. Biopsy from the lymph node shows the following picture. Which of the following is the correct set of diagnosis, etiology and the cell described?

Accepted Answer

Hodgkin's lymphoma; Epstein-Barr virus and Reed-Sternberg cells

Answer

Tuberculosis, Mycobacterium and Tiny granuloma

Answer

Hodgkin's lymphoma; Epstein-Barr virus and orphan annie eye nucleus

Answer

Non-Hodgkin's lymphoma; HIV and popcorn cell

Answer

Infectious mononucleosis; Epstein-Barr virus and Downey cells

Question 7

A 35-year-old presented with fever. On examination he had enlarged and ulcerated tonsils. Since peripheral smear shows lymphocytosis, monospot test was done which is negative. Tonsillectomy was done and stained section is shown below. Large cells mixed with lymphocytes are seen. The cells are positive for CD20, EBVLMP-1, MUM1, CD 79a and CD 15 negative. The background cells are positive for CD3. Diagnosis is: (AIIMS May 2017)

Accepted Answer

EBV positive- mucocutaneous ulcer

Answer

Infectious mononucleosis

Answer

Hodgkin lymphoma

Answer

EBV positive- DLBCL

Answer

Burkitt lymphoma

Question 8

A 70-year-old man presents with history of intractable diarrhea. His bone marrow and kidney biopsy are shown below. Which of the following is the most appropriate diagnosis?

Accepted Answer

Multiple myeloma

Answer

Leishmaniasis

Answer

Lymphoma

Answer

Urate nephropathy

Answer

Amyloidosis

Question 9

Which of the following hematological condition is shown below?

Accepted Answer

Megaloblastic anemia

Answer

Multiple myeloma

Answer

CML

Answer

Metastasis

Answer

Myelodysplastic syndrome

Hematopathology — MCQs

Hematopathology — MCQs

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