Deck 27: Precursor Lymphoid Neoplasms

Question 1

B-lymphoblasts in ALL exhibit which one of the following markers that is helpful in their identification?

A) CD4
B) CD2
C) CD10
D) HLA-DR

Answer 1

CD10

Question 2

Which of the following markers would be helpful in differentiating cortical T-cell ALL from medullary T-cell ALL?

A) HLA-DR
B) TdT
C) CD2
D) CD1a

Answer 2

CD1a

Question 3

Which of the following cytochemical stains would be most helpful in differentiating AML from ALL?

A) LAP
B) MPO
C) PAS
D) Wright's stain

Answer 3

MPO

Question 4

A peripheral blood smear from a patient with acute leukemia displayed a homogeneous population of small blasts with scanty cytoplasm. Based on this information, which WHO classification is described?

A) APL
B) AML
C) Information inadequate to classify the leukemia
D) ALL

Question 5

Which of the following patient populations is most commonly afflicted with ALL?

A) Newborns
B) Adults
C) Pregnant females
D) Children

Question 6

ALL most often arises from a defect in which of the following?

A) CMP
B) CLP
C) Prolymphocyte
D) Lymphoblast

Question 7

The most common translocation found in childhood B-cell ALL is:

A) t(12;21)(p13.2lq22.1)
B) t(9;22)(q34;q11)
C) t(5;14)(q31;q32.3)
D) t(1;19)(q23.3;p13.3)

Question 8

The WHO defines acute lymphoblastic leukemia as having a blast count that is which of the following?

A) ≥30%
B) ≥20%
C) ≥50%
D) ≥80%

Question 9

A patient, 2 years of age, presents with general fatigue, pallor, fever, and weight loss. The morphological exam reveals a normal leukocyte count, marked neutropenia, and thrombocytopenia with 35% blasts. A bone marrow smear reveals hypercellularity with neoplastic lymphoid cells. What immunophenotypic testing would be indicated for this patient?

A) CD 33, CD34
B) CD11c, CD117
C) CD2, CD3, CD5, CD7, CD19
D) CD19, CD20, CD22, Ig genes

Question 10

A patient has been diagnosed with B-cell ALL. Immunophenotyping has been ordered to confirm the subtype. Which marker would help differentiate Pre-B-cell ALL from Pro-B-cell ALL?

A) CD34
B) CD19
C) CD10
D) CD2

Question 11

The most common form of ALL relapse in children is:

A) CNS leukemia
B) BM relapse
C) Relapse in extramedullary hematopoietic organs
D) Relapse in the lymphatic system

Question 12

Which markers are found on lymphoblasts?

A) CD10
B) CD19
C) HLA-DR
D) All of the above

Question 13

Which of the following is an expected finding in the peripheral blood smear of an ALL patient?

A) A normal platelet count
B) The presence of nucleated RBCs
C) A decreased platelet count
D) An absolute increase in mature lymphocytes

Question 14

As part of their disease progression, ALL patients are at risk for developing which of the following?

A) Recurrent infections
B) Bleeding episodes
C) Fatigue
D) All of the above

Question 15

A 5-year-old patient has been diagnosed with Pre-B-cell ALL. Routine cytogenetic analysis confirms the presence of the Philadelphia chromosome. What does this mean for the patient?

A) The patient is in remission.
B) The patient has relapsed.
C) The patient has a poor prognosis.
D) More aggressive treatment is needed.

Question 16

An immunoglobulin (Ig) gene rearrangement can be identified in all of the following acute lymphoblastic leukemias except:

A) Pro-B
B) Common ALL
C) Pre-B
D) Precursor T

Question 17

What cytochemical stains are negative in ALL but positive in AML?

A) PAS and myeloperoxidase
B) PAS and Sudan Black B
C) Nonspecific esterase and myeloperoxidase
D) Acid phosphatase and PAS

Question 18

A phenotype workup is performed on a patient suspected to have ALL. The results indicate that some of the leukemic cells express myeloid markers, whereas others express T-cell markers. What is the most likely reason for this occurrence?

A) Two patient samples were mixed.
B) The diagnosis is bilineage acute leukemia.
C) There is a problem in the interpretation of the data.
D) The diagnosis is unilineage acute leukemia.

Question 19

A technologist is reviewing a patient's blood smear. She notices that 85% blasts are present but is having a difficult time identifying the lineage. Cytochemical staining is subsequently performed, and the results for MPO, SBB, NSE, and PAS are negative. Based on this information, what is the most likely lineage of the unknown blasts?

A) T lymphoid
B) B lymphoid
C) Erythroid
D) Myeloid

Question 20

Which of the following is a classic morphologic finding in the peripheral blood in ALL?

A) Increased WBC and platelets with increased lymphoblasts
B) Lymphoblasts, decreased platelets, and decreased neutrophils
C) Lymphoblasts, increased platelets, and increased neutrophils
D) Increased WBC, platelets, and neutrophils

Question 21

Which leukemia reveals the laboratory findings of TdT+, CD7+, and CD3+?

A) Precursor T-cell leukemia
B) Precursor B-cell leukemia
C) Acute lymphoblastic leukemia-Burkitt-type
D) Acute undifferentiated leukemia

Question 22

The WHO classification of subgroups of ALL uses which of these criteria to help define the categories?

A) Cytochemistry and immunophenotyping
B) Cytochemistry and molecular analysis
C) Morphology of the blasts
D) Morphology, immunophenotyping, and molecular analysis

Question 23

Which phase of leukemia treatment is considered to induce complete remission of the disease, eradicating the leukemic blast population?

A) Induction therapy phase
B) CNS prophylactic phase
C) CNS prophylactic phase and maintenance chemotherapy phase
D) Maintenance chemotherapy phase

Question 24

Which of the following cytochemical stains would be positive in this case?

A) MPO
B) LAP
C) NSE
D) PAS

Question 25

A patient with ALL underwent chemotherapy. Results from hematologic, cytogenetic, and molecular analyses indicated that the patient entered complete remission. Four years later, on routine follow-up, the peripheral blood results for the patient were in the normal range, and cytogenetic analysis revealed no abnormalities, but molecular analysis showed BCR/ABL1 transcripts that were found in the blasts at diagnosis 4 years ago. This patient can be said to:

A) Be in complete remission
B) Be in molecular and cytogenetic remission
C) Have minimal residual disease
D) Have partial cytogenetic remission

Question 26

Summarize and explain why patients develop the clinical signs and symptoms observed in patients with ALL.

Question 27

Cytogenetic analysis confirms the presence of t(1;14). This verifies which of the following types of ALL?

A) Precursor B-cell ALL
B) Precursor T-cell ALL
C) PV
D) AML

Question 28

Which of the following sets of markers would be useful for follow-up testing to differentiate B-cell ALL from T-cell ALL?

A) CD2, CD3, CD4, CD19, and CD22
B) HLA-DR, TdT, and CD10
C) CD34, Ig gene rearrangement, and CD22
D) cIg, HLA-DR, and TdT

Question 29

Contrast the clinical and laboratory findings of ALL to LBL.

Question 30

Define the phases and purposes of chemotherapy for ALL.

Question 31

Define acute undifferentiated leukemia and explain why it is difficult to identify.

Question 32

Name the classifications of ALL and explain how they differ in molecular analysis and immunophenotype.

Question 33

Which of the following is a positive predictive factor in children with precursor B-ALL?

A) High leukocyte count; less than 1 year of age
B) Low leukocyte count; 4-10 years of age
C) High leukocyte count; PBX1/E2A translocation
D) Hyperdiploid chromosomes, high leukocyte count, less than 1 year of age