Deck 25: Lymphoid Malignancies: Chronic Lymphoid Leukemias, Lymphomas, and Plasma Cell Neoplasms

Question 1

A physician is working up a patient.Based on physical examination, history, and initial screening tests, the physician suspects ALCL, but still needs to rule out classical HL.Which of the following test results would confirm ALCL?

A)CD15 positive, CD30 negative
B)CD15 positive, CD30 positive
C)CD15 negative, CD30 negative
D)CD15 negative, CD30 positive

Answer 1

CD15 negative, CD30 positive

Question 2

Differences between Hodgkin's and non-Hodgkin's lymphomas are defined by which of the following characteristics?

A)Molecular diagnostics and flow cytometry test results
B)Cytochemical and cytogenetic findings
C)Stage, distribution, mode of spread, extranodal disease, peripheral blood, cell type, and treatment regimen
D)Nodular growth pattern, BCL expression, and CD19+

Answer 2

Stage, distribution, mode of spread, extranodal disease, peripheral blood, cell type, and treatment regimen

Question 3

Which subgroup of CLL reveals pancytopenia, TRAP+, CD19+, CD5−, CD20+ strong intensity, CD22+, CD103+, CD11c+, and CD25+ with circulating hairy cells?

A)B cell chronic lymphocytic leukemia
B)T cell PLL
C)Hairy cell leukemia
D)Sézary syndrome

Answer 3

Hairy cell leukemia

Question 4

An increase in paraprotein concentration of a single isoform is defined as:

A)Immune response.
B)Monoclonal gammopathy.
C)Oligoclonal banding.
D)Hyperparaproteinemia.

Question 5

A 15-year-old patient has an active infection with Epstein-Barr virus.This will lead to which of the following?

A)Leukemia
B)Lymphoma
C)Multiple myeloma
D)Lymphadenopathy

Question 6

Hairy cell leukemia and chronic lymphocytic leukemia appear morphologically similar to the untrained eye.Which of the following tests would help differentiate between the two?

A)Immunophenotyping
B)Cytogenetic analysis
C)TRAP stain
D)PAS staining

Question 7

The presence of which of the following cell types confirms the diagnosis of Hodgkin's lymphoma?

A)Lymphocyte
B)Plasma cell
C)Reed-Sternberg cell
D)Cleaved Sézary cell

Question 8

Which of the following best represents the hematologic picture of a patient with lymphoma?

A)Prominent lymphocytosis
B)Normal until later stages of the disease
C)Prominent leukocytosis
D)Low hemoglobin, hematocrit and platelet count

Question 9

In multiple myeloma the erythrocytes have a distinct abnormality in the peripheral blood.Which of the following is that abnormality?

A)Rouleaux formation
B)Moth-eaten appearance
C)Agglutinates
D)Polychromasia

Question 10

Which of the following detects clonality in an unknown cell population?

A)Absolute lymphocytosis using morphology
B)CD4-positive T cells
C)Kappa light chain only present on B cells
D)Both kappa and lambda light chains present on B cells

Question 11

Which of the following test results is most consistent with a diagnosis of multiple myeloma?

A)Increased plasma cell concentration in peripheral circulation
B)Low calcium levels
C)RBC aggregates on the peripheral blood smear
D)Blasts in the peripheral blood

Question 12

A technologist is reviewing a blood smear and notices 35% lymphocytes with azurophilic granules and nuclei with mature clumped chromatin.These cells are typical of those found in:

A)Hairy cell leukemia.
B)Sézary syndrome.
C)Large granular lymphocyte leukemia.
D)Chronic prolymphocytic leukemia.

Question 13

A patient's symptoms include visual impairment, headache, dizziness, and deafness.The peripheral blood smear reveals lymphoplasmacytic lymphoma.What would rule out the diagnosis of Waldenström's macroglobulinemia?

A)Elevated plasma levels of IgM
B)Increased serum viscosity levels
C)Decreased plasma levels of IgM
D)Plasma cell neoplasm with lytic bone lesions

Question 14

Which of the following lymphoproliferative disorders is most closely associated with Richter's transformation?

A)CLL
B)PLL
C)Sézary syndrome
D)Hairy cell leukemia

Question 15

A 25-year-old male presents with an enlarged lymph node in his axillary region.Further testing confirms malignancy in the enlarged lymph node but nowhere else.In which stage of lymphoma, according to the Ann Arbor classification system, is the patient?

A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Question 16

The specimen of choice to confirm a lymphoma is:

A)Bone marrow aspirate.
B)A blood sample.
C)Lymph node biopsy.
D)A skin biopsy.

Question 17

Which protein is identified as free light chains in the urine?

A)MGUS
B)Heavy chains
C)M spike
D)Bence Jones

Question 18

Which of the following laboratory tests would best help differentiate multiple myeloma and Waldenstrom's macroglobulinemia?

A)Peripheral blood smear
B)Isoelectric focusing
C)Bone marrow aspirate
D)Total protein measurement

Question 19

A bone marrow aspirate is performed for staging purposes on a patient with Hodgkin's lymphoma.The results come back positive for infiltration by RS cells.What does this mean for the patient?

A)The patient is in the early stages of the disease.
B)The patient is in the late stages of the disease.
C)The patient is converting to non-Hodgkin's lymphoma.
D)The patient is entering remission.

Question 20

A technologist is reviewing a lymph node biopsy slide, and notices a prominent lymphocytosis as well as the presence of a few tumor cells with the following characteristics: large, multi-lobated nucleus with delicate nuclear membranes; finely granular chromatin; and small, indistinct nucleoli.Based on this information, from what stage and disease is the patient most likely suffering?

A)Anaplastic large cell lymphoma
B)Lymphocyte predominant Hodgkin's lymphoma
C)Monoclonal gammopathy of undetermined significance
D)Lymphocyte depleted Hodgkin's lymphoma

Question 21

Explain how environmental factors contribute to the pathogenesis of lymphoid neoplasms.

Question 22

In the subgroups of chronic leukemic lymphoid malignancies, which are the key features of Sézary syndrome?

A)CD3+, CD2+, CD5+, CD4+, CD8±
B)CD3+, CD2+, CD5+, CD4+, CD8±, CD7−
C)CD19+, CD5−, CD20+ strong intensity
D)CD22+, CD103+, CD11c+, CD25+

Question 23

A diagnosis of CLL requires morphologic and phenotypic findings of which of the following?

A)Variable absolute lymphocyte counts with few prolymphocytes and CD38+
B)Sustained absolute lymphocyte counts with mature lymphocytes, few prolymphocytes, smudge cells, CD20+, and ZAP-70+
C)Marked absolute lymphocytosis, anemia, and thrombocytopenia; prolymphocytes less than 10%
D)Sustained absolute lymphocyte counts, mature lymphocytes; CD3−, CD2+, CD4−, CD8−, CD7+, CD16+, CD56+/CD57−

Question 24

A lymph node biopsy is performed in a patient with lymphadenopathy.Which of the following findings would support the diagnosis of a reactive proliferation rather than a malignant lymphoma?

A)A mixed population of cells varying in size, shape, and color
B)Clonality
C)Presence of large, bizarre cells
D)Mitotic activity

Question 25

The presence of which of the following cells in peripheral circulation strongly indicates Sézary syndrome?

A)Lymphocytes with nuclear clefting
B)Lymphocytes with cerebriform convoluted nuclei
C)Normal lymphocytes
D)Lymphocytes with bilobed nuclei

Question 26

Which of the following statements is correct regarding MGUS and multiple myeloma (MM)?

A)MGUS has a low level of monoclonal spike without an underlying neoplasm, whereas MM has a monoclonal spike along with an underlying neoplasm.
B)MGUS has a monoclonal spike that is IgM in nature, whereas MM has a monoclonal spike that is IgG in nature.
C)MGUS exhibits tumor localization, whereas MM exhibits tumor dissemination.
D)MGUS and MM are the same.

Question 27

Which of the Hodgkin lymphoma histologic subtypes is composed of numerous reactive small lymphocytes and rare tumor cells that grow in loose nodular aggregates or popcorn cells-i.e., L&H cells?

A)Classic HL
B)Nodular sclerosis
C)Mixed cellularity
D)Lymphocyte-predominant

Question 28

Which of the following agents promotes the development of non-Hodgkin's lymphoma through MALT infiltration?

A)BCL-2 translocation
B)Helicobacter pylori
C)Epstein-Barr virus
D)Ataxia telangiectasia

Question 29

Describe the WHO and Ann Arbor classification systems of lymphoid neoplasms.

Question 30

A male of 65 years of age is seen at a local hospital with symptoms of enlarged lymph nodes and possible gastrointestinal tract problems.The peripheral blood smear revealed cells resembling diffuse large B cell lymphoma.The FISH studies demonstrated the translocation of BCL-1.What is the probable disease with these results?

A)MALT
B)MCL
C)Burkitt's leukemia
D)Follicular lymphoma

Question 31

Which of the following contributes to the pathogenesis of lymphoid neoplasms?

A)Genetic anomalies
B)Inherited immunodeficiency syndromes
C)Viral infections
D)All of the above

Question 32

Compare and contrast the lab features of the following disorders:

A)Plasmacytoma
B)Multiple myeloma
C)MGUS
D)Waldenström's macroglobulinemia

Question 33

Which test should be included when distinguishing between diffuse large B cell lymphoma and blastic mantle cell lymphoma?

A)CD20
B)Light chain analysis
C)Cyclin-D1 stain
D)IgM heavy chain analysis

Question 34

Explain the major differences between Hodgkin and non-Hodgkin lymphomas.