Deck 28: Mature Lymphoid Neoplasms

Question 1

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

Answer 1

Stage I

Question 2

All of the following are consistent with a diagnosis of plasma cell myeloma except:

A) Lytic bone lesions
B) Low calcium levels
C) Rouleaux on the peripheral smear
D) Clonal plasma cell infiltrates in the bone marrow

Answer 2

Low calcium levels

Question 3

Patients newly diagnosed with CLL/SLL often present with:

A) Fever
B) Bleeding
C) No apparent symptoms
D) Anemia

Answer 3

No apparent symptoms

Question 4

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

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

Question 5

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

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

Question 6

A bone marrow aspirate is performed for staging purposes on a patient with Hodgkin lymphoma. The results come back positive for infiltration by Reed Sternberg cells. This means that the patient is:

A) In the early stages of the disease
B) In the late stages of the disease
C) Converting to non-Hodgkin lymphoma
D) Entering remission

Question 7

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, multilobated nucleus with delicate nuclear membranes; finely granular chromatin; and small, indistinct nucleoli. Based on this information, what is the likely diagnosis?

A) Anaplastic large cell lymphoma
B) Lymphocyte rich Hodgkin lymphoma
C) Monoclonal gammopathy of undetermined significance
D) Lymphocyte-depleted Hodgkin lymphoma

Question 8

In plasma cell 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 9

Which protein is identified as a free light chain in the urine?

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

Question 10

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

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

Question 11

Which of the following characteristics differentiates Hodgkin and non-Hodgkin lymphomas?

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+

Question 12

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

A) CD15 positive, CD30 negative
B) CD20 positive, CD30 positive
C) CD2 negative, CD30 negative
D) CD3 positive, CD30 positive

Question 13

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

A) Peripheral blood smear
B) Positive MYD88 L265P mutation
C) Bone marrow aspirate
D) Total protein measurement

Question 14

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) Presence of monoclonal κ light chains
D) Plasma cell neoplasm with lytic bone lesions

Question 15

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 16

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

Question 17

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 18

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

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

Question 19

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 20

The specimen of choice to confirm a lymphoma is a:

A) Bone marrow aspirate
B) Blood sample
C) Lymph node biopsy
D) Skin biopsy

Question 21

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 22

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 IgH/CCND1 translocation. What is the probable disease?

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

Question 23

Describe the Ann Arbor staging system for malignant lymphoma.

Question 24

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 25

Morphological differences between ALL and Burkitt-type ALL include which of the following?

A) Cell size, nuclear shape, and nuclear chromatin
B) Cell size, cytoplasmic basophilia, and cellular heterogeneity
C) Nucleoli, cytoplasmic volume, and vacuolation
D) Cell size, cytoplasmic basophilia and vacuolation, and prominent nucleoli

Question 26

Neoplastic T-cells with irregular, convoluted, cerebriform nuclear outline are found in:

A) Sézary syndrome
B) Mantle cell leukemia
C) Burkitt lymphoma
D) Follicular lymphoma

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

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 29

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

A) MGUS has a low level of monoclonal spike without an underlying neoplasm, whereas MM has a monoclonal spike 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 30

Which of the following agents promotes the development of non-Hodgkin lymphoma through mucosa-associated lymphoid tissue (MALT) infiltration?

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

Question 31

A lymph node biopsy from a patient with lymphadenopathy is performed. 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 32

Large cells with abundant, intensely basophilic cytoplasm with prominent cytoplasmic vacuolization are identified on a peripheral smear. Multiple basophilic nucleoli are present. A starry sky appearance is seen with fields of basophilic leukemic blasts with benign macrophages that have ingested tumor cells. What leukemia should be suspected with this morphology?

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

Question 33

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

Question 34

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

Question 35

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 36

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 37

Identify the lab features of the following disorders:
a. Plasmacytoma
b. Plasma cell myeloma
c. MGUS
d. Waldenström's macroglobulinemia

Question 38

List and describe the five subtypes of Hodgkin lymphoma, focusing on laboratory features.

Question 39

Differentiate ALL from Burkitt-type ALL morphologically.

Question 40

The "starry sky" appearance of neoplastic cells in a lymph node biopsy are found in:

A) Sezary syndrome
B) Hairy cell leukemia
C) Burkitt lymphoma
D) Follicular lymphoma

Question 41

Explain the molecular and cytogenetic profile of a patient with Burkitt lymphoma.