Deck 23: Acute Myeloid Leukemias

Question 1

A bone marrow sample is sent to the lab for cytochemical staining.MPO, SBB, and NSE have been ordered.Staining results come back as follows:
MPO: positive $\quad$$\quad$ SBB: positive $\quad$$\quad$ NSE: positive
Based on these findings, what lineage(s) is/are most likely affected?

A)Myeloid and monocytic
B)Lymphoid
C)Erythroid
D)Monocytic

Answer 1

Myeloid and monocytic

Question 2

A technologist is reviewing a CBC on a new admission.The patient has a WBC count of 5 x 103/µL with 32% blasts present.From what is the patient most likely suffering?

A)AL
B)MDS
C)MPD
D)CLL

Answer 2

AL

Question 3

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female sees her physician because of unexplained bruising on her upper torso. The physician takes a history, and nothing remarkable is noted. Physical examination reveals a palpable liver and spleen. CBC results reveal a platelet count of 5,000/µL and WBC count of 12,000/µL with 80% blasts and 15% promyelocytes present. Additional CBC findings include: Hgb: 8.7 g/dL and Hct: 25% normal indices.
Bone marrow findings: hypercellular marrow with 47% myeloblasts present. Nucleated erythroblasts: 22%; promyelocytes: 28%; megakaryopoiesis appears normal.
Cytogenetic analysis: t (15, 17) present.
What is the most likely diagnosis?

A)AML without maturation
B)AML minimally differentiated
C)APL
D)AMML

Answer 3

APL

Question 4

The FAB classification nomenclature for acute leukemia also appears under which WHO classification group?

A)AML with recurrent genetic abnormalities
B)AML with multilineage dysplasia
C)AML and MDS-therapy-related
D)AML not otherwise categorized

Question 5

Bone marrow review on a 15-year-old girl with acute leukemia revealed many blasts with the following characteristics: high N:C ratio, prominent nucleoli, open chromatin pattern, and basophilic cytoplasm.Cytochemical staining revealed negative reactivity with MPO and SBB.Nonspecific esterase was positive.No cytogenetic abnormalities were detected.What is the most likely lineage of the blast cells in question?

A)Myeloid
B)Lymphoid
C)Monocytic
D)Erythroid

Question 6

Predict the typical platelet concentration of a patient with AML.

A)Marked decreased
B)Marked increased
C)Normal
D)Cannot be determined

Question 7

What is the typical erythrocyte morphologic picture in patients with AML?

A)Normocytic normochromic
B)Microcytic hypochromic
C)Macrocytic normochromic
D)Variable

Question 8

A PAS stain is ordered on a leukemic patient.The test is performed, and the technologist confirms that the PAS stain is positive with coarse granularity.Based on these findings, from what is the patient most likely suffering?

A)Acute myelomonocytic leukemia
B)Acute erythroleukemia
C)Acute megakaryoblastic leukemia
D)AML with minimal differentiation

Question 9

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female sees her physician because of unexplained bruising on her upper torso. The physician takes a history, and nothing remarkable is noted. Physical examination reveals a palpable liver and spleen. CBC results reveal a platelet count of 5,000/µL and WBC count of 12,000/µL with 80% blasts and 15% promyelocytes present. Additional CBC findings include: Hgb: 8.7 g/dL and Hct: 25% normal indices.
Bone marrow findings: hypercellular marrow with 47% myeloblasts present. Nucleated erythroblasts: 22%; promyelocytes: 28%; megakaryopoiesis appears normal.
Cytogenetic analysis: t (15, 17) present.
Which of the following laboratory findings would be most consistent with this clinical picture?

A)Multiple Auer rods in affected cells
B)Positive reactivity with PAS stain
C)CD4-positive cells
D)Swollen lymph nodes

Question 10

According to the WHO classification, what must be true to differentiate myelodysplastic syndromes from acute leukemia? In acute leukemia:

A)The blasts must be greater than 20% in the bone marrow.
B)The blasts must be greater than 20% in the bone marrow and contain Auer rods.
C)The bone marrow must contain fibrosis.
D)The blast count is close to 100%.

Question 11

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female sees her physician because of unexplained bruising on her upper torso. The physician takes a history, and nothing remarkable is noted. Physical examination reveals a palpable liver and spleen. CBC results reveal a platelet count of 5,000/µL and WBC count of 12,000/µL with 80% blasts and 15% promyelocytes present. Additional CBC findings include: Hgb: 8.7 g/dL and Hct: 25% normal indices.
Bone marrow findings: hypercellular marrow with 47% myeloblasts present. Nucleated erythroblasts: 22%; promyelocytes: 28%; megakaryopoiesis appears normal.
Cytogenetic analysis: t (15, 17) present.
Flow cytometry has also been ordered on this patient.Which of the following markers will stain positive in this case?

A)HLA-DR
B)CD35
C)CD33
D)CD8

Question 12

The presence of which of the following findings with a blast of unknown lineage confirms that the lineage is myeloid?

A)Toxic granulation
B)Leukocytosis
C)Auer rod
D)Basophilia

Question 13

The M:E ratio of a patient with AML typically displays which of the following?

A)Myeloid hyperplasia
B)Erythroid hyperplasia
C)Both myeloid and erythroid hyperplasia
D)Normal

Question 14

A technologist is reviewing a blood smear of an AML patient.She notices single azurophilic needle-like inclusions in the cytoplasm of many of the circulating blasts.What is the most probable identification of the inclusion?

A)Toxic granulation
B)Uric acid crystals
C)Döhle bodies
D)Auer rods

Question 15

Which of the following cell markers will differentiate AML from ALL?

A)CD10, CD19, CD20, and CD 22
B)CD2, CD3, CD5, and CD7
C)HLA-DR, CD34, and CD7
D)CD13, CD33, CD19, CD20, CD22, CD10, CD2, CD3, CD5, CD7.

Question 16

A technologist is reviewing a peripheral blood smear of a 10-year-old patient.She notices that 35% blasts are present on the patient's smear.What can you conclude from these findings?

A)The patient is normal.
B)The patient is suffering from an acute leukemia.
C)The patient is suffering from a chronic leukemia.
D)The patient is suffering from aplastic anemia.

Question 17

Which acute leukemia is characterized by a blast population with both myeloid and lymphoid markers on the same cell?

A)AML with multilineage dysplasia
B)Biphenotypic leukemia
C)Mixed lineage leukemia
D)AML not otherwise categorized

Question 18

All of the following AML subtypes have positive reactivity with myeloperoxidase stain except:

A)Acute monocytic leukemia.
B)AML with maturation.
C)Acute erythroid leukemia.
D)AML minimally differentiated.

Question 19

A patient presents with a morphological smear examination revealing greater than 20% blasts with prominent granules and ++ Auer rods, MPO, and Sudan Black positive.A 25% monocyte count was seen in the peripheral smear.There were no recurrent cytogenetic abnormalities observed.Under which classification of acute leukemia, not otherwise categorized, does this picture fall?

A)Acute myeloblastic leukemia with no maturation
B)Acute myelomonocytic leukemia
C)Acute monoblastic leukemia
D)Acute promyelocytic leukemia

Question 20

The distinction between the FAB classification and the WHO classification is based on which of the following?

A)Patients' signs and symptoms
B)Mutant neoplastic "stem" cell identification
C)Percent blasts
D)Cytochemical reactions

Question 21

Compare and contrast WHO and FAB classification systems of AML.

Question 22

The WHO classification system of AML incorporates which of the following?

A)Morphology of the proliferating cells
B)Immunophenotyping
C)Cytogenetic analysis
D)All of the above
E)A and C, but not B

Question 23

Why are Auer rods seen only in myeloblasts?

Question 24

A patient presents with acute leukemia, with blasts identified by a positive CD34, CD13, and CD33.Less than 3% of the blasts stain positive for MPO and SBB.Which category of AML is the most likely diagnosis for this patient?

A)AML minimally differentiated
B)AML without maturation
C)Acute myelomonocytic leukemia
D)Acute erythroid leukemia

Question 25

What is the definition of acute leukemia, according to the World Health Organization?

Question 26

Explain how bone marrow analysis helps establish an AML diagnosis.

Question 27

A patient presents with 25% blasts (nonerythroid), 34% monocytic cells, and 31% granulocytic cells in the bone marrow.The peripheral blood smear has 10% monocytes.The alpha-naphthyl esterase and chloroacete esterase are positive.What is the probable diagnosis based on these findings?

A)Acute monocyte leukemia
B)Acute monoblastic leukemia
C)Acute myelomonocytic leukemia
D)Acute erythroid leukemia

Question 28

Questions 9 and 10: Use the case below to answer the following questions:
A 57-year-old male is admitted with suspicion of AML. Preliminary CBC results show a high WBC count with 47% blasts present. Cytochemical staining shows negative reactions with MPO, SBB, and NSE. Platelet peroxidase staining was positive. Immunophenotyping was also ordered.
Predict the results of the immunophenotyping panel based on the information already given.

A)Positive reactions with CD13, CD33, and CD34
B)Positive reactions with CD41, CD42, and CD61
C)Positive reactions with HLA-DR and CD13
D)Positive reactions with CD11b and CD14

Question 29

List the common cytochemical stains used in the detection of AML, and predict their results in AML.

Question 30

A patient presents with bleeding, and is found to be in DIC.The peripheral smear contains hypergranular promyelocytes.The white count is slightly elevated.The bone marrow contains cells with multiple Auer rods with a clear blue cytoplasm.What is the probable type of AML?

A)AML with 11q23 abnormalities
B)AML with t(15;17) q22;q12)
C)Microgranular APL variant
D)AML with multilineage dysplasia

Question 31

An APL patient has been undergoing ATRA therapy for the last 5 weeks.A repeat bone marrow and cytogenetic analysis are performed at the end of the treatment cycle.Bone marrow shows no evidence of leukemic cells, and cytogenetic anomalies were not detected.Based on this information, what is the status of the patient?

A)The patient is in remission.
B)The patient has relapsed.
C)The patient has undergone engraftment.
D)The patient has undergone partial engraftment.

Question 32

Traditional therapy in APL includes pharmacological concentration of RA (ATRA) and chemotherapy.What is the function of the chemotherapy component in this treatment protocol?

A)Induces maturation of the promyelocytes to mature granulocytes
B)Binds with the target PML/RAR gene, and represses gene transcription
C)Eradicates the leukemic stem cells
D)Induces cytolysis of the malignant promyelocytes

Question 33

Questions 9 and 10: Use the case below to answer the following questions:
A 57-year-old male is admitted with suspicion of AML. Preliminary CBC results show a high WBC count with 47% blasts present. Cytochemical staining shows negative reactions with MPO, SBB, and NSE. Platelet peroxidase staining was positive. Immunophenotyping was also ordered.
What is the most likely diagnosis?

A)Acute erythroid leukemia
B)Acute megakaryoblastic leukemia
C)AML with maturation
D)AML minimally differentiated

Question 34

The patient presents with acute leukemia.The blast morphology is of neutrophil lineage with Auer rods and pseudo-Pelger-Huët nuclei; the immunophenotype is positive for CD33, CD13, CD34, and CD56 with a positive TdT, myeloperoxidase, and Sudan Black B.Cytogenetic analysis reveals a t(8;21)(q22;q22) translocation in the majority of the blasts.Which classification of AML best fits this morphology, immunophenotyping, and cytotechemistry?

A)AML not otherwise categorized
B)AML with multilineage dysplasia
C)AML with recurrent genetic abnormalities
D)AML, therapy-related

Question 35

Which of the following markers are positive for monoblasts?

A)HLA-DR
B)CD33
C)CD14
D)All of the above