Question 1

Which of the following represents the granule pattern of a dysplastic cell in MDS?

Accepted Answer

Dysplastic cells in Myelodysplastic Syndromes (MDS) can exhibit various abnormalities in granulation, including agranular (lacking granules), hypogranular (reduced number of granules), and clumped granular patterns. This variability reflects the diverse nature of dysplasia in MDS.

Question 2

Which of the following is a defining characteristic of myelodysplastic syndromes (MDS)?

Accepted Answer

Myelodysplastic syndromes (MDS) are characterized by one or more peripheral blood cytopenias, which refers to a deficiency in one or more types of blood cells (e.g. red blood cells, white blood cells, or platelets). This occurs due to dysfunctional hematopoietic stem cells in the bone marrow, which leads to ineffective production of functional blood cells. BCR/ABL1 is associated with chronic myeloid leukemia, overproliferation of all myeloid elements is seen in myeloproliferative neoplasms (MPNs), and dyslymphopoiesis is seen in some lymphoid malignancies.

Question 3

Which of the following MDS/MPN classifications includes the immunophenotype CD33, CD13 +, MPO +?

Accepted Answer

C

Question 4

Myelodysplastic syndromes are sometimes called preleukemias because:

Accepted Answer

Myelodysplastic syndromes have a high risk of progression to acute leukemia, making them a precursor or preleukemia. This progression may occur gradually over time or suddenly. However, not all cases of myelodysplastic syndromes transform into acute leukemia.

Question 5

All of the following are considered morphologic evidence of dyserythropoiesis except:

Accepted Answer

Abnormal degranulation is not considered a morphologic evidence of dyserythropoiesis. The other options, including dimorphic cell population, oval macrocytes, and karyorrhexis are common morphologic findings in dyserythropoiesis.

Question 6

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 10⁹/L monocytes?

Accepted Answer

The WHO classification for MDS with 5-19% blasts is Refractory anemia with excess blasts (RAEB) and since there are Auer rods present, it is classified as RAEB-2. The presence of cytopenia and dysplasia in multiple cell lines also supports the classification of RAEB-2 over other options.

Question 7

According to the WHO classification, what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?

Accepted Answer

According to the World Health Organization (WHO) classification, a patient is classified as having acute leukemia if there are 20% or more blasts present in the bone marrow.

Question 8

On which characteristic is the WHO classification system for each subgroup of myelodysplastic syndrome based?

Accepted Answer

The WHO classification system for each subgroup of myelodysplastic syndrome is based on multiple characteristics including peripheral blood and bone marrow morphology, cytogenetic abnormalities, and number of cytopenias. Therefore, the correct answer is D (All of the above).

Question 9

A bone marrow specimen is received in the cytogenetics lab. FISH analysis has been ordered. The laboratician performs the assay and notices that 96% of the patient's cells contain both 5q- and 12q- deletions. These cytogenetic findings are characteristic of:

Accepted Answer

The presence of both 5q- and 12q- deletions is a characteristic cytogenetic abnormality seen in myelodysplastic syndromes (MDS). This finding is not typically seen in chronic myeloid leukemia (CML), acute myeloid leukemia (AML), or acute lymphoblastic leukemia (ALL).

Question 10

A 60-year-old patient visited his general practitioner because of fatigue and unexplained bruising. Physical examination revealed a frail, thin, pale man with widespread bruising. A CBC was ordered and revealed abnormal granularity of platelets and leukocytes. Red cells appeared dimorphic. Bone marrow analysis showed 20% ringed sideroblasts with dysplastic changes in RBC and WBC precursors. No cytogenetic abnormalities were detected. Based on this information, what is a probable diagnosis?

Accepted Answer

The patient’s clinical findings, CBC results, and bone marrow analysis are consistent with myelodysplastic syndrome, a group of disorders characterized by ineffective blood cell production and a risk of transformation to acute leukemia. The abnormal granularity of platelets and leukocytes, dimorphic red cells, and ringed sideroblasts with dysplasia strongly suggest this diagnosis. Chronic lymphocytic leukemia would not present with the same degree of cytopenias and dysplasia seen in this patient. Myeloproliferative syndrome may present similarly to myelodysplastic syndrome but would have evidence of increased blood cell production rather than the cytopenias seen in this patient. Acute leukemia would have a higher percentage of blasts in the bone marrow and characteristic cytogenetic abnormalities.

Question 11

Which of the following IPSS scores has the highest survival rate in MDS?

Accepted Answer

The IPSS (International Prognostic Scoring System) score is a tool used to evaluate the prognosis of patients with myelodysplastic syndrome (MDS). The score ranges from 0 to 2.5, with higher scores indicating a worse prognosis. Studies have shown that patients with an IPSS score of 0 have the highest survival rate compared to those with higher scores. Therefore, A) 0 is the best choice.

Question 12

The chromosomal abnormalities present in most cases of MDS are located on which of the following chromosomes?

Accepted Answer

The most common chromosomal abnormalities in Myelodysplastic Syndromes (MDS) are deletions or mutations found on chromosomes 5, 7, and 8. These abnormalities can affect the function and regulation of cells, leading to the development of MDS.

Question 13

MDS associated with isolated del(5q) frequently shows dysplasia in which cell lineage?

Accepted Answer

MDS with isolated del(5q) is characterized by dysplasia in the megakaryocytic lineage, often showing hypolobulated megakaryocytes.

Question 14

Which of the following does the World Health Organization's classification consider an MDS/MPN variant?

Accepted Answer

Atypical chronic myeloid leukemia, BCR/ALB1^- is considered an MDS/MPN variant according to the World Health Organization's classification. Polycythemia vera and chronic myelogenous leukemia are classified as MPNs, while refractory anemia with ringed sideroblasts is classified as an MDS.

Question 15

A technologist is reviewing a blood smear and finds a rare blast. Bone marrow analysis shows dysplasia in 30% of the erythroblasts and the myeloid precursors and 4% blasts. What is a possible diagnosis based on these findings?

Accepted Answer

The findings of dysplasia in multiple lineages (erythroblasts and myeloid precursors) and less than 5% blasts in the bone marrow are consistent with Myelodysplastic Syndrome with Multilineage Dysplasia (MDS-MLD).

Question 16

An unknown cell possesses the following characteristics: blastlike with open chromatin pattern, prominent nucleoli, absence of granules, and a high N:C ratio. Based on this information, what is the cell's most probable identity?

Accepted Answer

The characteristics described are consistent with those of an agranular blast, which is a primitive cell in the myeloid lineage with an open chromatin pattern, prominent nucleoli, absence of granules, and a high nuclear to cytoplasmic ratio.

Question 17

A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?

Accepted Answer

The combination of oval macrocytes, dimorphic population, and basophilic stippling suggests a diagnosis of myelodysplastic syndrome (MDS). The presence of blasts in the peripheral blood indicates a possible progression to MDS with excess blasts, and a blast count of 6% indicates MDS-EB-1. It is important to note that a bone marrow biopsy and cytogenetic analysis would be necessary for confirmation and further classification.

Question 18

What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?

Accepted Answer

The diagnosis of refractory anemia with ringed sideroblasts requires the presence of at least 15% ringed sideroblasts in the bone marrow. Therefore, option D is the correct choice. A minimum of 30% ringed sideroblasts is seen in refractory anemia with excess blasts, while the presence of monoblasts is indicative of acute myeloid leukemia, but not specifically refractory anemia with ringed sideroblasts.

Question 19

Which of the World Health Organization's MDS subgroups contains two or more cytopenias, rare or no blasts, <1 × 10⁹/L monocytes in the peripheral blood, <5% blasts, and <15% ringed sideroblasts in the bone marrow?

Accepted Answer

MDS-MLD (Myelodysplastic Syndromes with Multilineage Dysplasia) is characterized by dysplasia in two or more myeloid cell lines, less than 1% blasts in the peripheral blood, and less than 5% blasts in the bone marrow, fitting the description provided.

Question 20

All of the following are included in the MDS/MPN family except:

Accepted Answer

The answer of All of the following are included in...

Quiz 25: Myelodysplastic Syndromes

Which of the following represents the granule pattern of a dysplastic cell in MDS?

Which of the following is a defining characteristic of myelodysplastic syndromes (MDS) ?

Which of the following MDS/MPN classifications includes the immunophenotype CD33, CD13 +, MPO +?

Myelodysplastic syndromes are sometimes called preleukemias because:

All of the following are considered morphologic evidence of dyserythropoiesis except:

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 10⁹/L monocytes?

According to the WHO classification, what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?

On which characteristic is the WHO classification system for each subgroup of myelodysplastic syndrome based?

A bone marrow specimen is received in the cytogenetics lab. FISH analysis has been ordered. The laboratician performs the assay and notices that 96% of the patient's cells contain both 5q- and 12q- deletions. These cytogenetic findings are characteristic of:

Which of the following IPSS scores has the highest survival rate in MDS?

The chromosomal abnormalities present in most cases of MDS are located on which of the following chromosomes?

MDS associated with isolated del(5q) frequently shows dysplasia in which cell lineage?

Which of the following does the World Health Organization's classification consider an MDS/MPN variant?

A technologist is reviewing a blood smear and finds a rare blast. Bone marrow analysis shows dysplasia in 30% of the erythroblasts and the myeloid precursors and 4% blasts. What is a possible diagnosis based on these findings?

An unknown cell possesses the following characteristics: blastlike with open chromatin pattern, prominent nucleoli, absence of granules, and a high N:C ratio. Based on this information, what is the cell's most probable identity?

A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?

What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?

Which of the World Health Organization's MDS subgroups contains two or more cytopenias, rare or no blasts, <1 × 10⁹/L monocytes in the peripheral blood, <5% blasts, and <15% ringed sideroblasts in the bone marrow?

All of the following are included in the MDS/MPN family except:

Quiz 25: Myelodysplastic Syndromes

Which of the following represents the granule pattern of a dysplastic cell in MDS?

Which of the following is a defining characteristic of myelodysplastic syndromes (MDS) ?

Which of the following MDS/MPN classifications includes the immunophenotype CD33, CD13 +, MPO +?

Myelodysplastic syndromes are sometimes called preleukemias because:

All of the following are considered morphologic evidence of dyserythropoiesis except:

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 109 /L monocytes?

According to the WHO classification, what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?

On which characteristic is the WHO classification system for each subgroup of myelodysplastic syndrome based?

A bone marrow specimen is received in the cytogenetics lab. FISH analysis has been ordered. The laboratician performs the assay and notices that 96% of the patient's cells contain both 5q- and 12q- deletions. These cytogenetic findings are characteristic of:

Which of the following IPSS scores has the highest survival rate in MDS?

The chromosomal abnormalities present in most cases of MDS are located on which of the following chromosomes?

MDS associated with isolated del(5q) frequently shows dysplasia in which cell lineage?

Which of the following does the World Health Organization's classification consider an MDS/MPN variant?

A technologist is reviewing a blood smear and finds a rare blast. Bone marrow analysis shows dysplasia in 30% of the erythroblasts and the myeloid precursors and 4% blasts. What is a possible diagnosis based on these findings?

An unknown cell possesses the following characteristics: blastlike with open chromatin pattern, prominent nucleoli, absence of granules, and a high N:C ratio. Based on this information, what is the cell's most probable identity?

A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?

What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?

Which of the World Health Organization's MDS subgroups contains two or more cytopenias, rare or no blasts, <1 × 109/L monocytes in the peripheral blood, <5% blasts, and <15% ringed sideroblasts in the bone marrow?

All of the following are included in the MDS/MPN family except:

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 10⁹/L monocytes?

Which of the World Health Organization's MDS subgroups contains two or more cytopenias, rare or no blasts, <1 × 10⁹/L monocytes in the peripheral blood, <5% blasts, and <15% ringed sideroblasts in the bone marrow?