Chapter 25-28 ONLINE
B-cell ALL/LBL with recurrent genetic abnormalities includes all of the following translocations except
t(9;22)
Which of the following cytochemical stains would be most useful in differentiating AML from ALL?
MPO
Which of the following represents the granule pattern of a dysplastic cell in MDS?
All of the above
A technologist is reviewing a blood smear and finds a rare blast. Bone marrow analysis shows dysplasiabin 30% of the erythroblasts and the myeloid precursors and 4% blasts. What is a possible diagnosis based on these findings?
RCMD
Which of the following does not fall into the category of AML as defined by the WHO classification?
Refractory anemia with excess blasts
A patient blood smear shows oval macrocytes, dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?
Refractory anemia with excess blasts-1
A patient has been diagnosed with B-cell ALL. Immunophenotyping has been ordered to confirm the subtype. Which markers would be ideal to help differentiate Pre-B-cell ALL from Pro-B-cell ALL?
CD10
B lymphoblasts in ALL exhibit which one of the following markers that is helpful in their identification?
CD10
Which of the following cell markers differentiate AML from ALL?
CD13, CD33, CD19, CD20, CD22, CD10, CD2, CD3, CD5, and CD7
Which of the World Health Organizations MDS subgroups contains two or more cytopenias, rare or no blasts, <1 x 10^9/L monocytes in the peripheral blood, <5% blasts and <15% ringed sideroblasts in the bone marrow?
Refractory cytopenia with multineage dysplasia (RCMD)
Which of the following IPSS scores has the highest survival rate in MDS?
0
According to the WHO classification what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?
20
Which of the following characteristics are associated with a poor prognosis for MDS?
25% bone marrow blasts
The chromosomal abnormalities present in most cases of MDS are located on which of the following chromosomes?
5, 7, 8
Which of the following is an expected finding in the peripheral blood smear of an ALL patient?
A decreased platelet count
Which of the following differentiates and AL and an MPN?
A defining characteristic of ALS is that the cell of origin acquired the ability to proliferate continuously and demonstrates arrested development.
What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?
A minimum of 15% ringed sideroblasts
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 mixed population of cells varying in size, shape, and color
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?
AML minimally differentiated
All of the following AML subtypes have positive reactivity with myeloperoxidase stain except:
AML minimally differentiated
An acute leukemia patient presents with blast morphology that is of neutrophil lineage with Auer rods and pseudo- Pelger-Huet nuclei, 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 cytochemistry?
AML with recurrent genetic abnormalities
Use this case to answer the following questions: A 45-year-old female was evaluated by her physician because she had unexplained bruising on her upper torso. Patient history was unremarkable. Physical examination revealed a palpable liver and spleen. CBC results revealed: WBC count: 12 x 10 9/L Hb: 8.7 g/dL Hct: 25% Normal indices PLT count: 5 x 10 9/L Differential: 80% blasts and 15% promyelocytes present 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?
APL
All of the following are considered morphologic evidence of dyserythropoiesis except:
Abnormal degranulation
A laboratory professional is reviewing a peripheral blood smear of a 10-year-old patient and notes that 35% blasts are present. Which of the following diagnoses is likely based on these findings?
Acute leukemia
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?
Acute lymphoblastic leukemia-Burkitt-type
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?
Acute myelomonocytic leukemia
A patient presents with a morphological smear examination revealing >20% blasts with prominent granules and Auer rods, MPO, and SBB positive. A 25% monocytes count was seen in the peripheral smear. There were no recurrent cytogenetic abnormalities observed. Under which classification of acute leukemia, not otherwise specific, does this diagnosis fall?
Acute myelomonocytic leukemia
Which acute leukemia is characterized by a blast population with both myeloid and monocytic markers on the same cell?
Acute myelomonocytic leukemia
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?
Agranular blast
Which of the following markers are positive for monoblasts?
All of the above
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 lymphoma (HL). Which of the following test results would confirm ALCL?
CD15 negative, CD30 positive
Which of the following markers would be helpful in differentiating cortical T-cell ALL?
CD1a
Which of the following does the World Health Organizations classification consider an MDS/MPN variant?
Atypical chronic myeloid leukemia, BCR/ALB1
Which of the following confirms that a blast of unknown lineage is myeloid?
Auer rod
A laboratory professional notes single azurophilic needle like inclusions in the cytoplasm of many of the circulating blasts while reviewing a blood smear of an AML patient. What is the most probable identification of the inclusion?
Auer rods
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?
B lymphoid
Use this case to answer the following questions: A 6-year-old boy was taken to see his pediatrician because of tiny pinpoint spots that had appeared on his upper torso 3 days earlier. A CBC revealed 70% blasts, and a platelet count of 18 x 10 9/L. A bone marrow aspirate and biopsy indicate a diagnosis of ALL. Which of the following sets of markers would be useful for follow-up testing to differentiate B-cell ALL from T-cell ALL?
CD2, CD3, CD4, CD19, and CD22
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?
CD2, CD3, CD5, CD7, CD19
In the subgroups of chronic leukemic lymphoid malignancies, which are the key features of Sezary syndrome?
CD3+, CD2+, CD5+, CD4+, CD8+/-, CD7-
All most often arises from a defect in which of the following?
CLP
The most common form of ALL relapse in children is:
CNS leukemia
Morphological differences between ALL and Burkett-type ALL include which of the following?
Cell size, cytoplasmic basophilia and vacuolation, and prominent nucleoli
Which of the following patient populations is most commonly affected by ALL?
Children
Which test or tests support the theory that the abnormal cells in MDS are clones derived from an abnormal pluripotent stem cell?
Cytogenetic and molecular studies
Traditional therapy in APL includes pharmacological concentration of retinoic acid (ATRA) and chemotherapy. What is function of the chemotherapy component in this treatment protocol?
Eradicated the leukemic stem cells
Which type of cell contains <20 primary granules in the cytoplasm, has a centralized nucleus, and can be found in both AML and MDS?
Granularblast
Which of the following agents promotes the development of non-Hodgkin lymphoma through mucosa-associated lymphoid tissue (MALT) infiltration?
Helicobacter pylori
Which of the following is a likely diagnosis in a 55 year old male with a bone marrow cellularity of 22%?
Hypoplastic MDS
Which of the following laboratory tests would not be helpful in identifying MDS/MPN, U?
Immunophenotyping
Use the following case to answer these questions: A 57-year-old male was admitted to the hospital 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
Positive reactions with CD41, Cd42, and CD61
An immunoglobulin (Ig) gene arrangement can be identified in all of the following acute lymphoblastic leukemias except:
Precursor T
Which of the following test results is most consistent with a diagnosis of multiple myeloma?
Increased plasma cell concentration in peripheral circulation
Which of the following laboratory tests would best help differentiate multiple myeloma and Waldenstrom's macroglobulinemia?
Isoelectric focusing
Which of the following detects clonality in an unknown cell population?
Kappa light chain only present on B cells
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:
Large granular lymphocyte leukemia
Which of the following is a positive predictive factor in children with precursor B-ALL?
Low leukocyte count; 4-10 years of age
The specimen of choice to confirm a lymphoma is a:
Lymph node biopsy
A 15-year-old patient has an active infection with Epstein-Barr virus, which will lead to which of the following?
Lymphadenopathy
Which of the following is a classic morphologic finding in the peripheral blood in ALL?
Lymphoblasts, decreased platelets and decreased neutrophils
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, from what stage and disease is the patient most likely suffering?
Lymphocyte predominant Hodgkin lymphoma
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)?
Lymphocyte-predominant
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:
MDS
Predict the typical platelet concentration of a patient with AML.
Marked decreased
An increase in paraprotein concentration of a single isoform is defined as:
Monoclonal gammopathy
A 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.
Monocytic
The WHO classification of subgroups of ALL uses which of these criteria to help define the categories?
Morphology, immunophenotyping, and molecular analysis
Use this case to answer the following questions: A 45-year-old female was evaluated by her physician because she had unexplained bruising on her upper torso. Patient history was unremarkable. Physical examination revealed a palpable liver and spleen. CBC results revealed: WBC count: 12 x 10 9/L Hb: 8.7 g/dL Hct: 25% Normal indices PLT count: 5 x 10 9/L Differential: 80% blasts and 15% promyelocytes present 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?
Multiple Auer rods in leukemic cells
Which leukemia reveals the laboratory findings of TdT+, CD7+, and CD3+
Precursor T-cell leukemia
The M:E ratio of a patient with AML typically displays which of the following?
Myeloid hyperplasia
Which of the following best represents the hematologic picture of a patient with lymphoma?
Normal until later stages of the disease
Which of the following is a defining characteristic of myelodysplastic syndromes (MDS)?
One or more peripheral blood cytopenias
Use this case to answer the following questions: A 6-year-old boy was taken to see his pediatrician because of tiny pinpoint spots that had appeared on his upper torso 3 days earlier. A CBC revealed 70% blasts, and a platelet count of 18 x 10 9/L. A bone marrow aspirate and biopsy indicate a diagnosis of ALL. Which of the following cytochemical stains would be positive in this case?
PAS
Use this case to answer the following questions: A 6-year-old boy was taken to see his pediatrician because of tiny pinpoint spots that had appeared on his upper torso 3 days earlier. A CBC revealed 70% blasts, and a platelet count of 18 x 10 9/L. A bone marrow aspirate and biopsy indicate a diagnosis of ALL. Cytogenetic analysis confirms the presence of t(1;14). This verifies which of the following types of ALL?
PV
A 58 year old male visits his physician for extreme fatigue. After conducting a standard investigation, the physician strongly suspects that the patient is suffering from CML. Which of the following lab results would confirm this picture?
Positive molecular analysis for BCR/ABL1
In multiple myeloma the erythrocytes have a distinct abnormality in the peripheral blood. Which of the following is that abnormality?
Rouleaux formation
A diagnosis of CLL requires morphologic and phenotypic findings of which of the following?
Sustained absolute lymphocyte counts with mature lymphocytes, few prolymphocytes, smudge cells, CD20+, and ZAP-70+
Hairy cell leukemia and chronic lymphocytic leukemia appear morphologically. Which of the following tests would help differentiate the two?
TRAP stain
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?
The diagnosis is unilineage acute leukemia
