Chapter 34: Mature Lymphoid Neoplasm

185. The peripheral blood shown in Color Plate 14B is from a 69-year-old female. Her WBC count was 83.0 X 109 cells/L (83.0 X 103/(xL) and her platelet count was normal. Based on the cell morphology and this information, what is the most likely diagnosis? A. Acute lymphoblastic leukemia B. Chronic lymphocytic leukemia C. Waldenstrom macroglobulinemia D. Viral infection

B. Chronic lymphocytic leukemia

16. The strongest risk factor for development of a lymphoproliferative disorders is a. age 15 to 34 years. b. altered immune function. c. female sex d. cytomegalovirus infection in childhood.

b. altered immune function.

5. Which of the following is true regarding the clinical course of chronic lymphocytic leukemia? a. aggressive disorder that presents with severe bleeding and anemia b. benign disorder that rarely requires treatment c. mild symptoms but usually fatal within 6 months d. incurable but with a median survival of approximately 10 years

b. benign disorder that rarely requires treatment

1. All of the following are functions of normal lymph nodes except a. lymphopoiesis b. granulopoiesis c. processing antigens d. antigen recognition

b. granulopoiesis

13. Which of the following are mature pan-B cell markers? a. CD4 and CD8 b. CD33 and CD45 c. CD19 and CD20 d. CD33 and CD59

c. CD19 and CD20

185. Which of the following cell surface markers is associated with a more aggressive subtype of CLL/SLL? a. CD13 b. CD21 c. CD38 d. CD125

c. CD38

190. Chronic lymphocytic leukemia cells are most likely to express which of the following cell surface markers? a. CD3, CD7, CD19, CD20 b. CD4, CD5, CD19, CD20 c. CD5, CD19, CD20, CD21 d. CD13, CD33, CD107

c. CD5, CD19, CD20, CD21

34. A positive tartrate-resistant acid phosphatase (TRAP) stain is indicative of: a. Burkitt's lymphoma b. Chronic myelogenous leukemia c. Hairy cell leukemia d. Multiple myeloma

c. Hairy cell leukemia

Which subgroup of CLL reveals pancytopenia, TRAP+, CD19+, CD5−, CD20+ strong intensity, CD22+, CD103+, CD11c+, and CD25+ with circulating lymphocytic cells? a. B-cell chronic lymphocytic leukemia b. T-cell PLL c. Hairy cell leukemia d. Sézary syndrome

c. Hairy cell leukemia

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. Sezary syndrome c. Large granular lymphocyte leukemia d. chronic prolymphocytic lymphoma

c. Large granular lymphocyte leukemia

2. Which laboratory test is most suggestive of autoimmune hemolytic anemia in a patient with CLL? a. Direct antiglobulin test b. Hemoglobin c. Lymphocyte count d. Platelet count

c. Lymphocyte count

7. Mature T cells with cerebriform, clefted nuclei found in the skin and peripheral blood describe a. hairy cells b. prolymphocytes c. lymphoblasts d. Sézary cells

d. Sézary cells

141. In comparison to malignant lymphocytes, reactive lymphocytes: a. have a denser nuclear chromatin b. are known to be T cells c. have more cytoplasm and more mitochondria d. are morphologically more variable throughout the smear

d. are morphologically more variable throughout the smear

18. Why are patients with plasma cell myeloma susceptible to infection? a. decreased lymphocytes b. neutropenia c. suppressed normal immunoglobulin levels d. both b and c

d. both b and c

12. Malignant proliferation of plasma cells with osteolytic bone lesions and the presence of monoclonal immunoglobulin in the serum describes a. Waldenström macroglobulinemia b. marginal zone B-cell lymphoma c. follicle center lymphoma d. plasma cell myeloma

d. plasma cell myeloma

213. What is the key diagnostic test for Hodgkin lymphoma? A. Bone marrow biopsy B. Lymph node biopsy C. Spinal tap D. Skin biopsy

B. Lymph node biopsy

164. Which CLL/SLL marker is associated with poor prognosis? A. CD138 B. ZAP-70 C. FMC7 D. TdT

B. ZAP-70

2. Normal lymph nodes contain all of the following cell types except a. myelocytes b. plasma cells c. lymphocytes d. macrophages

a. myelocytes

17. Serum protein electrophoresis on an elderly patient reveals a monoclonal protein spike. Increased plasma cells are present in the bone marrow. They are CD19 and CD20 negative but demonstrate high-density CD38 and monoclonal cytoplasmic immunoglobulin. What is the most likely diagnosis? a. plasma cell myeloma b. Hodgkin lymphoma c. Burkitt lymphoma d. chronic lymphocytic leukemia

a. plasma cell myeloma

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 HL? a. CD15 positive, CD30 negative b. CD15 positive, CD30 positive c. CD15 negative, CD30 negative d. CD15 negative, CD30 positive

b. CD15 positive, CD30 positive

182. The most common type of chronic lymphocytic leukemia (CLL) in the United States involves the A. Bcell B. NKcell C. Tcell D. Plasma cell

A. Bcell

173. Based on the WHO classification system, B cell ALL (FAB type L3) and represent different clinical presentations of the same disease entity. A. Burkitt lymphoma B. Hodgkin lymphoma C. Mycosis fungoides D. Small lymphocytic lymphoma

A. Burkitt lymphoma

222. Which of the following statements about non-Hodgkin types of lymphoma is true? A. Lymphadenopathy is the most common presenting symptom. B. Initially, they present as a systemic disease rather than a localized tumor. C. They are often associated with multiple bone lesions. D. They are characterized by proliferation of malignant cells primarily involving the bone marrow.

A. Lymphadenopathy is the most common presenting symptom.

22. Waldenström's macroglobulinemia is a malignancy of the: A. Lymphoplasmacytoid cells B. Adrenal cortex C. Myeloblastic cell lines D. Erythroid cell precursors

A. Lymphoplasmacytoid cells

152. Which of the following cells is most likely identified in lesions of mycosis fungoides? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells

A. T lymphocytes

149. Morphologic variants of plasma cells include: A. flame cells B. Cabot cells C. bite cells D. Gaucher cells

A. flame cells

167. Which of the following translocation is most commonly associated with Burkitt lymphoma? A. t(8;14) B. t(11;18) C. t(15;17) D. t(18;22)

A. t(8;14)

14. Review the following CBC results on a 70-year-old man: WBCs = 58.2 × 109/L MCV = 98 fL RBCs = 2.68 × 1012/L MCH = 31.7 pg Hgb = 8.5 g/dL MCHC = 32.6% Hct = 26.5 mL/dL% PLT = 132 × 109/L Differential: 96 lymphocytes; 2 band neutrophils 2 segmented neutrophils 25 smudge cells/100 WBCs What is the most likely diagnosis based on these values? A. Acute lymphocytic leukemia B. Chronic lymphocytic leukemia (CLL) C. Infectious mononucleosis D. Myelodysplastic syndrome

B. Chronic lymphocytic leukemia (CLL)

148. Which of the following is a characteristic usually associated with hairy cell leukemia? A. neutrophilia B. mononuclear cells with ruffled edges C. positive for CD5 D. increased resistance to infection

B. mononuclear cells with ruffled edges

150. Which of the following bone marrow finding favor the diagnosis of multiple myeloma? A. presence of Reed Sternberg cells B. sheaths of immature plasma cells C. presence of occasional flame cells D. presence of plasmacytic satellitosis

B. sheaths of immature plasma cells

111. What accounts for the frequent smudge cells in CLL? A. increased in vivo cell lysis B. apoptosis related changes C. artifact due to fragile cells D. artifact due to heparin

C. artifact due to fragile cells

147. Hairy cell leukemia is a(n): A. acute myelocytic leukemia B. chronic leukemia of myelocytic origin C. chronic leukemia of lymphocytic origin D. acute leukemia of monocytic origin

C. chronic leukemia of lymphocytic origin

142. Which of the following 2 malignancies represent different clinical manifestations of the same disease? A. chronic lymphocytic leukemia and adult T cell leukemia B. hairy cell leukemia and Hodgkin lymphoma C. chronic lymphocytic leukemia and small lymphoma D. Sezary syndrome and prolymphocytic leukemia

C. chronic lymphocytic leukemia and small lymphoma

21. The pathology of multiple myeloma includes which of the following? A. Expanding plasma cell mass B. Overproduction of monoclonal immunoglobulins C. Production of osteoclast activating factor (OAF) and other cytokines D. All of these options

D. All of these options

163. Which of the following immunohistochemical patterns is most consistent with CLL/SLL? A. CD5-/CD23- B. CD5-/CD23+ C. CD5+/CD23- D. CD5+/CD23+

D. CD5+/CD23+

183. Which of the following are characteristic findings in Waldenstrom disease? A. Increased IgA and hepatosplenomegaly B. Increased IgE and renal failure C. Increased IgG and hypercalcemia D. Increased IgM and blood hyperviscosity

D. Increased IgM and blood hyperviscosity

220. The blood findings present in Color Plate 20 are from a patient with complaints of fatigue and severe lower back pain. Which of the following would not be typical of this disease? A. Bone tumors of plasma cells B. Hypercalcemia C. Progressive renal impairment D. Normal sedimentation rate

D. Normal sedimentation rate

17. Multiple myeloma and Waldenström's macroglobulinemia have all the following in common except: A. Monoclonal gammopathy B. Hyperviscosity of the blood C. Bence-Jones protein in the urine D. Osteolytic lesions

D. Osteolytic lesions

19. All of the following are associated with the diagnosis of multiple myeloma except: A. Marrow plasmacytosis B. Lytic bone lesions C. Serum and/or urine M component (monoclonal protein) D. Philadelphia chromosome

D. Philadelphia chromosome

188. Which of the following suggests a diagnosis of Hodgkin disease rather than other lymphoproliferative disorders? A. Presence of a monoclonal population of large lymphoid cells B. Predominance of immature B cells with irregular nuclear clefts C. Circulating T cells with a convoluted, cerebriform nucleus D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli

D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli

3. Which of the following cells is considered pathognomonic for Hodgkin's disease? A. Niemann-Pick cells B. Reactive lymphocytes C. Flame cells D. Reed-Sternberg cells

D. Reed-Sternberg cells

151. Which of the following have a B cell origin? A. Sezary syndrome B. large granular lymphocytosis C. Sternberg sarcoma D. Waldenstrom macroglobulinemia

D. Waldenstrom macroglobulinemia

146. Chronic lymphocytic leukemia is defined as a(n): A. malignancy of the thymus B. accumulation of prolymphocytes C. accumulation of hairy cells in the spleen D. accumulation of monoclonal B cells

D. accumulation of monoclonal B cells

"Flower cell" are associated with a. ATLL b. Burkitt lymphoma c. HCL d. CLL

a. ATLL

15. Which of the following are mature pan-T cell markers? a. CD3 and CD5 b. surface immunoglobulin c. CD4 and CD5 d. CD4 and CD8

a. CD3 and CD5

10. Which of the following is present in monoclonal gammopathy of underdetermined significance? a. Hypercalcemia b. Serum monoclonal protein c. Anemia d. Bone lesion

a. Hypercalcemia

170. What is the most common immunoglobulin present in plasma cell myeloma? a. IgG b. IgA c. light chains d. IgD

a. IgG

10. Which of the following is true regarding classic Hodgkin lymphoma? a. It is seen in young adults and includes enlarged mediastinal lymph nodes. b. It is seen in young children and includes splenomegaly. c. It is seen in young adults and is rapidly fatal in most cases. d. It is seen in older adults and spreads through the body before any symptoms develop.

a. It is seen in young adults and includes enlarged mediastinal lymph nodes.

8. In Hodgkin lymphoma the Reed-Sternberg cell and _________ are malignant. a. Popcorn cells b. T cells c. B cells d. Histiocytes

a. Popcorn cells

186. The leukemic phase of T cell lymphoma is marked by the following cellular abnormality: a. Sezary cell b. plasmacytoid lymphocyte c. mantle cell d. Reed Sternberg cell

a. Sezary cell

171. Which of the following is associated with mycosis fungoides? a. Sezary cells b. hairy cells c. prolymphocytes d. large granular lymphocytes

a. Sezary cells

172. Which of the following is a characteristic of Hodgkin lymphoma? a. bimodal age distribution b. high incidence of peripheral blood infiltration c. unpredictable lymph node involvement d. uniformly fatal

a. bimodal age distribution

8. Where are malignant plasma cells found in plasma cell myeloma? a. bone marrow and rarely in the peripheral blood b. lymph nodes and liver c. spleen and liver d. bone marrow and lymph nodes

a. bone marrow and rarely in the peripheral blood

6. A middle-aged man has a white blood cell (WBC) count of 80 x 10 9 /L with 90% lymphocytes and many smudge cells. Which of the following is most likely? a. chronic lymphocytic leukemia b. hairy cell c. T-cell lymphoma d. Sézary syndrome

a. chronic lymphocytic leukemia

6. If not treated, which of the following would generally be associated with the best outcome? a. Peripheral T cell lymphoma b. Burkitt lymphoma c. Splenic marginal zone lymphoma d. Sézary syndrome

b. Burkitt lymphoma

19. Why is Burkitt lymphoma such an aggressive malignancy? a. Cells readily metastasize to bone marrow. b. Cells have a high proliferative rate. c. Cells fail to mature to functional immunophenotype. d. Cells destroy red cells.

b. Cells have a high proliferative rate.

44. A 75-year-old male patient visits his physician for an annual checkup. His CBC showed an elevated WBC count with numerous small lymphocytes and smudge cells, and a subsequent bone marrow biopsy and aspirate showed hypercellularity with increased lymphoid cells. What is a presumptive diagnosis based on this information? a. Acute lymphoblastic leukemia b. Chronic lymphocytic leukemia/small cell lymphocytic lymphoma c. Hairy cell leukemia d. Therapy-related acute myelogenous leukemia

b. Chronic lymphocytic leukemia/small cell lymphocytic lymphoma

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

b. Helicobacter pylori

7. What do CLL and myeloma have in common? a. Osteolytic lesions b. Light chain restriction c. Cell of origin d. Immunophenotype

b. Light chain restriction

5. Which test is often used to differentiate CLL from mantle cell lymphoma? a. Annexin A staining b. Lymph node biopsy c. Immunohistochemistry d. FISH for BCL2 translocation

b. Lymph node biopsy

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? a. MALT b. MCL c. Burkitt leukemia d. Follicular lymphoma

b. MCL

84. The diagnostic cell type seen in Hodgkin lymphoma is: a. Binucleate plasma cell b. Reed Sternberg cell c. Bence Jones lymphocyte d. Burkitt lymphocyte

b. Reed Sternberg cell

82. A 78-year-old man was previously diagnosed with chronic lymphocytic leukemia (CLL). Periodic CBCs were ordered, and several months of CBCs maintained an appearance consistent with cases of CLL. WBC 58.5 X10^12/L RBC 3.90x10^12/L Hgb 12.0 g/dL Hct 36.0% MCV 92 fL MCH 3 pg MCHC 33% Platelet 132x10^9 /L Differential: 70% lymphocytes 8% segmented neutrophils 2% monocytes 20% unidentified cells with lymphoid appearance and a prominent nucleolus Which of the following is most likely? a. The patient has developed Sezary syndrome b. The patient has developed prolymphocyticleukemia c. The patient has developed multiple myeloma d. The patient now has a concurrent case of CLL and ALL

b. The patient has developed prolymphocyticleukemia

275. The characteristic peripheral blood morphologic feature in multiple myeloma is: a. cytotoxic T cells b. rouleaux formation c. spherocytosis d. macrocytosis

b. rouleaux formation

166. At least what percentage of prolymphocytes must be present for a diagnosis of prolymphocytic leukemia? a. >10% b. >25% c. >55% d. >75%

c. >55%

85. Which of the following appearances describes the types of cells seen in Sezary syndrome? a. Plasma cells containing immunoglobulin deposits b. Large circulating micromegakaryocytes c. Lymphocytes with convoluted, cerebriform nuclei d. Prolymphocytes with prominent azurophilic granules

c. Lymphocytes with convoluted, cerebriform nuclei

9. In most cases the diagnosis of lymphoma relies on all of the following except: a. Microscopic examination of affected lymph nodes b. Immunophenotyping c. Molecular analysis d. Peripheral blood examination and complete blood count

c. Molecular analysis

45. Which of the following is not considered a disorder of plasma cells? a. Monoclonal gammopathy of undetermined significance b. Multiple myeloma c. Sezary syndrome d. Waldenstrom's macroglobulinemia

c. Sezary syndrome

111. What accounts for the frequent smudge cells in CLL? a. increased in vivo cell lysis b. apoptosis related changes c. artifact due to fragile cells d. artifact due to heparin

c. artifact due to fragile cells

4. What is the clinical significance of an enlarged lymph node? a. usually benign related to an infection b. usually indicates lymphoma c. can be benign or malignant depending on the microscopic evaluation d. diagnostic for an autoimmune disorder

c. can be benign or malignant depending on the microscopic evaluation

14. Which of the following is true of plasma cells? a. express pan-B cell markers b. express surface immunoglobulin c. express cytoplasmic immunoglobulin d. express pan-T cell markers

c. express cytoplasmic immunoglobulin

4. A rise in the lymphocyte count from 4.1 3 109 /L to 5.5 3 109 /L in a patient with monoclonal B lymphocytosis suggests: a. Acute lymphocyte leukemia b. Chronic lymphocytic leukemia c. Acute myelocytic leukemia d. A reactive condition

d. A reactive condition

1. Non-Hodgkin lymphoma can be best differentiated from reactive disorders by: a. Genetic testing b. Immunophenotyping c. Absolute lymphocyte count d. Blood film review

d. Blood film review

20. What lymphoproliferative disorder has a very favorable response to highly aggressive chemotherapy with no radiotherapy? a. chronic lymphocytic leukemia b. mycosis fungoides c. Hodgkin lymphoma d. Burkitt lymphoma

d. Burkitt lymphoma

9. Neoplastic lymphocytes with noncleaved clumped nuclei and very basophilic cytoplasm with prominent vacuoles describes a. Reed-Sternberg cells b. mantle cell lymphoma cells c. small-cell lymphocytic lymphoma cells d. Burkitt lymphoma cells

d. Burkitt lymphoma cells

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. CD15 positive, CD30 positive c. CD15 negative, CD30 negative d. CD15 negative, CD30 positive

d. CD15 negative, CD30 positive

83. Multiple myeloma exhibits laboratory features except which of the following? a. Occasional plasma cells in the peripheral blood b. Rouleaux c. Hypercalcemia d. Decreased immunoglobulin

d. Decreased immunoglobulin

3. What is the best test or method for determining if a clonal population of T cells is present in a specimen? a. Molecular diagnostic testing b. Flow cytometry for CD3, CD5, and CD7 c. Immunohistochemical stain d. Karyotyping

d. Karyotyping

11. What is the diagnostic cell, found in involved lymph nodes, for Hodgkin lymphoma? a. small B lymphocyte b. plasma cell c. small T lymphocyte d. Reed-Sternberg cell

d. Reed-Sternberg cell

188. A useful chemical test for the diagnosis of hairy cell leukemia is the: a. peroxidase test b. Sudan black test c. periodic acid-Schiff test d. tartrate-resistant acid phosphate test

d. tartrate-resistant acid phosphate test

3. What is the preferred specimen to evaluate cellular morphology in the lymphoproliferative disorders? a. peripheral blood b. bone marrow c. node frozen sections d. touch imprints of nodes

d. touch imprints of nodes

165. Which of the following morphologic characteristics is consistently associated with hairy cell leukemia? a. small cells b. clumped nuclear chromatin c. flocculent dark blue cytoplasm d. uneven cytoplasmic margins

d. uneven cytoplasmic margins

20. Multiple myeloma is most difficult to distinguish from: A. Chronic lymphocytic leukemia B. Acute myelogenous leukemia C. Benign monoclonal gammopathy D. Benign adenoma

C. Benign monoclonal gammopathy

172. Which of the following statements about hairy cell leukemia is true? A. It is an acute disease, primarily affecting young adults. B. Splenomegaly is an unusual finding. C. Hairy cells contain tartrate-resistant acid phosphatase. D. Hairy cells are abnormal T lymphocytes.

C. Hairy cells contain tartrate-resistant acid phosphatase.

18. What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma? A. Microcytic hypochromic cells B. Intracellular inclusion bodies C. Rouleaux D. Hypersegmented neutrophils

C. Rouleaux

210. Which of the following statements about Hodgkin disease is false? A. Peak incidence occurs in young adults. B. Staging determines extent of disease and treatment course. C. Stage IV has the best prognosis. D. Almost a 2:1 male predominance over females is characteristic.

C. Stage IV has the best prognosis.