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Lymphoma Quiz

Lymphoma Quiz. Question 27.

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Lymphoma Quiz

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  1. Lymphoma Quiz

  2. Question 27 • A 69-year-old man notices the presence of “lumps” in the right side of his neck that have been enlarging over the past year. Physical examination shows firm, nontender, posterior cervical lymph nodes 1-2cm in diameter. The overlying skin is intact and not erythematous. A lymph node is biopsied. Which of the following histologic features provides the best evidence for malignant melanoma in this node?

  3. Question 27 • A. Presence of lymphoid cells positive for kappa, but not lambda, light chains • B. Absence of a pattern of follicles with germinal centres • C. Proliferation of small capillaries in the medullary and paracortical regions • D. Presence of cells that stain with monocloncal antibody to the CD30 antigen • E. Absence of plasma cells and immunoblasts in sinusoidal spaces

  4. Question 28 • A 62-year-old man visits his physician because of prolonged fever and 4kg weight loss over the past 6 months. On physical examination, his temperature is 38.6 C. He had generalisednontender lymphadenopathy and the spleen tip is palpable. Laboratory studies show: • Haemoglobin 10.1g/dL • Haematocrit 30.3% • Platelet count 140,000/mm^3 • WBC count 24,500/mm^3 with 10% segmented neutrophils, 1% bands, 86% lymphocytes and 3% monocytes • A cervical lymph node biopsy specimen shows a nodular pattern of small lymphoid cells. A bone marrow specimen shows infiltrates of similar small cells having surface Ig that are CD5+ but CD10-. Cytogenetic analysis indicates t(11;14) in these cells.

  5. Question 28 • What is the most likely diagnosis? • Mantle cell lymphoma • Follicular lymphoma • Acute lymphoblastic leukaemia • Burkitt lymphoma • Small lymphocytic lymphoma

  6. Question 31 • A 58-year old man from Nagasaki, Japan, has noted an increasing number of skin lesions for the past 8 months. On examination, there are scaling red-brown patches on all skin surfaces. He also has generalised lymphadenopathy and hepatosplenomegaly. Laboratory studies show: • Haemoglobin 9.7g/dL • Haematocrit 31% • MCV 89um^3 • Platelet count 177,000mm^3 • WBC count 18,980/mm^33 with differential count of 35 segmented neutrophils, 2 band neutrophils, 58 lymphocytes and 5 monocytes • Serum calcium is 11.5mg/dL • Examination of peripheral blood smear shows multilobated “cloverleaf” cells. Despite aggressive chemotherapy, his condition worsens with development of paresthesias along with erythematous plaques and red-brown nodules on his skin.

  7. Question 31 • Which of the following infectious agents most likely caused his illness? • Cytomegalovirus • Epstein-Barr virus • HIV • HTLV-1 • Rochalimea henselae • Yersinia pestis

  8. Question 32 • In an experiment, cell samples are collected from patients who were diagnosed with lymphoproliferative disorders. Cytogenetic analyses are performed on these cells, and a subset of the cases is found to have the BCR-ABL fusion gene from the reciprocal translocation t(9;22)(q24;11). The presence of this gene results in increased tyrosine kinase activity. Patients with which of the following conditions are most likely to have this gene?

  9. Question 32 • Follicular lymphoma • Chronic myelogenousleukaemia • Hodgekin lymphoma, lymphocyte depletion type • Acute promyelocyticleukaemia • Multiple myeloma

  10. Question 37 • A 39-year old woman felt a lump in her breast 1 week ago. She visits the physician, who palpates a firm, fixed, irregular 3cm mass in the upper outer quadrant of the right breast and a firm, non-tender lymph node in the right axilla. A lumpectomy and axillary node dissection aer performed and microscopic examination shows an infiltrating ductal carcinoma of the breast. Flow cytometric analysis of the node shows a polyclonal population od CD3+, CD19+, CD20+ and CD68+ cells with no aneuplloidy or increase in S phase.

  11. Question 37 • Which of the following is most likely to be present in microscopic examination of the axillary node? • Acute lymphadenitis • Diffuse large B-cell lymphoma • Metastatic infiltrating ductal carcinoma • Necrotizing granulomas • Plasmacytosis • Sinus histiocytosis

  12. Question 40 • A 38-year-old woman visits her physician because she has had bleeding gums for the past 3 weeks. Physical examination shows that her gingivae are thickened and friable. She has hepatosplenomegaly and generalised non-tender lymphadenopathy. • Haemoglobin 11.2g/dL • Haematocrit 33.9% • MCV 89um^3 • WBC count 4500/mm^3 with 25% segmented neutrophils, 10% bands, 2% metamyelocytes, 55% lymphocytes, 8% monocytes and 1 nucleated RBC / 100 WBCs. • A bone marrow biopsy shows 100% cellularity with many large blasts that are peroxidase negative and nonspecific esterase positive.

  13. Question 40 • What is the most likely diagnosis? • Acute lymphoblastic leukaemia • Acute megakaryocytic leukaemia • Acute promyelocyticleukaemia • Acute erythroleukaemia • Acute monocyticleukaemia

  14. Question 49 • A 38-year-old woman has experienced increasing dyspnoea for the past 2 months. On physical examination, she is afebrile and normotensive. Inspiratory wheezes are noted on auscultation of the chest. A chest CT scan shows an 8-10cm posterior mediastinal mass that impinges on the trachea and oesphagus. A mediatinoscopy is performed as the mass is biopsied. Histologically, there are scattered dark multinucleated cells with prominent nucleoli that mark with CD15, and lymphocytes and macrophages separated by dense collagenous bands.

  15. Question 49 • Which of the following is most likely to be seen microscopically in this biopsy specimen? • Atypical lymphocytes • Histiocytes with Birbeck granules • Hairy cells • Lacunar cells • Lymphoblasts • Myeloblasts

  16. Question 48 • A clinical study is performed in which the subjects are children 1-4 years who have had multiple infections with viral, fungal and parasitic diseases. Compared with a normal control group, these children do not have a subpopulation of cells lacking surface immunoglobulin that mark with CD1a, CD2, CD3, CD4 and CD8.

  17. Question 48 • Which of the following karyotypic abnormalities is most likely to be seen in the children in this study? • +21 • 22q11.2 • T(9;22) • t(15;17) • X(fra) • XXY

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