Practice questions Lymphoid neoplasms IV

Practice questions

Lymphoid neoplasms IV

© Jun Wang, MD, PhD

 

1. Use this case and image for the next three questions. A 9-year-old boy presents to the clinic with a rapidly growing mass on his left face for the last 3 weeks. He has had intermittent night sweat, fatigue and a 9-lb weight loss during this period. Physical examination reveals a 7 cm poorly circumscribed firm mass on the left mandible. No other abnormality is noted. His CBC reveals a hemoglobin of 10.5 g/dL (11-13.5 g/dL). His WBC and platelet counts are within normal range. Peripheral blood smear reveals no significant morphological abnormalities of the blood cells. An image of his biopsy is shown.



(Image credit: Ed Uthman, MD., CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)

These cells are positive for CD10, CD19 and CD20, but negative for ALK, CD3, CD5, CD23, CD30, CD56 and cytokeratin. Proliferative index by Ki67 is approximately 100%. What gene is most likely abnormal in these cells?

A. ALK
 B. BRAF
 C. CCND1
 D. c-Myc
 E. MYD88

2. A 9-year-old boy presents to the clinic with a rapidly growing mass on his left face for the last 3 weeks. He has had intermittent night sweat, fatigue and a 9-lb weight loss during this period. Physical examination reveals a 7 cm poorly circumscribed firm mass on the left mandible. No other abnormality is noted. His CBC reveals a hemoglobin of 10.5 g/dL (11-13.5 g/dL). His WBC and platelet counts are within normal range. Peripheral blood smear reveals no significant morphological abnormalities of the blood cells. An image of his biopsy is shown.

(Image credit: Ed Uthman, MD., CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)

These cells are positive for CD10, CD19 and CD20, but negative for ALK, CD3, CD5, CD23, CD30, CD56 and cytokeratin. Proliferative index by Ki67 is approximately 100%. What is most likely associated with this lesion?

A. EB virus
 B. H. pylori
 C. HHV-8
 D. HPV
 E. HTLV-1

3. A 9-year-old boy presents to the clinic with a rapidly growing mass on his left face for the last 3 weeks. He has had intermittent night sweat, fatigue and a 9-lb weight loss during this period. Physical examination reveals a 7 cm poorly circumscribed firm mass on the left mandible. No other abnormality is noted. His CBC reveals a hemoglobin of 10.5 g/dL (11-13.5 g/dL). His WBC and platelet counts are within normal range. Peripheral blood smear reveals no significant morphological abnormalities of the blood cells. An image of his biopsy is shown.

(Image credit: Ed Uthman, MD., CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)

These cells are positive for CD10, CD19 and CD20, but negative for ALK, CD3, CD5, CD23, CD30, CD56 and cytokeratin. Proliferative index by Ki67 is approximately 100%. What is most likely the diagnosis?

A. Anaplastic large cell lymphoma
 B. Burkitt lymphoma
 C. Diffuse large B cell lymphoma
 D. Hodgkin lymphoma
 E. Mantle cell lymphoma
 F. Marginal zone lymphoma
 G. Small lymphocytic lymphoma

 

4. Use this case and image for the next four questions. A 69-year-old man presents to the clinic with a progressive fatigue and back pain for the last 5 months. He has lost 15 lb during this period. His history is significant for prostate adenocarcinoma at age 61, that was treated with localized radiation therapy. Physical examination reveals tenderness to palpation over the lower thoracic and lumbar spine. His laboratory tests reveal a hemoglobin of 9.5 g/dL (14-18 g/dL) and a serum calcium of 11.5 mg/dL (8.5-10.5 mg/dL). His WBC and platelet counts, liver and renal function tests are within normal ranges. Radiologic exam reveals multiple lytic lesions involving thoracic and lumbar vertebrae. An image of his bone lesion biopsy is shown.



(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD38, CD138, and kappa light chain, but negative for CD3, CD4, CD19, CD20, and cytokeratin. What additional serum test is likely abnormal?

A. Folate
B. M-protein
C. Parathyroid hormone
D. Prostate specific antigen
E. Total iron binding capacity

5. A 69-year-old man presents to the clinic with a progressive fatigue and back pain for the last 5 months. He has lost 15 lb during this period. His history is significant for prostate adenocarcinoma at age 61, that was treated with localized radiation therapy. Physical examination reveals tenderness to palpation over the lower thoracic and lumbar spine. His laboratory tests reveal a hemoglobin of 9.5 g/dL (14-18 g/dL) and a serum calcium of 11.5 mg/dL (8.5-10.5 mg/dL). His WBC and platelet counts, liver and renal function tests are within normal ranges. Radiologic exam reveals multiple lytic lesions involving thoracic and lumbar vertebrae. An image of his bone lesion biopsy is shown.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD38, CD138, and kappa light chain, but negative for CD3, CD4, CD19, CD20, and cytokeratin. What is likely associated with his bone findings?

A. Amyloid deposit
B. Metastatic adenocarcinoma
C. Myelofibrosis
D. Osteoblasts activation  
E. RANKL overproduction

6. A 69-year-old man presents to the clinic with a progressive fatigue and back pain for the last 5 months. He has lost 15 lb during this period. His history is significant for prostate adenocarcinoma at age 61, that was treated with localized radiation therapy. Physical examination reveals tenderness to palpation over the lower thoracic and lumbar spine. His laboratory tests reveal a hemoglobin of 9.5 g/dL (14-18 g/dL) and a serum calcium of 11.5 mg/dL (8.5-10.5 mg/dL). His WBC and platelet counts, liver and renal function tests are within normal ranges. Radiologic exam reveals multiple lytic lesions involving thoracic and lumbar vertebrae. An image of his bone lesion biopsy is shown.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD38, CD138, and kappa light chain, but negative for CD3, CD4, CD19, CD20, and cytokeratin. What additional finding is likely seen in his peripheral blood smear?

A. Faggot cells
B. Giant platelet
C. Nucleated red cells
D. Rouleaux formation
E. Target cells

7. A 69-year-old man presents to the clinic with a progressive fatigue and back pain for the last 5 months. He has lost 15 lb during this period. His history is significant for prostate adenocarcinoma at age 61, that was treated with localized radiation therapy. Physical examination reveals tenderness to palpation over the lower thoracic and lumbar spine. His laboratory tests reveal a hemoglobin of 9.5 g/dL (14-18 g/dL) and a serum calcium of 11.5 mg/dL (8.5-10.5 mg/dL). His WBC and platelet counts, liver and renal function tests are within normal ranges. Radiologic exam reveals multiple lytic lesions involving thoracic and lumbar vertebrae. An image of his bone lesion biopsy is shown.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD38, CD138, and kappa light chain, but negative for CD3, CD4, CD19, CD20, and cytokeratin. What is most likely the diagnosis?

A. Anaplastic large cell lymphoma
B. Diffuse large B cell lymphoma
C. Metastatic prostate adenocarcinoma
D. Monoclonal gammopathy of undetermined significance
E. Multiple myeloma
F. Osteosarcoma
G. Plasmacytoma

 

8. Use this case and image for the next question. A 58-year-old woman presents to the clinic with localized pain in her lower back. She does not have history of trauma or other diseases. Physical examination reveals pain to palpation around upper lumbar spine. Her laboratory test results including CBC, renal function, and serum metabolites and electrophoresis are all within normal range. Imaging studies reveal a 2.5 cm solitary bone lesion in the L2 vertebra. An image of the biopsy is shown.



(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD38, CD138, and kappa light chain, but negative for CD3, CD4, CD19, CD20, and cytokeratin, and occupies approximately 20% of cells in the biopsy. What is most likely the diagnosis?

A. Diffuse large B cell lymphoma
B. Monoclonal gammopathy of undetermined significance
C. Multiple myeloma
D. Osteoblastoma
E. Plasmacytoma

 

9. Use this case and image for the next three questions. A 39-year-old man presents to the clinic with a rapid growing mass at his left axilla for two months. He has had intermittent fever and night sweat for 3 weeks. He has lost 10 lb during this period. His past history is significant for infectious mononucleosis at age 19. Physical examination reveals a 6 cm firm mobile mass at his left axilla. His CBC reveals a hemoglobin of 10.5 g/dL (14-18g/dL). His WBC and platelet are normal in quantity and morphology. Other lab test results, including liver and renal function tests are within normal ranges. An image of his mass biopsy is shown.



(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for CD3, CD30 and CD45, but negative for cytokeratin, CD19 and CD20. What additional marker is likely positive for these cells?

A. ALK
B. Bcl2
C. CD15
D. EBV
E. HHV8

10. A 39-year-old man presents to the clinic with a rapid growing mass at his left axilla for two months. He has had intermittent fever and night sweat for 3 weeks. He has lost 10 lb during this period. His past history is significant for infectious mononucleosis at age 19. Physical examination reveals a 6 cm firm mobile mass at his left axilla. His CBC reveals a hemoglobin of 10.5 g/dL (14-18g/dL). His WBC and platelet are normal in quantity and morphology. Other lab test results, including liver and renal function tests are within normal ranges. An image of his mass biopsy is shown.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for ALK, CD3, CD30 and CD45, but negative for cytokeratin, CD19, CD20 and EBV. What gene is most likely abnormal in these cells?

A. ALK
B. BRAF
C. CCND1
D. JAK2
E. NF-kB
F. NOTCH1

11. A 39-year-old man presents to the clinic with a rapid growing mass at his left axilla for two months. He has had intermittent fever and night sweat for 3 weeks. He has lost 10 lb during this period. His past history is significant for infectious mononucleosis at age 19. Physical examination reveals a 6 cm firm mobile mass at his left axilla. His CBC reveals a hemoglobin of 10.5 g/dL (14-18g/dL). His WBC and platelet are normal in quantity and morphology. Other lab test results, including liver and renal function tests are within normal ranges. An image of his mass biopsy is shown.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

These cells are positive for ALK, CD3, CD30 and CD45, but negative for cytokeratin, CD19, CD20 and EBV. What is most likely the diagnosis?

A. Adult T cell lymphoma
B. Anaplastic large cell lymphoma
C. Diffuse large B cell lymphoma
D. Extranodal T cell lymphoma
E. Hodgkin lymphoma

 

12. Use this case and image for the next two questions. A 52-year-old man presents to the clinic with progressive nasal congestion, epistaxis for 3 months. His past history is significant for type 2 diabetes. He has been HIV positive for 5 years. Physical examination reveals an ulcerated mass within left nasal cavity. His laboratory tests including CBC are within normal ranges. Image studies reveals a 3.5 cm left nasal cavity mass with destruction of the nasal septum. An image of his biopsy is shown.


(Image credit: Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons)

These cells are positive for CD2, CD3, CD5, CD56 and EB virus, but negative CD10, CD19, CD20, CD30 and CD38. What is most likely associated with this lesion?

A. EB virus
B. HHV-8
C. Helicobacter pylori
D. HPV
E. HTLV-1

13. A 52-year-old man presents to the clinic with progressive nasal congestion, epistaxis for 3 months. His past history is significant for type 2 diabetes. He has been HIV positive for 5 years. Physical examination reveals an ulcerated mass within left nasal cavity. His laboratory tests including CBC are within normal ranges. Image studies reveals a 3.5 cm left nasal cavity mass with destruction of the nasal septum. An image of his biopsy is shown.

(Image credit: Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons)

These cells are positive for CD2, CD3, CD5, and EB virus, but negative CD10, CD19, CD20, CD30 and CD56. What is the diagnosis?

A. Adult T cell lymphoma
B. Anaplastic large cell lymphoma
C. Diffuse large B cell lymphoma
D. Extranodal T cell lymphoma
E. Hodgkin lymphoma
F. Mantle cell lymphoma

 

14. Use this case and image for the next two questions. A 72-year-old woman presents to the clinic with fatigue and frequent infections for 6 months. She has a history of rheumatoid arthritis for 10 years. Physical examination reveals slightly pale skin and conjunctiva without jaundice. Her spleen is 5 cm below left costal margin. Her CBC reveals a hemoglobin of 10.5 g/dL (12-16 g/dL), WBC count of 6.5 x 109/L (4.5-11 x 109/L) and platelet count of 185 x 109/L (150-450 x 109/L). WBC differential reveals 80% of large lymphocytes, 10% neutrophils, 8% monocytes and 2% eosinophils. An image of her peripheral blood smear is shown.



(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)

These cells are positive for CD2, CD3, CD5 and CD56, but negative for CD10, CD20, CD33, CD34, and TdT. What gene is most likely abnormal in these cells?

A. ALK
B. BRAF
C. CCND1
D. JAK2
E. NOTCH1
F. STAT3

15. A 72-year-old woman presents to the clinic with fatigue and frequent infections for 6 months. She has a history of rheumatoid arthritis for 10 years. Physical examination reveals slightly pale skin and conjunctiva without jaundice. Her spleen is 5 cm below left costal margin. Her CBC reveals a hemoglobin of 10.5 g/dL (12-16 g/dL), WBC count of 6.5 x 109/L (4.5-11 x 109/L) and platelet count of 185 x 109/L (150-450 x 109/L). WBC differential reveals 80% of large lymphocytes, 10% neutrophils, 8% monocytes and 2% eosinophils. An image of her peripheral blood smear is shown.

(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)

These cells are positive for CD2, CD3, CD5 and CD56, but negative for CD10, CD20, CD33, CD34, and TdT. What is most likely the diagnosis?

A. Acute myeloid leukemia
B. Adult T-cell leukemia
C. Chronic lymphocytic leukemia
D. Hairy cell leukemia
E. T-cell acute lymphoblastic leukemia
F. T-cell large granular lymphocytic leukemia

 

16. Use this case and image for the next four questions. A 22-year-old woman presents to the clinic with a slowly growing left neck mass for 3 months. She does not have other symptoms except occasional night sweat. Her past medical history is unremarkable. Her vital signs are within normal ranges. Physical examination reveals a 3 cm non-tender firm lymph at her left lateral lower neck. Her lab test results including CBC are within normal range. A high-power image of her lymph node biopsy is shown. At low power, her lymph node has a nodular appearance, separated by thick fibrous septa. Scattered neutrophils and eosinophils are noted.


(Image credit: Ed Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)

What immunohistochemistry profile is most likely seen for the binucleated cells?

A. Positive for CD5, CD20, CD23, negative for CD10, CD30 and Cyclin D1
B. Positive for CD5, CD20, and cyclin D1, negative for CD10, CD23
C. Positive for CD10, CD20, CD45, negative for CD5, CD23, CD30
D. Positive for CD15, CD30, and negative for CD3, CD45
E. Positive for CD20, CD45, negative for CD5, CD10 and CD23
F. Positive for CD30, CD45, ALK, and negative for CD10, CD20

17. A 22-year-old woman presents to the clinic with a slowly growing left neck mass for 3 months. She does not have other symptoms except occasional night sweat. Her past medical history is unremarkable. Her vital signs are within normal ranges. Physical examination reveals a 3 cm non-tender firm lymph at her left lateral lower neck. Her lab test results including CBC are within normal range. A high-power image of her lymph node biopsy is shown. At low power, her lymph node has a nodular appearance, separated by thick fibrous septa. Scattered neutrophils and eosinophils are noted.

(Image credit: Ed Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)

The binucleated cells are positive for CD15 and CD30, but negative for ALK, CD45. What is most likely associated with this lesion?

A. EB virus
B. HHV-8
C. Helicobacter pylori
D. HPV
E. HTLV-1

18. A 22-year-old woman presents to the clinic with a slowly growing left neck mass for 3 months. She does not have other symptoms except occasional night sweat. Her past medical history is unremarkable. Her vital signs are within normal ranges. Physical examination reveals a 3 cm non-tender firm lymph at her left lateral lower neck. Her lab test results including CBC are within normal range. A high-power image of her lymph node biopsy is shown. At low power, her lymph node has a nodular appearance, separated by thick fibrous septa. Scattered neutrophils and eosinophils are noted.

(Image credit: Ed Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)

The binucleated cells are positive for CD15 and CD30, but negative for ALK, CD45. What intracellular signaling factor is most likely functioning abnormally?

A. ALK
B. BRAF
C. JAK2
D. NF-kB
E. STAT3

19. A 22-year-old woman presents to the clinic with a slowly growing left neck mass for 3 months. She does not have other symptoms except occasional night sweat. Her past medical history is unremarkable. Her vital signs are within normal ranges. Physical examination reveals a 3 cm non-tender firm lymph at her left lateral lower neck. Her lab test results including CBC are within normal range. A high-power image of her lymph node biopsy is shown. At low power, her lymph node has a nodular appearance, separated by thick fibrous septa. Scattered neutrophils and eosinophils are noted.

(Image credit: Ed Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)

The binucleated cells are positive for CD15 and CD30, but negative for ALK, CD45. What is the diagnosis?

A. Acute lymphadenitis
B. Anaplastic large cell lymphoma
C. Classical Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Mantle cell lymphoma
F. Nodular lymphocyte-predominant Hodgkin lymphoma

 

20. Use this case and image for the next two questions. A 35-year-old woman presents to the clinic with a painless lump at her right neck for 4 months. She does not have other symptoms. Her past medical history is unremarkable. Physical examination reveals a 2.2 cm non-tender mobile lymph node at her right lower neck. Her laboratory test results including CBC are within normal range. A high-power image of the lymph node biopsy is shown. At low power, the lymph node is composed of primarily small lymphocytes forming vague nodular appearance. No fibrosis nor inflammatory infiltrate is noted.


(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

What immunohistochemistry profile is most likely seen for the large cell with irregular nuclear membrane?

A. Positive for CD5, CD20, CD23, negative for CD10, CD30 and Cyclin D1
B. Positive for CD5, CD20, and cyclin D1, negative for CD10, CD23
C. Positive for CD10, CD20, CD45, negative for CD5, CD23, CD30
D. Positive for CD15, CD30, and negative for CD3, CD45
E. Positive for CD20, CD45, negative for CD15, CD30

21. A 35-year-old woman presents to the clinic with a painless lump at her right neck for 4 months. She does not have other symptoms. Her past medical history is unremarkable. Physical examination reveals a 2.2 cm non-tender mobile lymph node at her right lower neck. Her laboratory test results including CBC are within normal range. A high-power image of the lymph node biopsy is shown. At low power, the lymph node is composed of primarily small lymphocytes forming vague nodular appearance. No fibrosis nor inflammatory infiltrate is noted.

(Image credit: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)

The large cells are positive for CD20 and CD45, but negative for ALK, CD15 and CD30. What is the diagnosis?

A. Acute lymphadenitis
B. Anaplastic large cell lymphoma
C. Classical Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Mantle cell lymphoma
F. Nodular lymphocyte-predominant Hodgkin lymphoma

 

 

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