Non-neoplastic hematopathology_hemepath boards

  1. What benign condition can show aberrant expression of CD34 in megas?
    Megaloblastic anemia
  2. Characteristic PB, BM and clinical findings in megaloblastic anemia?
    Sieve-like nucleus, pancytopenia, marked anisopoikilocytosis (from spleen chomping up RBCs)
  3. Characteristic findings in spleen with ITP?
    • 1. Secondary follicles with well developed GCs in white pulp (follicles diminished w/steroid tx)
    • 2. Dilated sinuses
    • 3. GC contain CD41 and show macrophage phagocytosis of nuclear debris
    • 4. Mild myeloid metaplasia or extramedullary hematopoiesis (megas mainly)
    • 5. Histiocytes and neutrophils in red pulp
  4. Name causes of extramedullary hematopoiesis.
    • 1) MPD: Idiopathic Myelofibrosis, polycythemia vera, CML
    • 2) Carcinoma with mets to bone
    • 3) MDS
    • 4) Hepatitis
    • 5) Hemolytic anemia
  5. CD117
    myeloblasts and will also highlight proerythroblasts, mast cells, and occasionally promyelocytes.
  6. IgG4 disease findings
    • 1) LPC infiltrate with lots T cells
    • 2) fibrosis
    • 3) phlebitis
    • 4) elevated serum IgG4
    • 5) esp middle aged+ and males
    • 6) can present as masses or nodules in lung
  7. In HIV, what bone marrow features are prominent?
    • 1) Chronic thrombocytopenia (impaired production and immune-mediated peripheral destruction)
    • 2) small hypolobated or denuded megakaryocytes with pyknotic/smudgy nuclei
    • 3) megakaryocytic hyperplasia and dysplasia
  8. What is the theorized selective advantage in PNH?
    Clonal abnormalities of GPI-linked surface proteins confer increased resistance to NK cell mediated apoptosis, increasing survival in an adverse enviroment of an aplastic BM
  9. Image Upload 1
    Identify the image.  What conditions cause this?
    Cabot ring - microtubules, remnants from mitotic spindle; pernicious anemia, erythroid production disorder, Pb poisoning
  10. All of the following are major extrinsic causes of neutropenia except:

  11. What is the differential diagnosis for a non-neoplastic sinus pattern in a LN?
    Rosai Dorfman vs. lymphangiogram effect vs. nonspecific/reactive vs. Whipple disease hemophagocytic syndrome vs. dermatopathic lymphadenitis
  12. What is the differential diagnosis for a non-neoplastic follicular pattern in a LN?
    Viral (HIV) vs. Toxoplasmosis vs. syphilis vs. Castleman disease vs. rheumatoid arthritis or Sjogren syndrome vs. nonspecific
  13. What is the differential diagnosis for a non-neoplastic inrterfollicular/paracortical pattern in a LN?
    Viral (mono, CMV, postvaccine) vs. hypersensitivity (dilantin) vs. Kimura disease (eosinophilia with florid follicular hyperplasia and immunoblasts)
  14. What is the differential diagnosis for a non-neoplastic granulomatous pattern in a LN?
    • -Suppurative granulomata (cat-scratch, lymphogranulomatous venereum, tularemia)
    • *LGV looks like cat-scratch in an inguinal node
    • -Necrotizing (TB, Histoplasmosis, C. immitus, M. scrofulaceum)
    • -Kikuchi (karyorrhexis with histiocytes and absent neutrophils)
  15. What is the differential diagnosis for a non-neoplastic diffuse pattern in a LN?
    Mainly viral (EBV, CMV, measles, post vaccine)
  16. If a person presents with thrombocytopenia, left-shifted neutrophils without toxic granulation, hemoconcentration, and >10% immunoblast, what virus should you be worried about?
  17. What does the presence of osteoblasts/osteoclasts in an adult BM indicate?
    Bone destruction/repair (usually pathologic)
  18. What are the clinical findings in hemophagocytic syndrome?
    • 1) Hepatosplenomegaly
    • 2) Markedly increased ferritin (>500 microg/L), CRP, ESR
    • 3) Pancytopenia
    • 4) Hemophagocytosis
    • 5) Low fibrinogen
    • 6) Elevated LFTs
    • 7) Fever
  19. Typical causes of hemophagocytic syndrome?
    EBV, T-cell lymphoma, autoimmune
  20. Image Upload 2Image Upload 3
    BM biopsy. What is the likely infection here?
    Q fever (ring granuloma)
  21. Image Upload 4
    What's this?
    Pappenheimer bodies - blue/purple in color, in periphery, and not perfectly round; smaller than Howell-Jolly bodies; expelled iron-containing mitochondria
  22. All of the following can show extensive replacement of BM by fibrous/spindled processes except:
    A) Hodgkin lymphoma
    B) AITL
    C) Hairy cell leukemia
    D) AML M4
    E) Mastocytosis
    D - only AML M7 (megakaryoblastic)
  23. What are potential causes of serous fat atrophy (gelatinous transformation)?
    • Mnemonic: MaDAM anorexic
    • Malnutrition - anorexia
    • Debilitation
    • Advanced malignancy
    • Malabsorption
  24. What is the average MPV for a platelet?  What is the relationship between platelet volume (MPV) and platelet count?  When does MPV go down? Up?
    Between 2fL and 20fL; inverse relationship; down with thrombocytopenia or impaired production (AA); up with destruction, ITP, MPN, Bernard Soulier, etc. (basically getting bigger immature plts pushed out)
  25. Image Upload 5
    a 36 year old female presented with fever and flank pain. She was found to be pancytopenic with a WBC of 1.7, K/mm3. Absolute neutrophil count of 1.1, H/H 11.6/33.3, and plts 124 K/mm3.  Diagnosis?
    Parvovirus (picture shows giant proerythroblasts with nuclear inclusions)
  26. A two-month old girl presented with cough and SOB. CBC showed leukocytosis with marked lymphocytosis.  PB smear below. Dx?
    Image Upload 6
    Pertussis -Numerous mature lymphs with clefted nuclei
  27. Image Upload 7
    Likely PB smear findings?
    (Megaloblastic anemia with sieve-like chromatin) - macrocytic anemia with hypersegmented neutrophils
  28. Image Upload 8
    Metabolic disorder?
    Nieman Pick - vacuolated cells
  29. Image Upload 9
    Metabolic disorder?
    Gaucher's disease -  tissue paper looking
  30. What is the defect in Autoimmune lymphoproliferative syndrome (ALPS)?  Flow cytometric findings? Clinical presentation?
    • Defect in Fas/CD95/Apo-1 mediated apoptosis; CD4-/CD8-, CD25-, CD45RO-, CD3+, CD57+
    • LAD and splenomegaly in healthy child progresses to cytopenias
  31. Sequence of abnormal lab values in iron deficiency anemia with respect to ferritin, transferrin, serum Fe, ZPP, and MCV?
    ↓ferritin → ↓serum Fe →  ↑ZPP→ ↓Hb → ↓MCV
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Non-neoplastic hematopathology_hemepath boards
Non-neoplastic hematopathology hemepath boards