20. Chronic Lymphocytic Leukemia and Related Lymphoproliferative Disorders

Question 1

1. The cells of CLL are morphologically identical to those of:
   a.ALL
   b. Small lymphocytic lymphoma
   c.Infectious mononucleosis
   d. Sézary syndrome

Answer 1

b. Small lymphocytic lymphoma

Question 2

2. Surface immunoglobulin is the most reliable surface marker for:
   a. T lymphocytes
   b. Plasma cells
   c.B lymphocytes
   d.Histiocytes

Answer 2

c.B lymphocytes

Question 3

3. Cells that demonstrate a positive reaction with the tar-trate-resistant acid phosphatase (TRAP) stain are most likely:
   a.T lymphoblasts of ALL
   b. Atypical lymphocytes of a viral infection
   c. Large granular lymphocytes of T-gamma lymphopro-liferative disorder
   d. Hairy cells of hairy-cell leukemia

Answer 3

d. Hairy cells of hairy-cell leukemia

Question 4

4. A mutated tumor suppressor gene found in a variety of human cancers, including CLL is:
   a.p53
   b.MDM2
   c.HLA-DR
   d.CD4

Answer 4

a.p53

Question 5

5. The immunophenotype that best describes mantle cell lymphoma is:
   a.CD5+,CD19+,CD23+,FMC7+,cyclin D1+
   b.CD5+,CD19+ CD23+,FMC7+,cyclin D1-
   c. CD5+,CD19+ CD23+,FMC7-,cyclin D1+
   d. CD5+,CD19+ CD23- ,FMC7+,cyclin D1+
   e. CD5- ,CD19+ CD23+,FMC7+,cyclin D1+

Answer 5

d. CD5+,CD19+ CD23- ,FMC7+,cyclin D1+

Question 6

6. In chronic lymphocytic leukemia:

a. The absolute lymphocyte count is usually equal to or exceeds 5000x109 cells/L.
b.Hemoglobin level,platelet count, and absolute number of neutrophils may be normal or elevated.
c.The neoplastic lymphocytes in the blood or bone mar-row are large with fine chromatin and prominent nucleoli.

Answer 6

a. The absolute lymphocyte count is usually equal to or exceeds 5000x109 cells/L.

Question 7

Directions: Each item below contains one or more correct answers.Use the following letters to answer questions 7 through 9.
a. If 1,2,and 3 are correct
b.If 1 and 3 are correct
c.If 2 and 4 are correct
d.If 4 is correct
e.If 1,2,3,and 4 are correct

7.Which of the following findings would point to a diag-nosis of CLL?
1. Clonal proliferations of B lymphocytes
2. CD19+/CD51+,CD23-
3.CD19+/CD51+,CD23+
4.Ph chromosome-positive

Answer 7

b.If 1 and 3 are correct

Question 8

Directions: Each item below contains one or more correct answers.Use the following letters to answer questions 7 through 9.
a. If 1,2,and 3 are correct
b.If 1 and 3 are correct
c.If 2 and 4 are correct
d.If 4 is correct
e.If 1,2,3,and 4 are correct

8.Which of the following clinical and laboratory manifesta-tions would point to a diagnosis of hairy-cell leukemia?
1.Pancytopenia
2.Splenomegaly
3.CD20+,CD103+,CD25+
4.Prominent generalized lymphadenopathy

Answer 8

a. If 1,2,and 3 are correct

Question 9

Directions: Each item below contains one or more correct answers.Use the following letters to answer questions 7 through 9.
a. If 1,2,and 3 are correct
b.If 1 and 3 are correct
c.If 2 and 4 are correct
d.If 4 is correct
e.If 1,2,3,and 4 are correct

9.The poorest prognosis for patients with CLL is associ-ated with which of the following features?
1.Anemia
2.Splenomegaly
3.Thrombocytopenia
4.White cell count greater than 15,000 cells/μL

Answer 9

b.If 1 and 3 are correct

Question 10

10. The workup step(s) include:
    a.Cytochemical staining, including myeloperoxidase a nonspecific esterase, and TdT
    b. Immunohistochemical study of trephine biopsy sectio
    c. Immunophenotypic study by flow cytometry
    d.Cytogenetic studies
    e.All of the above

Answer 10

e.All of the above

Question 11

11.Immunophenotypic study using flow cytometry shows negative T-cell markers.However,neoplastic cells express bright CD19,CD20,and weak CD5 and show monotypic k light-chain restriction.Cyclin D1 immunohistochemical stain is negative. These cells will also express:
a.CD103
b.Strong FMC7
c.CD23
d. Dim surface immunoglobulin
e. CD38

Answer 11

b.Strong FMC7

Question 12

12.Cytochemical sains (myeloperoxidase, nonspecific esterase) and TdT performed on samples of bone mar-row aspirate smear were negative.The most likely diagnosis is:
a.Chronic myelocytic leukemia,accelerated phase
b.Typical chronic lymphocytic leukemia
c. Acute lymphoblastic leukemia
d. Chronic lymphocytic leukemia/prolymphocytic leukemia
e. B-cell prolymphocytic leukemia

Answer 12

e. B-cell prolymphocytic leukemia